Listeria Monocytogenes Meningitis Research Articles

Fatal meningitis due to Listeria monocytogenes in elderly patients with underlying malignancy

Adult patients with malignancies are considered to be at a high risk for Listeria monocytogenes meningitis. The Microbiology Laboratory's database of the University Hospital of Ioannina, Greece, was searched for cases of L. monocytogenes during the period from January 1990 to December 2002. Listerial meningitis occurred in three patients: one with brain tumour, one with chronic lymphocytic leukaemia, and one with non-Hodgkin's lymphoma. All the patients were older than 70 and they were actively receiving therapy for their malignancy. L. monocytogenes type 4b was isolated from blood and cerebrospinal fluid. All were treated with ampicillin and gentamicin, but they died shortly after the initiation of the treatment. Experience with the three present cases indicated the high mortality rate due to listerial meningitis in this immunosuppressed population. So, listeriosis should be suspected in patients with meningitis and underlying malignancy. Since meningitis due to L. monocytogenes is not distinguishable clinically from other types of bacterial meningitis, it is recommended to cover Listeria in the initial empirical therapy of bacterial meningitis in immunosuppressed patients.

Successful replacement of systemic immunosuppression by local graft irradiation in the management of listeria meningitis

HE DEVELOPMENT of powerful antirejection drugs has allowed renal transplantation to become established as the treatment of choice for patients with end-stage renal disease. Unfortunately, these drugs may lead to severe life-threatening infections in the transplant recipient, requiring cessation of immunosuppression to ensure patient survival. The subsequent graft loss from acute rejection is both psychologically and physically devastating to the patient. Successful substitution of systemic immunosuppression by local antirejection prophylaxis would obviously be beneficial in this situation. We report on a case of Listeria monocytogenes meningitis in a renal transplant recipient 2 weeks posttransplantation. Systemic immunosuppression was ceased, and the patient was successfully treated by a protocol of high-dose intravenous antibiotics and external beam allograft irradiation in an attempt to prevent allograft rejection.

Safety and steroid-sparing experience using infliximab for Crohn’s disease at a pediatric inflammatory bowel disease center

Objectives The published experience using infliximab (Remicade, Centocor, Malvern, PA) for the treatment of pediatric Crohn’s disease is limited but suggests utility in the treatment of refractory disease. Experience using infliximab at a large pediatric center is reviewed. Methods A retrospective review of all infliximab infusions administered to patients with Crohn’s disease (CD) was undertaken. Data were obtained from database and pharmacy records. Chart review and interviews with physicians, patients, and families were used to obtain missing data. Results A total of 432 infusions were administered to 82 patients (34 female and 48 male) with CD. The number of infusions each patient received ranged from one to 18, with a mean of 5.3 (SD 4.6) and median of 3. Of 33 patients, 19 (57.6%) became independent and remained free of corticosteroids. There was a statistically significant difference in the steroid dose between 0 and 4 wk and 0 and 8 wk. In all, 23 infusion reactions occurred (5.3%). Three patients developed herpes zoster, and one developed Listeria monocytogenes meningitis. No patients were documented to have delayed hypersensitivity reactions or malignancies. Conclusions Infliximab is safe and effective for treating pediatric patients with CD. A steroid-sparing effect was demonstrated. The most common adverse reaction to infliximab was infusion reaction. These reactions did not preclude further use of the agent. Serious infections were seen in a small number of patients.

Safety and steroid-sparing experience using infliximab for Crohn's disease at a pediatric inflammatory bowel disease center.

