Listeria Monocytogenes Meningitis Research Articles

Potential PD-1 inhibitor immune dysregulation as a risk factor for Listeria monocytogenes bacteremia and meningitis

As immune checkpoint inhibitor (ICI) therapy becomes increasingly popular for the treatment of cancer, there is a growing body of literature on opportunistic infections associated with ICI therapy. Pembrolizumab binds specifically to the PD-1 receptor on T cells, preventing PD-1’s interaction with PD-L1 and PD-L2. This blockade interrupts the inhibitory signal and restores a T cell’s ability to recognize and attack tumor cells. We present a case of invasive Listeria infection associated with ICI therapy. The case also suggests treating patients undergoing active ICI therapy as potential immunocompromised hosts due to possible immune dysregulation related to ICI therapy.

Potential PD-1 inhibitor immune dysregulation as a risk factor for Listeria monocytogenes bacteremia and meningitis

As immune checkpoint inhibitor (ICI) therapy becomes increasingly popular for the treatment of cancer, there is a growing body of literature on opportunistic infections associated with ICI therapy. Pembrolizumab binds specifically to the PD-1 receptor on T cells, preventing PD-1’s interaction with PD-L1 and PD-L2. This blockade interrupts the inhibitory signal and restores a T cell’s ability to recognize and attack tumor cells. We present a case of invasive Listeria infection associated with ICI therapy. The case also suggests treating patients undergoing active ICI therapy as potential immunocompromised hosts due to possible immune dysregulation related to ICI therapy.

Clinical characteristics and prognosis of pediatric Listeria monocytogenes meningitis based on 10-year data from a large children's hospital in China.

This study aims to summarize the clinical characteristics and prognosis of Listeria monocytogenes (LM) meningitis in children in Chongqing, China. A retrospective analysis of the clinical data and follow-up results of 20 LM meningitis patients admitted to the Children's Hospital of Chongqing Medical University (CHCMU) from January 2012 to December 2022 was performed. The LM meningitis incidence rate was between 0 and 14.3 per 100,000 persons. The median age at onset was 8.98 months. There were five neonate cases, which all had perinatal abnormalities. Seven non-neonatal cases (7/15, 46.7%) had a documented history of contaminated food intake. One case had primary immunodeficiency. The most common symptoms were fever (20/20), altered consciousness (19/20), and vomiting (15/20). Seven cases had seizures, eight cases had cranial nerve involvement, eight cases had positive Babinski sign, and 10 cases had positive meningeal signs. The most common complications were hyponatremia (6/20), hypokalemia (6/20), respiratory failure (5/20), subdural effusion (3/20), and hydrocephalus (2/20). Treatment primarily involved monotherapy or combination therapy with meropenem (15/20) and ampicillin (10/20). Fifteen cases were treated with monotherapy or combination therapy using vancomycin. Twelve cases were successfully followed up from 10 months to 9 years and 6 months, and all had favorable long-term outcomes. LM meningitis incidence in children is low and with nonspecific clinical manifestations. Strengthening food hygiene and safety education, and avoiding infections during pregnancy are important to prevent LM infection in neonates and high-risk individuals. Meropenem and ampicillin are the preferred treatments. Early diagnosis and treatment can improve prognosis.IMPORTANCEThe incidence of LM meningitis is extremely low, and there is currently no standardized treatment. We conducted a retrospective analysis of ten years of data from CHCMU regarding diagnosed LM meningitis cases, aiming to provide clinical evidence for the diagnosis and treatment.

Meningitis a Listeria monocytogenes in a young, immunocompetent male

Listeria Monocytogenes (LM) is a gram-positive intracellular pathogen usually transmitted to humans by ingesting contaminated food. It typically infects immunocompromised individuals, such as pregnant women, newborns, alcoholics, and the elderly. LM is a rare cause of meningitis in immunocompetent, healthy adults. However, its clinical presentation is similar to that of other viral or bacterial central nervous system infections and its course can be rapid and aggressive. Physicians should therefore always consider LM as a possible etiologic agent of meningitis, especially in cases that do not respond to first-line empiric antibiotic therapy. We report a case of Listeria Monocytogenes meningitis in a previously healthy 16-year-old.

Bilateral Facial Nerve Palsy Following Antibiotic Treatment for Listeria Monocytogenes Meningitis

Listeria monocytogenes (LM) is an intracellular, facultative, gram-positive bacillus transmitted mainly through contaminated food, particularly dairy products and cold deli meats. It typically affects immunocompromised patients, and a rarely neuroinvasive disease in immunocompetent healthy adults has been described in the literature. Despite the timely intervention, neurologic morbidity has been observed after extended periods of recommended antibiotic regimens. This case study highlights the challenges in diagnosing and managing LM meningitis, especially when atypical symptoms and complications arise. Herein, we describe the case of a 57-year-old healthy man admitted with symptoms of nausea, vomiting, headache, neck pain, and stiffness, who was eventually diagnosed with LM-related meningitis and treated with antibiotics. The patient’s hospital course was complicated by bilateral facial nerve palsy, while other symptoms improved with antibiotic treatment, raising suspicion for parainfectious immunological response, which improved with a short course of steroids. This case contributes to the medical literature by providing insights into the immunological response for treating LM meningitis and managing LM meningitis–associated complications. To our knowledge, this could potentially be the first case of LM meningitis causing the parainfectious immunological response of bilateral facial nerve palsy after antibiotic treatment.

Pemphigus foliaceus complicated with Listeria monocytogenes infection and meningitis.

Pemphigus foliaceus complicated with Listeria monocytogenes infection and meningitis.

Adjunctive dexamethasone treatment in adults with listeria monocytogenes meningitis: a prospective nationwide cohort study

A French cohort study described a detrimental effect of adjunctive dexamethasone treatment in listeria meningitis. Based on these results guidelines recommend not to use dexamethasone if L.monocytogenes is suspected or stop dexamethasone when the pathogen is detected. We studied clinical characteristics, treatment regimens and outcome of adults with Listeria monocytogenes meningitis in a nationwide cohort study on bacterial meningitis. We prospectively assessed adults with community-acquired L.monocytogenes meningitis in the Netherlands between Jan 1, 2006, and July 1, 2022. We identified independent predictors for an unfavourable outcome (Glasgow Outcome Scale score 1 to 4) and mortality by logistic regression. 162 out of 2664 episodes (6%) of community-acquired bacterial meningitis episode were caused by L.monocytogenes in 162 patients. Adjunctive dexamethasone 10mg QID was started with the first dose of antibiotics in 93 of 161 patients (58%) and continued for the full four days in 83 (52%) patients. Different doses, duration or timing of dexamethasone were recorded in 11 patients (7%) and 57 patients (35%) did not receive dexamethasone. The case fatality rate was 51 of 162 (31%) and an unfavourable outcome occurred in 91 of 162 patients (56%). Age and the standard regimen of adjunctive dexamethasone were independent predictors for an unfavourable outcome and mortality. The adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0.40 (95% confidence interval 0.19-0.81). Adjunctive dexamethasone is associated with an improved outcome in patients with L.monocytogenes meningitis and should not be withheld if L.monocytogenes is suspected or detected as causative pathogen. European Research Council and Netherlands Organisation for Health Research and Development.

A case of Listeria monocytogenes Meningitis Complicated with Acute Hydrocephalus in an Immunosuppressed Patient

Listeria monocytogenes menenjiti, yaşlı veya bağışıklığı baskılanmış hastalarda görülür ve yüksek mortaliteye neden olabilir. Hidrosefali, L.monocytogenes meningoensefalitinin ciddi bir komplikasyonudur. Uygunsuz ampirik antimikrobiyal tedavi ve hidrosefali gelişimi, mortalite ile ilişkili ana bağımsız prognostik faktörlerdir. L.monocytogenes, özellikle bağışıklığı baskılanmış hastalarda menenjit ve bakteriyemi etkeni olabilir. L.monocytogenes’in akut hidrosefali ve yüksek mortaliteye sebep olabileceği unutulmamalıdır. Olgumuz; 58 yaşında kadın hastaydı ve otoimmün hepatit tanısı ile öncesinde kortikosteroid kullanmaktaydı. İki gündür bilinç bulanıklığı ve ateş şikayeti ile hastaneye başvurdu. Akut hidrosefali ile komplike olan L. monocytogenes’e bağlı menenjit tanısıyla yoğun bakımda izlemi yapıldı. Hasta yoğun bakım takibinin 21. gününde ve mekanik ventilatör desteğinin 16. gününde kaybedildi. L.monocytogenes, özellikle immünosupresif hastalarda menenjit ve bakteriyemi etkeni olabilir. Yaşlı veya bağışıklığı baskılanmış hastalarda Listeria akılda tutulmalı ve Listeria için etkin ampirik tedavilere başlanmalıdır. Tedaviye rağmen kliniği kötüleşen hastalarda akut hidrosefali akılda tutulmalıdır.

