Листериозный менигоэнцефалит у больных, перенесших COVID-19 тяжелого течения

Abstract

Objective. Analysis of the course and outcomes of listeria meningoencephalitis (LME) in patients in the postcovid period. Patients and methods. A retrospective study of 29 patients with listeria meningoencephalitis (LME), who were observed in hospitals in Moscow in the period 2020-2022, was conducted. 17 men (mean age M ± SD 57.8 ± 6.9 years) and 12 women (mean age 42.3 ± 4.7 years) were observed. During the examination of cerebrospinal fluid by polymerase chain reaction (PCR), the DNA of Listeria monocytogenes was detected in all patients. Of particular interest were the medical histories of 9 patients (31%) who had a history of severe COVID-19 during 1 month before LME with the use biological therapy in combination with GCS, average age 46.1 ± 4.3 years. Results. Risk factors such as viral infections, autoimmune diseases, and cancer contribute to the early development of LME. Due to the polymorphism of clinical manifestations in half (55.5%) of patients, LME was not suspected at the initial medical treatment. Diagnosis of LME in the postcovid period presents certain difficulties due to the lack of specific clinical manifestations, and symptoms can be considered LONG-term as LONG-COVID. Upon admission, 78% of LME patients had elevated blood levels of C-reactive protein 36-116 mg/l and fibrinogen 4.6–20.3 g/l. In the cerebrospinal fluid in admission: pleocytosis 760 ± 128 cl/μl, protein 1.2 ± 0.6 g/l, glucose 1.1 ± 0.2 mmol/L, lactate 8.9 ± 1.0 mmol/L. The fatal outcome was recorded in 10 (34.5%) patients with LME on the 9th–51st (on average, 18.25 ± 5.1) days of treatment. The causes of death were late hospitalization, swelling in the brain, subarachnoid hemorrhage, purulent ventriculitis. Conclusion. The lack of alertness towards listeriosis in young patients with neurological symptoms and who had severe COVID-19 with the treating of immunosuppressive and GCS against the background of a decrease in the immune response due to exposure to SARS-CoV-2 leads to late diagnosis of neurolisteriosis and contributes to the long course of the disease and rehabilitation. Key words: listeriosis, meningoencephalitis, COVID-19, SARS-CoV-2, immunodeficiency, immunosuppressive therapy, post-COVID syndrome