The published experience using infliximab (Remicade, Centocor, Malvern, PA) for the treatment of pediatric Crohn's disease is limited but suggests utility in the treatment of refractory disease. Experience using infliximab at a large pediatric center is reviewed. A retrospective review of all infliximab infusions administered to patients with Crohn's disease (CD) was undertaken. Data were obtained from database and pharmacy records. Chart review and interviews with physicians, patients, and families were used to obtain missing data. A total of 432 infusions were administered to 82 patients (34 female and 48 male) with CD. The number of infusions each patient received ranged from one to 18, with a mean of 5.3 (SD 4.6) and median of 3. Of 33 patients, 19 (57.6%) became independent and remained free of corticosteroids. There was a statistically significant difference in the steroid dose between 0 and 4 wk and 0 and 8 wk. In all, 23 infusion reactions occurred (5.3%). Three patients developed herpes zoster, and one developed Listeria monocytogenes meningitis. No patients were documented to have delayed hypersensitivity reactions or malignancies. Infliximab is safe and effective for treating pediatric patients with CD. A steroid-sparing effect was demonstrated. The most common adverse reaction to infliximab was infusion reaction. These reactions did not preclude further use of the agent. Serious infections were seen in a small number of patients.

Listeria monocytogenes Meningitis in a Patient with Chronic Hepatitis C Infection, Treated by Interferon alfa and Ribavirin

We present a patient with chronic hepatitis C infection without cirrhosis, treated by interferon alfa and ribavirin, who developed listeria monocytogenes meningitis. The possible pathophysiological association is discussed, along with therapeutic implications.

Meningitis in the Neonate.

Group B beta-hemolytic streptococci and Escherichia coli strains account for approximately two thirds of all cases of neonatal meningitis, while bacteria that typically account for meningitis in older age groups (Haemophilus influenzae type B, Neisseria meningitidis, and Streptococcus pneumoniae) are infrequent causes of meningitis in the neonatal population. As with other medical problems in neonates, signs and symptoms of bacterial infection of the central nervous system are generally few in number and nonspecific in nature. Manifestations that can suggest meningitis, as well as other serious illnesses, include temperature instability, lethargy, respiratory distress, poor feeding, vomiting, and diarrhea. Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. Ampicillin and either gentamicin or cefotaxime are recommended for initial empiric therapy of neonatal meningitis. When the results of the cerebrospinal fluid (CSF) culture and susceptibilities are known, therapy can be narrowed to cover the specific pathogen identified. In general, penicillin G or ampicillin is preferred for group B streptococcal meningitis, ampicillin for Listeria monocytogenes meningitis, and ampicillin plus either an aminoglycoside or cefotaxime for gram-negative meningitis. For the very low birth weight neonate who has been in the nursery for a prolonged period of time, organisms such as enterococci and gentamicin-resistant gram-negative enteric bacilli must also be considered. In patients with long-term vascular catheters, Staphylococcus aureus or coagulase-negative staphylococci must also be considered. Empiric combinations of antibiotics for such patients would include ampicillin or vancomycin, plus amikacin or cefotaxime. All neonates should undergo repeat CSF examination and culture at 48 to 72 hours after initiation of therapy. If organisms are observed on gram stain, modification of the therapeutic regimen should be considered, and neuroimaging should be performed. In general, therapy should be continued for 14 to 21 days for neonatal meningitis caused by group B streptococci or L. monocytogenes, and for at least 21 days for disease caused by gram-negative enteric bacilli. All patients with neonatal meningitis should have hearing and development monitored serially. The first audiologic evaluation should occur 4 to 6 weeks after resolution of the meningitis.

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

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.

An epidemiological study of listeriosis complicating a bone marrow transplant

Following an unrelated-donor bone marrow transplant a six-year-old child with severe aplastic anaemia developed Listeria monocytogenes septicaemia and meningitis. Cook-chill foods consumed during his stay in hospital were found to contain strains of L. monocytogenes and other Listeria species. Whole cell protein SDS-PAGE was performed on all isolates. No food isolates were found that were identical to the patient's strain by this technique or by serotyping. The usefulness of whole cell protein SDS electrophoresis for listeria strain differentiation is discussed.