Listeria monocytogenes septicemia and meningitis induced from immunosuppressant treatments in a patient with neuromyelitis optica spectrum disorder: A case report

Introduction: The aim of this study is to report a fatal case of Listeria monocytogenes septicemia and meningitis complicating azathioprine and glucocorticosteroid treatments during an acute flare of neuromyelitis optica spectrum disorder (NMOSD). Case Report: A Chinese woman who was diagnosed with NMOSD had been on oral prednisolone and azathioprine for about three years. After her fourth relapse, she was treated with high-dose glucocorticosteroids again, and she soon developed an impaired consciousness, headache, and neck stiffness. Her blood culture was positive for L. monocytogenes, and a head computed tomography showed severe hydrocephalus. Although shunt surgery was performed and antibiotics were used, the patient continued to decline and eventually died. Conclusion: We reported the first Asian case of azathioprine-associated L. monocytogenes septicemia in a patient with NMOSD. Physicians should be aware of this serious and potentially lethal side effect when adding multiple immunosuppressants to the regimen of a patient who is already immunocompromised.

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

Next-Generation Sequencing-Based Diagnosis of Bacteremic Listeria monocytogenes Meningitis in a Patient with Anti-Interferon Gamma

Abstract Although various opportunistic infections have been described in patients with anti-interferon gamma autoantibodies, so far there is no Listeria monocytogenes infection reported to be associated with this primary immunodeficiency. Here, we describe the first case of bacteremic L. monocytogenes meningitis in a 59-year-old Chinese man with anti-interferon gamma autoantibodies, who presented with acute onset of fever and severe headache. Blood culture was positive but culture of the cerebrospinal fluid was negative, although it showed features suggestive of partially treated bacterial meningitis. The presence of L. monocytogenes in the cerebrospinal fluid was confirmed by next-generation sequencing. Avoidance of high-risk food items in these patients is important for the prevention of listeriosis. The use of antibiotic regimens that cover Listeria is crucial for empirical treatment, particularly if such patients develop acute or subacute meningitis. Next-generation sequencing is becoming an important diagnostic modality for culture-negative infections.

Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last 2 years, and the patient's history was notable for severe Listeria monocytogenes meningitis 4 years before presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled man-in-the-barrel syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.

Neural Injury and Repair in a Novel Neonatal Mouse Model of Listeria Monocytogenes Meningoencephalitis.

To improve the therapy of neonatal central nervous system infections, well-characterized animal models are urgently needed. The present study analyzes neuropathological alterations with particular focus on neural injury and repair in brains of neonatal mice with Listeria monocytogenes (LM) meningitis/meningoencephalitis using a novel nasal infection model. The hippocampal formation and frontal cortex of 14 neonatal mice with LM meningitis/meningoencephalitis and 14 uninfected controls were analyzed by histology, immunohistochemistry, and in situ tailing for morphological alterations. In the dentate gyrus of the hippocampal formation of mice with LM meningitis/meningoencephalitis, an increased density of apoptotic neurons visualized by in situ tailing (p = 0.04) and in situ tailing plus immunohistochemistry for activated Caspase-3 (p < 0.0001) was found. A decreased density of dividing cells stained with an anti-PCNA-antibody (p < 0.0001) and less neurogenesis visualized by anti-calretinin (p < 0.0001) and anti-calbindin (p = 0.01) antibodies were detected compared to uninfected controls. The density of microglia was higher in LM meningitis (p < 0.0001), while the density of astrocytes remained unchanged. Infiltrating monocytes and neutrophilic granulocytes likely contributed to tissue damage. In conclusion, in the brains of LM-infected mice a strong immune response was observed which led to neuronal apoptosis and an impaired neural regeneration. This model appears very suitable to study therapies against long-term sequelae of neonatal LM meningitis.

Listeria monocytogenes Meningitis in a Female Patient with Primary Mediastinal (Thymic) Large B-Cell Lymphoma: A Case Report

Listeriosis with severe clinical manifestations in the form of bacteraemia, sepsis, and meningitis/meningoencephalitis is a rare but a challenging issue of supportive care in oncohematology. Early diagnosis of listeriosis, as well as any other infection, is hampered by severe general manifestations of a malignant lymphoproliferative disorder or tumor complications and its treatment. In patients with pronounced decreased drug-induced immunity listeriosis is usually characterized as a rapidly developing and, as a rule, severe disease with high immediate mortality. The present article offers a case report of severe listeria infection in a female patient admitted to the intensive care unit for the treatment of primary mediastinal (thymic) large B-cell lymphoma with a large tumor mass in anterior mediastinum complicated by mediastinal and superior vena cava compression syndromes.

A fatal case of Listeria monocytogenes meningitis and sepsis in an immunocompromised female

Listeria monocytogenes should be considered as a source of sepsis and meningitis in immunocompromised individuals. Immunosuppressant agents including biologic therapies have transformed the management of various rheumatological and dermatological conditions. We report a case of life-threatening Listeria monocytogenes sepsis and meningitis in a 52-year-old female who was on immunosuppressive therapy.

Early switch therapy from ceftriaxone to ampisilin in an immunosuppressed patient with Listeria monocytogenes septicemia and meningitis

Early switch therapy from ceftriaxone to ampisilin in an immunosuppressed patient with Listeria monocytogenes septicemia and meningitis

High incidence of severe neurologic manifestations and mortality in adults with listeria monocytogenes meningitis in Taiwan: A hospital-based study

High incidence of severe neurologic manifestations and mortality in adults with listeria monocytogenes meningitis in Taiwan: A hospital-based study

Listeria Meningitis in Danish Children 2000-2017: A Rare Event Even in a Country With High Rates of Invasive Listeriosis.

Listeria monocytogenes meningitis in Danish children 1 month to 17 years from 2000 to 2017 was identified and patient files reviewed. There were 5 cases, equaling an annual incidence of 0.024 per 100,000 children or 0.014 when excluding 2 immunodeficient children. Even in a country with a high general incidence of listeriosis, Listeria meningitis is a rare event in healthy children.

High incidence of severe neurological manifestations and high mortality rate for adult Listeria monocytogenes meningitis in Taiwan

The clinical characteristics and therapeutic outcomes of adult Listeria monocytogenes meningitis are not commonly examined in isolation in the literature. During a study period of 19 years (2000–2018), 366 patients with culture-proven adult bacterial meningitis (ABM) were identified in the author’s hospital (264 patients in 2000–2010 and 102 patients in 2011–2018). Of the 366 ABM patients, 330 had monomicrobial infections while the other 36 had mixed infections. L. monocytogenes infection was identified in 11 of the 330 patients with monomicrobial ABM (3 in 2000–2010 and 8 in 2011–2018). These 11 patients included 5 males and 6 females, aged 47 to 76 years (median age = 61.7). None of the 11 patients had a postneurosurgical state as the underlying cause, but 3 of them contracted the infection nosocomially. Common underlying conditions included liver cirrhosis (4), systemic malignancy (3), diabetes mellitus (3), and renal disease (2). The most common clinical manifestations were fever (11), altered consciousness (8), seizure (8), bacteremia (7) and hydrocephalus (5). The therapeutic result revealed a mortality rate of 72.7% (8/11), but no significant prognostic factors were identified. The clinical features of 8 additional Taiwanese L. monocytogenes ABM patients reported in the literature, were also included for analysis. The present study revealed an increase in L. monocytogenes ABM in recent years and most patients presented with severe neurological manifestations. The current study is a preliminary overview of L. monocytogenes meningitis in adults and a further large-scale study is needed for improved delineation of this specific infectious syndrome.

Clinical characteristics and next generation sequencing of three cases of Listeria monocytogenes meningitis with complications

Objective: To summarize the clinical characteristics of Listeria monocytogenes meningitis (LMM) with complications, and analyze the outcomes of next generation sequencing. Methods: Clinical characteristics, laboratory findings, imaging features, antibiotics treatment, and next generation sequencing of cerebrospinal fluid were analyzed in 3 LMM patients who were hospitalized in the Department of Infectious Diseases of Beijing Children's Hospital Affiliated to Capital Medical University from July 2015 to November 2017. Results: The three patients were 1-year-old girl, 2-year-old girl, and 9-year-old boy, with normal immune function. They had eaten refrigerated food, milk or dairy products before onset. Symptoms included fever, headache, abdominal pain, diarrhea, vomiting, and convulsions, etc. The complications of two cases (case 2 and 3) were appendicitis and Meckel's diverticulitis. The other one (case 1) was with sepsis and pneumonia. Leukocyte counts in cerebrospinal fluid were elevated in all the three cases, and cranial magnetic resonance imaging showed meningeal or periventricular involvement. All the children were diagnosed with LMM by positive CSF culture. CSF for next generation sequencing was sent after carbapenem antibiotics using, yet all the results were positive. The positive results were returned 2, 9, and 9 days earlier than culture results, respectively. The gene coverage was 5.00%, 7.00%, 0.04%, and the reads was 2 561, 1 011 and 8, respectively. All the three children had recurrent fever despite using cephalosporin. Levels of leukocytes in the blood and CSF further elevated. After using carbapenem antibiotics, patients improved eventually and were discharged from hospital. Conclusions: LMM can occur in children with normal immune function and is usually associated with digestive system symptoms. Listeria monocytogenes can be detected quickly and accurately by the next generation sequencing technology, without being limited to sampling time and antibiotics application.