1/9. trimethoprim-sulfamethoxazole salvage for refractory listeriosis during maintenance chemotherapy for acute lymphoblastic leukemia.A 5-year-old boy with acute lymphoblastic leukemia (ALL) and intolerance to oral trimethoprim-sulfamethoxazole (TMP/SMX) had listeria monocytogenes bacteremia and meningitis develop during maintenance chemotherapy. Despite prompt administration of IV amoxicillin/gentamicin and microbiologic clearance of the bloodstream, the patient had no response to therapy after a course of 7 days. Intravenous TMP/SMX (10 mg/kg per day of TMP) was added to the antibiotic regimen after desensitization. fever and meningeal signs rapidly resolved, and the patient was ultimately cured. amoxicillin and gentamicin, although highly active and synergistic in vitro against L. monocytogenes, have limited intracellular penetration and activity. In contrast, TMP/SMX has bactericidal extracellular and intracellular activity against Listeria and excellent central nervous system penetration, and thus may be effective for the treatment of refractory listeriosis.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/9. Listeria spinal cord abscess responsive to trimethoprim-sulfamethoxazole monotherapy.OBJECTIVE: To describe an alternative antibiotic regimen for the treatment of central nervous system listeria monocytogenes infection. BACKGROUND: Classical treatment of listeria infections of the brain and spinal cord has included ampicillin in combination with gentamicin and chloramphenicol. Antibiotic resistance to L. monocytogenes is extraordinarily low, and the combined risks of nephrotoxicity, ototoxicity, and agranulocytosis in an already critically ill patient make the potential use of trimethoprim-sulfamethoxazole monotherapy for coverage or treatment of listeria an important alternative. methods: Case report. RESULTS: A 58-year-old woman presented with a two-week history of progressive quadriplegia. gadolinium enhanced MRI showed diffuse edema of the cervical and thoracic spine with ring-enhancing lesions. cerebrospinal fluid and blood cultures both grew L. monocytogenes. Spinal cord biopsy of the lesion revealed inflammation with necrosis and also grew listeria. Intravenous trimethoprim-sulfamethoxazole (8 mg/kg in four divided doses) was administered for six weeks with resultant arrest of neurological symptoms and stabilization of the clinical course. Although the patient was quadraparetic she was able to be discharged to a rehabilitation facility. CONCLUSIONS: trimethoprim-sulfamethoxazole monotherapy may be a potential alternative option for critically ill patients with central nervous system L. monocytogenes infection.- - - - - - - - - - ranking = 2keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/9. Listeria meningoencephalitis: two cases and a review of the literature.INTRODUCTION: Although presently uncommon locally, Listeria is increasing an important cause of central nervous system (CNS) infection worldwide. It differs from the common meningitis pathogens in its clinical features and treatment. CLINICAL PICTURE: We present 2 recently encountered cases of Listeria meningoencephalitis. In case 1, a previously healthy 42-year-old man presented with clinical features of meningoencephalitis. In case 2, a 64-year-old woman had clinical features of pneumonia and meningoencephalitis. Both had a predominantly lymphocytic picture in their cerebrospinal fluid (CSF) samples. Listeria grew in blood cultures of both patients and the CSF culture of the first. TREATMENT: In both cases, Listeria was resistant to the empirical antibiotics used. Intravenous ampicillin was eventually used in both patients, with gentamicin, added for synergistic action in the first. OUTCOME: The first patient developed complications of hydrocephalus, subdural collection and extensive cerebritis and ventriculitis. The second patient had focal seizures and a pontine infarct. Both did not survive. CONCLUSION: These 2 recent cases with different presentations of intracranial listerosis highlight the increasing importance of listerial infections in singapore. Clinicians need to be familiar with the features of this lethal disease in order to recognize and manage it successfully.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/9. syringomyelia following Listeria meningoencephalitis: report of a case.A case of symptomatic syringomyelia which appeared six years after Listeria meningoencephalitis is described. Chronic spinal arachnoiditis, as shown by standard MRI and dynamic phase contrast (PC) cine-MRI, may occur after spinal infection and is likely the cause of syringomyelia. To our knowledge, there are no previous reports of delayed spinal complications following listeria monocytogenes infection. The possibility of developing syringomyelia should be always considered in any patient with a history of central nervous system infection.