Limitations of empirical therapy for bacterial meningitis in a healthy child with Listeria monocytogenes meningitis

Abstract

Whilst Listeria monocytogenes ( L. monocytogenes ) meningitis is more common in neonates and the immunosuppressed, consideration of listeriosis is also warranted in otherwise healthy children. We present a case of L. monocytogenes meningitis in an immunocompetent 6-year-old girl. She presented with fever, irritability, pain on neck flexion and signs of a left-sided hemiplegia. Cerebrospinal fluid analysis showed hypoglycorrhachia and raised protein, as well as a pleocytosis with lymphocyte predominance. Standard empirical therapy for meningitis, utilising a third-generation cephalosporin with or without vancomycin would fail to cover L. monocytogenes . Therefore, in cases of meningitis where focal neurological signs are present, consideration should be given to the use of ampicillin or meropenem as part of first-line therapy.