Listeria monocytogenes Meningitis in Previously Healthy Adults: Long-term Follow-up

A few cases of Listeria meningitis in healthy individuals have been recorded in the world literature. The lack of a prolonged follow-up in most of these cases makes it difficult to exclude the existence of an underlying disease. The clinical and CSF data of four previously healthy patients with meningitis due to Listeria monocytogenes are presented. These patients were followed prospectively over 2-6 years; during this time none developed any disease associated with immunosuppression, including HIV infection, and none died. Listeria meningitis in an otherwise healthy person is, therefore, not always a sign of underlying immunosuppressive disease, and does not necessarily have a poor prognosis.

Listeria monocytogenes brain abscesses in a girl with acute lymphoblastic leukaemia after late central nervous system relapse

A case of Listeria monocytogenes bacteraemia and meningitis with intracerebral abscesses in a girl with acute lymphoblastic leukaemia in relapse is reported. The clinical features included subacute onset with fever and marked irritability followed by seizures, meningism and confusion. The pathogen was isolated from blood and cerebrospinal fluid. Computerised tomography of the brain showed two intracerebral parenchymal localisations, in the left frontal lobe and in the right occipital lobe, respectively. The patient survived this severe infection without neurological sequelae. 2 months later she underwent allogeneic bone marrow transplantation without major complications. This case report should alert pediatric oncologists about the possible occurrence of severe intracerebral listerial infections in the immunocompromised child and suggests that this infection can be treated successfully and should not necessarily preclude continuation of antineoplastic treatments.

Western blot analysis of the antibody response in patients withListeria monocytogenes meningitis and septicemia

The antibody response in patients with Listeria monocytogenes septicemia and/or meningitis was investigated using Western blot analysis (WBA). Protein antigen preparations were produced from two strains of Listeria monocytogenes, representing serogroup 1 and 4, by sonication and differential centrifugation. IgG antibodies from 8 (50%) of 16 patients with culture verified septicemia and/or meningitis due to Listeria monocytogenes reacted with a 93 kDa antigen from serogroup 1, in contrast to IgG antibodies from only 1 (2%) of 51 controls; these controls represented 21 patients with infections caused by other bacteria and 30 apparently healthy blood donors. Furthermore, IgM antibodies from 3 (19%) of the patients with listeric infections bound to a 106 kDa protein antigen in contrast to none of the controls. In 3 (33%) of 9 patients from whom acute and convalescence serum were available, the patients responded by producing antibodies against new protein antigens. Current methods used in routine serological investigations, i.e. complement fixation and O-agglutination tests, were positive in only 4 (24%) of the 16 patients with listeriosis. The results point to the possibility of designing new immunoassays for detection of septicemia and meningitis caused by Listeria monocytogenes.

In vitro bactericidal activity of amoxicillin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazole alone or in combination againstListeria monocytogenes

The in vitro bactericidal activity of amoxicillin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazole alone or in combination was determined against seven strains of Listeria monocytogenes by the killing curve method. Amoxicillin plus gentamicin was the most rapidly bactericidal combination, whereas trimethoprim-sulfamethoxazole was less bactericidal at 6 h but as bactericidal at 24 h. The combination of trimethoprim-sulfamethoxazole with either amoxicillin, ciprofloxacin or rifampicin did not result in antagonism, but the combinations were no more active than trimethoprim-sulfamethoxazole alone. The interaction of amoxicillin with rifampin was fairly antagonistic (1 log10 difference). The combination of amoxicillin and ciprofloxacin, although producing antagonism during the first 6 h, was more active at 24 h than amoxicillin alone and prevented the regrowth observed with ciprofloxacin alone. Ciprofloxacin and rifampicin interacted antagonistically during the first 6 h, and the combination was not very bactericidal (3 log10) but prevented the emergence of mutants, as observed with each drug alone, when used at concentrations greater than the MICs for the strain tested. These regimens merit evaluation in in vivo models of Listeria monocytogenes meningitis.

