Abstract
ObjectivesListeria meningoencephalitis (LMM) is very rare in healthy children. We aimed to assess the clinical features, differential diagnosis, treatment options, and outcomes of LMM in immunocompetent children through a retrospective study.MethodsThe clinical symptoms, laboratory findings, imaging features, antibiotic use, and metagenomic next-generation sequencing (mNGS) results of the cerebrospinal fluid (CSF) were obtained from immunocompetent children who were diagnosed with LMM and admitted to the Xi'an Children's Hospital from May 2018 to July 2020.ResultsThe data from 8 immunocompetent children were retrospectively analyzed in this study. The cohort included data from 5 males and 3 females who were aged from 1 year and 7 months to 16 years and 6 months. A total of 4 patients had chilled food before onset. The complications included hyponatremia (3/8), hydrocephalus (2/8), and hemophagocytic syndrome (1/8). In total, 8 patients were diagnosed with Listeria monocytogenes by positive CSF culture or mNGS results. The positive rate of CSF culture was 62.5% (5/8). A total of 5 patients conducted CSF mNGS, and the results of the mNGS were positive in 4 patients (80%, 4/5) and suspected in 1 patient. A total of 7 patients changed their therapeutic regimen to combined antibacterial therapies that included linezolid and meropenem (5/8), or ampicillin and meropenem (2/8). A total of 5 patients had favorable outcomes (Glasgow Outcome Scale, GOSE = 5) while two patients had unfavorable outcomes (GOSE = 1) and were complicated with hyponatremia and hydrocephalus.ConclusionsListeria meningoencephalitis (LMM) can occur in children with normal immune function and is commonly mistaken for other central nervous system infections. L. monocytogenes can be quickly and accurately detected by mNGS. Hyponatremia and hydrocephalus may indicate unfavorable outcomes.
Highlights
Listeriosis is the third leading cause of death among major pathogens that are commonly transmitted by Listeria monocytogenes-contaminated food such as raw meats, milk, and ready-to-eat foods [1, 2]
The diagnosis of L. monocytogenes meningoencephalitis (LMM) was based on the following criteria: A). clinical characteristics, including irritability, poor feeding, fever, seizures, fontanel bulge, neck stiffness, vomiting, and headache, B). elevated white blood cell and protein levels, low glucose concentrations in the cerebrospinal fluid (CSF), and a low CSF to blood glucose ratio [8], C). positive L. monocytogenes in the blood, CSF culture, or next-generation sequencing (NGS) of the CSF, D). primary immune deficiency based on immunological testing
Our study focused on L. monocytogenes infections in 8 children that included 5 boys and 3 girls with no previous medical history
Summary
Listeriosis is the third leading cause of death among major pathogens that are commonly transmitted by Listeria monocytogenes-contaminated food such as raw meats, milk, and ready-to-eat foods [1, 2]. L. monocytogenes typically causes invasive infections (e.g., sepsis, meningitis, and congenital listeriosis) in newborn children, pregnant women, the elderly, organ transplant recipients, and patients with primary or secondary immunodeficiency [1–3]. The. Rare LMM in Immunocompetent Children incidence of listeria infection has risen sharply in developed countries since the 1980s [4]. The main entry site for listeria infection is the gastrointestinal tract through contaminated water or food [6]. The bacteria can infiltrate the brain from the blood or through the peripheral nerves, yet the precise mechanisms of infection remain to be fully understood [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
