Listeria monocytogenes rhombencephalitis: a case report and review of current literature

Objective To improve the awareness of Listeria monocytogenes meningoencephalitis in clinical practice. Methods The diagnosis and treatment of a case with nephrotic syndrome complicated with Listeria monocytogenes meningoencephalitis collected from PLA Rocket Force Characteristic Medical Center at October 24th, 2018 were analyzed and relevant literature was reviewed. Results The 25-year-old male patient with nephrotic syndrome complicated with Listeria monocytogenes meningoencephalitis was treated with comprehensive anti-infection therapy and symptomatic treatment. The temperature of the patient returned to normal, after the improvement of the Listeria state and meningoencephalitis, the patient was discharged from hospital, with good prognosis. Conclusion Early diagnosis and standard antibiotic treatment are the key to the state and prognosis of Listeria monocytogenes meningoencephalitis. Key words: Listeria meningoencephalitis; Meningoencephalitis; Nephrotic syndrome

Bacterial meningitis is one of the most severe infectious diseases with high rate of morbidity and mortality in developing countries. The current study aimed to investigate the frequency of etiological agents of bacterial meningitis among patients admitted to three hospitals in Zanjan, Iran. A total of 100 cerebrospinal fluid (CSF) samples were collected aseptically, and cytochemical analysis, Gram staining, culture, and PCR were performed. Forty-six percent of CSF samples had positive bacterial culture results. However, PCR showed a higher detection rate of bacterial meningitis causing pathogens when compared with culture (52% vs. 46%; p > 0.05). Fifty-two percent of patients with bacterial meningitis were aged <1 year. The most prevalent pathogen was Streptococcus pneumoniae (36.5%), followed by Neisseria meningitidis (28.8%) and Streptococcus agalactiae (15.4%). Listeria monocytogenes was not isolated from CSF culture. The frequency of Haemophilus influenzae, L. monocytogenes and Escherichia coli was 7.7%, 1.9% and 9.6%, respectively. Although in patients aged <1 year, S. pneumonia, N. meningitidis and group B streptococcus were the most common pathogens causing meningitis, and in patients aged between 1 and 10 years, Escherichia coli was the most common. According to the results, the culture was less effective for diagnosis of bacterial meningitis than PCR. Our findings indicate that the most common causative agents of bacterial meningitis in Iran may be vaccine-preventable pathogens. Therefore, the prevention and control measures should be considered to reduce the incidence of bacterial meningitis.

Multistate Outbreak of Fungal Infection Associated With Injection of Methylprednisolone Acetate Solution From a Single Compounding Pharmacy—United States, 2012

A total of 14 cerebrospinal fluid (CSF) samples from ruminants clinically suspected of suffering from listeric encephalitis were examined by polymerase chain reaction (PCR) for the detection of Listeria monocytogenes (L. m.). Of these samples, 11 were examined bacteriologically. Although the clinical diagnosis was confirmed in eight of 11 ruminants by histological and/or bacteriological examination of the brains, L. m. was only detected in one of the CSF samples using PCR, and in none by culture. The PCR-positive CSF sample was obtained from a sheep which had been treated with antibiotics prior to CSF sampling. From these findings, it was concluded that L. m. only occasionally gains access to the meningoventricular system in the course of listeric encephalitis of ruminants and that a reliable aetiological in vivo diagnosis of listeric encephalitis generally cannot be based on the detection of L. m. in the CSF of affected ruminants.

Background: The etiology of meningitis, an infection and inflammation of the meningeal membranes surrounding the brain and spinal cord, is multifactorial. Among the infectious etiologies are viruses, bacteria, parasites, and fungi. Objectives: The objective of this study is to utilize the molecular polymerase chain reaction (PCR) method to detect bacterial infections causing meningitis in cerebrospinal fluid (CSF) samples from hospitalized patients suspected of having meningitis. Subsequently, a comparison is made between the PCR results and the results of sample cultures obtained in the laboratories of Hamadan educational hospitals. Methods: This study was conducted on 104 CSF samples collected from hospitalized patients suspected of having meningitis at the educational hospitals of Hamadan University of Medical Sciences from February 2022 to August 2023. The most common etiological agents of bacterial meningitis were identified using culture and PCR methods. These included Escherichia coli K1, Listeria monocytogenes, Streptococcus agalactiae, Neisseria meningitidis, S. pneumoniae, and Haemophilus influenzae. Results: The mean age of the patients in this study was 31.57 ± 25.85 years. Of the participants, 53.85% were male and 46.15% were female. No bacteria were isolated from the studied samples by culture in hospital laboratories. However, the PCR method yielded the identification of five (4.81%) bacterial cases, including L. monocytogenes (0.96%), S. pneumoniae (1.92%), and S. agalactiae (1.92%), in the CSF samples under investigation. Conclusions: The findings of this study indicated a low prevalence of common bacterial infections in CSF samples. Furthermore, the study demonstrated that the molecular method is more precise and sensitive in detecting these bacteria compared to traditional culture techniques.