リステリア髄膜炎の3例

Three infants having Listeria monocytogenes meningitis were admitted to our hospital in the last ten years. They were a nineteen-month-old boy, a two-year-old girl and a five-year-old girl. They were all healthy infants. The two female patients survived, while the male patient died. At autopsy, arachnoid turbid, swollen brain substance and slight bleeding under the cerebellar tent were observed. Judging from the minimal inhibitory concentration of antibiotics against the isolated L. monocytogenes, antibacterial activity of penicillin G and ampicillin was good, whereas that of cefotaxime and latamoxef was poor. In conclusion, for therapy of bacterial meningitis due to unknown origin, the combination of ampicillin and cephalosporins is necessary.

Recurrent Listeria monocytogenes meningitis in a heart transplant recipient

A case of recurrent Listeria monocytogenes meningitis is reported, the two episodes arising 4 months and 8 months after the patient had received a heart transplant. Both episodes immediately followed increased doses of corticosteroids for allograft rejection. The source of infection was not identified. Previous reports and possible explanations of recurrent L. monocytogenes infection are reviewed.

Listeria monocytogenes meningitis in the acquired immune deficiency syndrome—limitations of conventional typing methods in tracing a foodborne source

Listeria monocytogenes is an unusual pathogen in the acquired immune deficiency syndrome (AIDS). We report a case of meningitis caused by L. monocytogenes in a patient with AIDS dementia who had eaten cheese from which a similar organism was isolated.

Recurrence of Listeria monocytogenes meningitis

A case of Listeria monocytogenes meningitis in a 3-year-old boy which relapsed after chloramphenicol treatment is described. The patient was subsequently successfully treated with ampicillin and gentamicin and made a complete recovery. In vitro studies confirmed the inadequacy of chloramphenicol therapy. The value of combination therapy, as evidenced by chessboard and killing-curve techniques with the strain, is discussed.

Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973–1982 : Hansen PB, Jensen TH, Lykkegaard S, et al: Scand J Infect Dis 19:55–60, 1987

Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973–1982 : Hansen PB, Jensen TH, Lykkegaard S, et al: Scand J Infect Dis 19:55–60, 1987

Listeria monocytogenes meningitis associated with eating soft cheese

A 36-year-old woman became ill with meningitis caused by Listeria monocytogenes. She had eaten soft cheese from which a similar organism was isolated.

Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973-1982.

16 adult patients with Listeria monocytogenes meningitis were reviewed to see whether clinical features or initial laboratory findings could discriminate between these patients and patients with purulent meningitis of other causes. Six patients suffered from known predisposing diseases and 4 were alcoholics. The initial clinical picture was indistinguishable from meningitis of other causes. Microscopy of cerebrospinal fluid (CSF) was negative in all cases but 2 where gram-positive rods were seen. CSF cytology and biochemistry could not discriminate from other causes of purulent meningitis although a low leucocyte content and a low percentage of neutrophils were often present. All L. monocytogenes strains isolated were sensitive to ampicillin and aminoglycosides whereas susceptibility to other antibiotics was low or varying. In adult patients suffering from purulent meningitis initial therapy should include ampicillin until an etiological diagnosis is established. The same is true in some cases of febrile encephalopathy with low content of neutrophils in CSF, especially when the glucose content is low.

Neurologic complications of bone marrow transplantation.

Among 78 patients who died after bone marrow transplantation, neurologic complications were present in 55 (70%) and were the cause of death in 5 (6%). Metabolic encephalopathy occurred in 29 patients (37%). CNS infections included aspergillosis (3), herpes simplex encephalitis (2), and Listeria monocytogenes meningitis (1). Six additional patients had neuropathologic changes possibly due to cytomegalovirus infection. Cerebrovascular complications occurred in five patients (two hemorrhages and three infarcts). All infarcts were associated with endocarditis. The rate of nonbacterial thrombotic endocarditis was significantly higher (p less than 0.001) than in the general autopsy population. CNS leukemia and therapy-induced injury were rare. There was no evidence of graft-versus-host disease involving the CNS.