Abstract
BackgroundListeria monocytogenes causes gastroenteritis, meningitis and bacteraemia in immunocompromised, pregnant patients, the elderly as well in immunocompetent patients. Focal infections with this organism are uncommon, especially in sporadic (non-outbreak) setting, require high index of suspicion and are challenging to diagnose. We present 3 cases of Listeria monocytogenes presenting as focal infections to our hospitals, all of which are the first reported cases from Australia.Case presentationThree unrelated cases of unique focal infections caused by Listeria monocytogenes are presented. 1) A 73 year old Caucasian lady on immunosuppression for colorectal cancer presented with prosthetic knee joint septic arthritis, 2) An 83 year old Caucasian man presented with prosthetic vascular graft infection and 3) A 60 year old Asian man with perianal abscess. Except for case 1, the other cases had a prolonged duration of symptoms on presentation. Listeria was not thought to be causative organism in any of these cases until microbiological specimens isolated the organism. Matrix Associated Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) assisted in making an earlier diagnosis of the infection in all three cases. All of these patients had Listeria monocytogenes isolated from clinical specimens. They were managed with antibiotics and surgery with favourable outcomes. Public health investigations to determine any dietary association were done, however no intervention was thought to be necessary in any of the cases except provide dietary advice. The first two cases highlight the importance of microbiological sampling in serious infections for definitive antibiotic therapy to be administered.ConclusionSporadic focal infections with Listeria occur infrequently and are often not diagnosed till culture results from microbiological specimens become available. Dietary history should be an important aspect of thorough clinical history and food consumption advice is crucial in immunocompromised patients on similar lines as given to pregnant women about listeriosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0641-x) contains supplementary material, which is available to authorized users.
Highlights
Listeria monocytogenes causes gastroenteritis, meningitis and bacteraemia in immunocompromised, pregnant patients, the elderly as well in immunocompetent patients
1) A 73 year old Caucasian lady on immunosuppression for colorectal cancer presented with prosthetic knee joint septic arthritis, 2) An 83 year old Caucasian man presented with prosthetic vascular graft infection and 3) A 60 year old Asian man with perianal abscess
Listeriosis is a serious food borne disease caused by the bacterium Listeria monocytogenes, affecting mostly pregnant women, neonates, the elderly and immunecompromised hosts with relatively high mortality rates in these groups
Summary
Localised and focal infections with Listeria are rare, they present with challenges associated with diagnosis and may not have clear risk factors for their development. Consent Written informed consent was obtained from all patients for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Authors’ contributions RC- Conceived the case report, wrote the initial manuscript, performed literature review, managed Case 3 in this report, and liaised with local public health unit and reference laboratories in Sydney and Melbourne. CK- Managed Case 1 and Case 2, performed literature review and liaised with Health Protection NSW, Sydney. SQ- Managed and followed up on Case 1. HF- Consultant in charge of Case 2, provided input into the manuscript. All authors read and approved the final manuscript
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