Objective To study risk factors associated with predisposition to Lm -ABM in adult patients and to evaluate the clinical features,management and out in this cohort of patients because Listeria monocytogenes (Lm) is the third most common cause of acute community acquired bacterial meningitis (Ac-ABM),after Streptococcus pneumoniae and Neisseria meningitides aetiologies.Methods A descriptive,prospective study carried out in a tertiary grade medical center emergency department in Beijing over a 10 -year period.During the study period,15 patients of Lm- ABM were included.Comparison of episodes of Lm - ABM versus other aetiologies was made.Results Fifteen episodes of Lm - ABM were identified in327 adult Ac - ABM patients.Three cohorts of individuals were vulnerable to Lm - ABM:the elderly ( RR=3.14; 95％ CI 1.84-5.35),the immunocompromised (RR =3.34; 95％ CI2.08-5.38),and pregnant women ( RR 12.48 ; 95％ CI 3.29 ～ 47.39 ).The classic triad of fever,neck stiffness,and altered mental status was present in 40％ (6 of 15) Lm - ABM patients.Similarly,40％ patients had at least one of cerebrospinal fluid (CSF) samples with features met the criteria of typical bacterial meningitis.The coverage of empirical antimicrobial therapy was microbiologically inadequate for 13 ( 86.7％ ) patients.The mortality rate was 33.3％ (5 of 15),and 7 (46.7％ ) of 15 patients led to an unfavorable outcome ( GOS ＜ 4),both of which were significantly higher than those in other aetiologies of Ac - ABM ( P =0.015P =0.009 respectively). Conclusions Our study showed the elderly,the immunocompromised patients,and pregnant women predisposed to Ac - ABM most likely to be Listeria monocytogenes aetiology.In contrast with similar previous reports, the current study showed that patients with meningitis due to Listeria monocytogenes did not present with atypical clinical features.A high proportion of patients received empirical antimicrobial therapy that did not cover Listeria monocytogenes.Lm - ABM is still a serious disease that leads to high morbidity and mortality rates.With these important caveats in mind,our findings have implications for clinical practice and food safety policy makers. Key words: Listeria monocytogenes; Acute community acquired bacterial meningitis; Clinical feature ; Adult ; Predisposing factor ; Empirical antimicrobial therapy, Ampicillin, China

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.

A Single-Tube Nucleic Acid Extraction, Amplification, and Detection Method Using Aluminum Oxide

Neonatal listeriosis is a rare but severe infectious disease caused by the gram-positive bacterium Listeria monocytogenes with a mortality rate of almost 30%. Pregnant women are mostly infected with Listeria...

Purulent meningitis (PM) is a severe infectious disease that is associated with high rates of morbidity and mortality. It has been recognized that bacterial infection is a major contributing factor to the pathogenesis of PM. However, there is a lack of information on the bacterial composition in PM, due to the low positive rate of cerebrospinal fluid bacterial culture. Herein, we aimed to discriminate and identify the main pathogens and bacterial composition in cerebrospinal fluid sample from PM patients using high-throughput sequencing approach. The cerebrospinal fluid samples were collected from 26 PM patients, and were determined as culture-negative samples. The polymerase chain reaction products of the hypervariable regions of 16S rDNA gene in these 26 samples of PM were sequenced using the 454 GS FLX system. The results showed that there were 71,440 pyrosequencing reads, of which, the predominant phyla were Proteobacteria and Firmicutes; and the predominant genera were Streptococcus, Acinetobacter, Pseudomonas, and Neisseria. The bacterial species in the cerebrospinal fluid were complex, with 61.5% of the samples presenting with mixed pathogens. A significant number of bacteria belonging to a known pathogenic potential was observed. The number of operational taxonomic units for individual samples ranged from six to 75 and there was a comparable difference in the species diversity that was calculated through alpha and beta diversity analysis. Collectively, the data show that high-throughput sequencing approach facilitates the characterization of the pathogens in cerebrospinal fluid and determine the abundance and the composition of bacteria in the cerebrospinal fluid samples of the PM patients, which may provide a better understanding of pathogens in PM and assist clinicians to make rational and effective therapeutic decisions.

