Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura

Abstract

Ten new cases of Listeria monocytogenes meningitis (LMM) in the adult are here reported. Also, a review is made of reported cases by Spanish authors in the last 30 years, with an analysis of the predisposing conditions and mortality rate from this type of bacterial meningitis (BM) throughout the study period. The reported cases met two criteria: CSF biochemistry consistent with BM and positive CSF and/or blood culture for Listeria monocytogenes. The bibliographic search of previously reported cases was made through Medline. Cases were divided into two periods: from 1974 to 1988, and from 1989 onwards. Predisposing conditions, therapy, and mortality were analyzed and compared between the two study periods. The features of the cases reported here did not differ from those in the cases reported so far, with the single feature of two HIV-positive patients. Of the analyzed cases, 73% had some predisposing condition. Thirty-eight and 39% of the total of patients and of patients with some predisposing conditions, respectively, died, with a statistically significant difference (p < 0.001) between those with and without predisposing conditions. Among the treated patients, 87% received either ampicillin or penicillin and the mortality rate among these patients was 30%. No differences regarding mortality was rate observed between the two study periods, the total of cases of between those treated with the aforementioned antibiotics. Patients with LMM commonly have a predisposing condition. The mortality rate in this type of BM is still high among those treated with ampicillin or penicillin, and a decrease in the mortality rate was not observed when the reported cases in Spain in the last 30 years were analyzed. The optimal therapy for this condition is still to be defined.