Culture Negative Listeria monocytogenes Meningitis Resulting in Hydrocephalus and Severe Neurological Sequelae in a Previously Healthy Immunocompetent Man with Penicillin Allergy.

Shahin Gaini,Heidi Madsen,Debes Hammershaimb Christiansen,Gunn Hege Karlsen,Anirban Nandy,Sanna Á Borg

doi:10.1155/2015/248302

Abstract

A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. The cerebrospinal fluid showed negative microscopy for bacteria, no bacterial growth, and negative polymerase chain reaction for bacterial DNA. The patient developed hydrocephalus on a second CT scan of the brain on the 5th day of admission. An external ventricular catheter was inserted and Listeria monocytogenes grew in the cerebrospinal fluid from the catheter. The patient had severe neurological sequelae. This case report emphasises the importance of covering empirically for Listeria monocytogenes in all patients with penicillin allergy with suspected bacterial meningitis. The case also shows that it is possible to have significant infection and inflammation even with negative microscopy, negative cultures, and negative broad range polymerase chain reaction in cases of Listeria meningitis. Follow-up spinal taps can be necessary to detect the presence of Listeria monocytogenes.

Highlights

Listeria monocytogenes (LM) meningitis is a rare disease entity with an estimated incidence of 0.03–0.2 cases/100.000 people/year [1, 2]
From the literature it is known that only approx. 10–30% of Gram stains of cerebrospinal fluid (CSF) are positive in LM meningitis [7]
Cultures of the CSF do not have an optimal sensitivity with positive cultures in 83% of patients with LM meningitis [8]

Summary

Introduction

Listeria monocytogenes (LM) meningitis is a rare disease entity with an estimated incidence of 0.03–0.2 cases/100.000 people/year [1, 2]. The disease is mainly transmitted by contaminated food and has been associated with newborn infants, pregnant women, and patients with comorbidity, to elderly and to immunosuppressed individuals [3,4,5,6]. Listeria meningitis can be difficult to diagnose because of no optimal sensitivities in diagnostic tests of the cerebrospinal fluid (CSF) and blood cultures [7, 8]. The patient reported in this case report illustrates very well the clinical dilemmas in this serious condition, where even modern laboratory analyses showed failing sensitivities in a patient with penicillin allergy, not covered for Listeria infection up-front at the time of admission

Case Presentation

Discussion

Findings

Conflict of Interests