Infection after cerebrospinal fluid (CSF) shunts or ventriculostomies is a common complication associated with significant morbidity and mortality. Polymerase chain reaction (PCR) is a powerful molecular technique that allows rapid and precise amplification of bacterial deoxyribonucleic acid (DNA) and has proven a powerful tool in the detection of a wide variety of clinically important infectious diseases. We analyzed specimens of CSF derived from ventriculoperitoneal shunts or external ventricular drains by using both conventional cultures and PCR and report herein our preliminary results. We selected 86 CSF samples from adult patients who underwent either shunt tap or routine surveillance cultures of their ventriculostomy. These specimens were chosen from a larger group of 300 specimens that were routinely collected (many serially) in our clinical practice. They were chosen because clinical suspicion of infection was increased because of either patient signs and symptoms (fever, stiff neck, lethargy, worsening neurological examination) or preliminary laboratory analysis of CSF data (increased white blood cell count, increased protein level, decreased glucose). We considered this subgroup optimal to efficiently initiate our investigation of the correlation of PCR and culture results. CSF was increased by using standard culture techniques and by using PCR. Samples of CSF that were to undergo PCR had DNA extracted, purified, and amplified for 16S rRNA using primers 16S-Forward and 16S-Reverse of conserved sequence regions of all bacteria. DNA was PCR-amplified for 30 cycles. One microliter of the first PCR product was subjected to nested PCR using primers specific for gram-positive and gram-negative bacteria. Samples were also subjected to PCR amplification for specific detection of Propionibacterium acnes, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus using specific primers for 16S rRNA Propionibacterium, nuclease gene of Staphylococcus, and Mec gene of methicillin-resistant Staphylococcus aureus. For 18 of 86 specimens (21%), both the culture and PCR were positive. For 30 of 86 specimens (35%), both the PCR and culture results were negative. For 42 of 86 specimens (49%), cultures were negative and PCR was positive. There were no positive culture results with negative PCR results. Most negative culture/positive PCR cases occurred after prolonged intravenous antibiotics. Of the 56 PCR-positive specimens, 30 were positive for Propionibacterium acnes, whereas 40 were positive for Staphylococcus aureus. Of the Staphylococcus aureus-positive specimens, two were positive for methicillin resistant-Staphylococcus aureus. Among the 56 PCR-positive specimens, 30 were positive for both Propionibacterium acnes and Staphylococcus aureus; gram-negative organisms were not detected by any method in these specimens. These preliminary data suggest that PCR is a highly sensitive, rapid, and potentially promising modality for the detection and treatment of CSF shunt ventriculostomy infection.

Background. Listeria monocytogenes is one of the most important human foodborne pathogens; it may beresponsible for several disorders, like meningoencephalitis. Listerial isolation in cerebrospinal fluid (CSF) isoften difficult using microbiologic traditional assays. The aim of this study is to evaluate the reliability ofmolecular techniques as an alternative tool in order to identify Listeria monocytogenes meningitis and inparticular, to evaluate a real-time PCR and a conventional PCR for the target hlyA gene.Methods. In 2000-2004, 145 patients, without T-cell immunodeficiency, affected by meningoencephalitis ofunknown origin were admitted to the Infectious Diseases Institute of Sassari, Italy; a lumbar puncture wasperformed at the time of hospital admission. Two different PCR techniques, i.e. RT-PCR and a conventional PCR,were performed in order to detect CNS listerial infection, in conjunction with traditional microbiologic assays.Results. We identified fourteen patients affected by listerial meningitis using RT-PCR and conventional PCR.All but one of the CSF cultures were negative for L. monocytogenes. Molecular techniques were performedon the CSF samples collected during follow-up revealing that signal intensity decreased by 40%, 80% and100% at day 15, 30 and 55 respectively, from the start of antibiotic treatment.Conclusions. Considering the seriousness of CNS involvement caused by L. monocytogenes infection, promptdiagnosis is necessary in order to rapidly start specific treatment. Conventional PCR and RT-PCR are rapid assaysfor L. monocytogenes diagnosis and they might be useful for monitoring the efficacy of antibiotic therapy.

Listeria monocytogenes is one of the most common causes of bacterial central nervous system infections in adults. It often affects immunicompromised and elderly patients. Even with appropriate antimicrobial treatment, mortality due to Listeria monocytogenes meningoencephalitis is among the highest of all causes of bacterial central nervous system infections. We presented a previously healthy, 79-year-old farmer with typical clinical features of meningoencephalitis. The initial treatment with vancomycin and meropenem did not produce any clinical effect. On day six, Listeria monocytogenes was isolated from the cerebrospinal fluid and blood culture and identified by using conventional and automated microbiology methods. Antimicrobial susceptibility testing was performed by E test method. After bacterial isolation and identification, the administration of ampicillin and gentamicin was followed by the complete recovery of our patient. This case is presented to emphasize the negative outcome of empirical treatment when Listeria monocytogenes is not taken into consideration. Furthermore, the administration of ampicillin and gentamicin combination for treatment should be considered as the best therapeutic option in Listeria monocytogenes meningoencephalitis.

Listeria monocytogenes rhombencephalitis in a patient with multiple sclerosis during fingolimod therapy

Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques