Abstract
Listeriosis is an uncommon and potentially severe zoonotic bacterial infection that usually occurs in outbreaks instead of isolated cases. In recent years, there has been an increase in the incidence of this disease. One of the most severe of its complications involves the central nervous system (CNS) in a condition known as neurolisteriosis. Here, we describe the demographic and clinical features of patients presenting with neurolisteriosis between 2001 and 2015 using administrative data and attempt to identify potential predictors for mortality. We used the Spanish Minimum Basic Data Set at Hospitalization, a compulsory registry that collects data from clinical discharge reports. Up to 2015, data were coded based on the International Classification of Diseases, 9th Revision, so we used diagnoses and clinical conditions based on these codes. Age, sex, clinical presentation, mortality, and involvement of the CNS were identified. Using algorithms to aggregate data, variables such as immunosuppression and malignant disease were obtained. We analyzed correlations among clinical features and identified risk factors for morbidity and mortality. Between 2001 and 2015 we identified 5180 individuals, with a hospitalization rate of 0.76 per 100,000 population. Most (94%) were adults, and only 5.4% were pregnant women. The average age was 66 years. Neurological involvement was present in 2313 patients (44.7%), mostly meningitis (90.4%). Global mortality was 17%, but mortality in CNS infections was 19.2%. Age, severe sepsis, chronic liver disease, chronic kidney disease, and malignancy were the main risk factors for mortality in patients with CNS infections by Listeria monocytogenes. Although it is uncommon, neurolisteriosis can be a severe condition, associated with a high rate of mortality. Health care providers should be aware of potential sources of infection so that appropriate measures can be taken to prevent it.
Highlights
Listeriosis is an infection caused by Listeria monocytogenes, a Gram-positive bacterium that can cause a wide spectrum of clinical presentations in humans, from neonatal infection to neuroinvasive disease
Listeriosis is infrequent in humans, because L. monocytogenes is more commonly seen in ruminants [1]
Neurolisteriosis, according to published series in the medical literature, is the thirdor fourth-ranked cause of meningitis, but the resulting condition can be more severe than is seen in the usual pathogens, as the mortality rate is high
Summary
Listeriosis is an infection caused by Listeria monocytogenes, a Gram-positive bacterium that can cause a wide spectrum of clinical presentations in humans, from neonatal infection to neuroinvasive disease. Recent studies [4,5] highlighted the role of malignancies, and immunosuppression as the most frequently recorded comorbid conditions in non-pregnant patients, which had a great impact on mortality and clinical sequelae. The MONALISA study found that central nervous system (CNS) infections, along with immunosuppression and malignancy had three-fold higher mortality [4]. Other studies found that patients with no underlying conditions usually have a good prognosis [6,7,8]. The prognosis in pregnant women is usually good, listeriosis during pregnancy can cause abortion, premature delivery, fetal mortality, and severe neonatal morbidity [9,10]. Cultures of cerebrospinal fluid are positive, but blood cultures are often negative [3,11]
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