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/9. Successful treatment of disseminated cerebritis complicating methicillin-resistant staphylococcus aureus endocarditis unresponsive to vancomycin therapy with linezolid.A unique case of community acquired methicillin resistant Staphylococcus aureus (MRSA) sepsis, with endocardial and cerebral metastatic seeding, caused by a strain representative of the Italian clone, is described. The patient was a 47-y-old man without apparent risk factors for endocarditis and for MRSA infection who developed coma with multiple cerebritis lesions under vancomycin plus amikacin therapy. He was eventually cured with the addition of linezolid to the initial antimicrobial regimen. This observation seems to confirm previous reports of the efficacy of linezolid for the treatment of central nervous system infections caused by multidrug resistant gram-positive bacteria. To our knowledge, this is the first report of MRSA disseminated cerebritis, a nearly always fatal disease, cured with this oxazolidinone drug. The increase in community acquired MRSA may have some impact on empirical treatment of serious infections caused by this organism.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/9. Neurolisteriosis causing hydrocephalus, trapped fourth ventricle, hindbrain herniation and syringomyelia.Central nervous system infection by listeria monocytogenes is relatively uncommon, but is known to be highly morbid and fatal. We describe a case of listeria meningoencephalitis, wherein the acute episode was followed by a hitherto unreported conglomeration of severe and progressive neurological sequelae, in the form of supratentorial hydrocephalus, aqueduct block, trapped fourth ventricle, hindbrain herniation and syringomyelia. Pertinent literature is reviewed and the pathogenesis of the observed sequelae is explored.- - - - - - - - - - ranking = 0.21885351148223keywords = nervous system (Clic here for more details about this article) |
7/9. Symptomatic hydrocephalus and reversible spinal cord compression in listeria monocytogenes meningitis. Case report.central nervous system infections with listeria monocytogenes result in varied clinical syndromes ranging from meningitis to rhomboencephalitis. A case of Listeria meningitis complicated by symptomatic communicating hydrocephalus and hydrostatic cervical cord compression is presented which clinically and radiographically improved with aggressive ventricular drainage.- - - - - - - - - - ranking = 0.21885351148223keywords = nervous system (Clic here for more details about this article) |
8/9. Diagnostic ultrastructure of listeria monocytogenes in human central nervous tissue.The pathogenesis of listeria monocytogenes infection of the human central nervous system is poorly understood and ultrastructural aspects are not documented. A case of fatal human L. monocytogenes meningoencephalitis is described, in which diagnosis was confirmed by blood culture and in which special staining (Brown's) showed slender gram-positive bacilli in inflamed areas of the brainstem at autopsy. Electron microscopy of blocks rescued from formalin revealed rods, up to 2.5 microns long x 0.4 microns in diameter, with gram-positive type cell walls and distinctive conic ends, the latter being apparent in axial section only. The organism was either free within the cytoplasm or within endosomes or phagosomes of macrophages, smooth muscle cells, and endothelial cells. In one instance, one was seen adhering to the luminal aspect of the vascular endothelium. Central nervous system parenchymal cell infection was suspected but not confirmed. Intra-cytoplasmic bacteria were surrounded by an electron-transparent halo and, beyond that, a cloud of host-derived microfilaments, as previously described by others in vitro and in animals. The morphology of L. monocytogenes is compared with that of other intracellular pathogens and is found to be distinctive, suggesting the value of ultrastructural study in diagnosis. Such work could also help to solve outstanding pathogenetic questions of central nervous system invasion and spread.- - - - - - - - - - ranking = 2.2188535114822keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/9. MRI appearances of Listeria rhombencephalitis.listeria monocytogenes is a rare cause of central nervous system infection in the non-immunocomprised patient and 10% of these patients develop a rhombencephalitis. We present such a case and discuss the clinical, pathological and radiological features.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |