ABSTRACTA dynamic homeostasis is maintained between the host and native bacteria of the gastrointestinal tract in animals, but migration of bacteria from the gut to other organs can lead to disease or death.Enterococcus faecalisis a commensal of the gastrointestinal tract; however,Enterococcusspp. are increasingly frequent causes of nosocomial infections with a high mortality rate. We investigated the commensal-to-pathogen switch undergone byE. faecalisOG1RF in the lepidopteran model hostManduca sextaassociated with its location in the host.E. faecalispersists in the harsh midgut environment ofM. sextalarvae without causing apparent illness, but injection ofE. faecalisdirectly into the larval hemocoel is followed by rapid death. Additionally, oral ingestion ofE. faecalisin the presence ofBacillus thuringiensisinsecticidal toxin, a pore-forming toxin that targets the midgut epithelium, induces an elevated mortality rate. We show that the loss of gut integrity due toB. thuringiensistoxin correlates with the translocation ofE. faecalisfrom the gastrointestinal tract into the hemolymph. Upon gaining access to the hemolymph,E. faecalisinduces an innate immune response, illustrated by hemocyte aggregation, in larvae prior to death. The degree of hemocyte aggregation is dependent upon the route ofE. faecalisentry. Our data demonstrate the efficacy of theM. sextalarval model system in investigatingE. faecalis-induced sepsis and clarifies controversies in the field regarding the events leading to larval death followingB. thuringiensistoxin exposure.IMPORTANCEThis study advances our knowledge ofEnterococcus faecalis-induced sepsis following translocation from the gut and provides a model for mammalian diseases in which the spatial distribution of bacteria determines disease outcomes. We demonstrate thatE. faecalisis a commensal in the gut ofManduca sextaand a pathogen in the hemocoel, resulting in a robust immune response and rapid death, a process we refer to as the “commensal-to-pathogen” switch. While controversy remains regardingBacillus thuringiensistoxin-induced killing, our laboratory previously found that under some conditions, the midgut microbiota is essential forB. thuringiensistoxin killing ofLymantria dispar(N. A. Broderick, K. F. Raffa, and J. Handelsman, Proc. Natl. Acad. Sci. U. S. A. 103:15196–15199, 2006; B. Raymond, et al., Environ. Microbiol. 11:2556–2563, 2009; P. R. Johnston, and N. Crickmore, Appl. Environ. Microbiol. 75:5094–5099, 2009). We and others have demonstrated that the role of the midgut microbiota inB. thuringiensistoxin killing is dependent upon the lepidopteran species and formulation ofB. thuringiensistoxin (N. A. Broderick, K. F. Raffa, and J. Handelsman, Proc. Natl. Acad. Sci. U. S. A. 103:15196–15199, 2006; N. A. Broderick, et al., BMC Biol. 7:11, 2009). This work reconciles much of the apparently contradictory previous data and reveals that theM. sexta-E. faecalissystem provides a model for mammalian sepsis.