1/84. Listeria meningitis in children: report of two cases. We report two cases of meningitis caused by listeria monocytogenes in children. The first patient was a healthy 14-month-old boy and the second patient a 3-year-old girl with Byler disease which, however, is not reported as a predisposing factor for listeriosis. We present these cases because Listeria infection, although common in neonates, is extremely infrequent during infancy and childhood. ( info) |
| 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. ( info) |
3/84. Neurolisteriosis presenting as recurrent transient ischemic attacks. An elderly man experienced recurrent transient episodes of right arm weakness and expressive aphasia. He was initially treated with aspirin and then with coumadin. Thirteen days after initial presentation, he became febrile and had signs of meningitis. The illness progressed relentlessly to death 9 weeks after admission to the hospital. Necropsy showed prominent meningitis with vasculitis extending into the left frontal lobe. polymerase chain reaction identified the organism as listeria monocytogenes. ( info) |
| 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. ( info) |
| 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. ( info) |
6/84. A case report of sporadic ovine listerial menigoencephalitis in iowa with an overview of livestock and human cases. A case of ovine listeriosis was examined in a flock of sheep. The index case was a male lamb, which was part of a flock of 85 sheep located in central iowa. Because the sheep were raised on a premise where soybean sprouts were also cultivated for the organic foods market, the potential of a public health concern was addressed. To identify the source of contaminations, clinical and environmental samples were cultured for listeria monocytogenes. Isolates were serotyped and analyzed using pulsed-field gel electrophoresis (PFGE). listeria monocytogenes (serotype 1) was recovered from the brain of a male lamb with clinical signs of listerial encephalitis. Isolates of serotypes 1 and 4 were also cultured from feces of clinically healthy lambs, compost piles, and soybean cleanings. By PFGE, the clinical isolate was distinctly different from the other isolates. Environmental isolates were identified as L. monocytogenes serotypes 1 and 4. However, by PFGE, none matched the profile of the single clinical isolate. Thus, the ultimate source of contamination is unknown. ( info) |
| 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. ( info) |
8/84. Early-onset listeriosis in prematurity. listeria monocytogenes has been recognized as a human pathogen for more than 70 years. It causes illness mainly in pregnant women, newborns, elderly, and immunocompromised persons. Although L. Monocytogenes is a relatively uncommon pathogen in neonates, it can cause considerable morbidity and mortality in this age group, especially in the early-onset form of the disease. In taiwan, neonatal listeriosis is rarely reported. We report one case of a premature newborn with early-onset listeria sepsis and meningitis. ( info) |
| listeriosis is a not uncommon infection in humans, usually associated with immunodeficient states and with newborns. However, relatively few cases have been reported in hiv-infected patients. This scarcity of reported cases has aroused interest in the association of listeriosis and AIDS. In this paper we present a case of meningitis and septicemia caused by listeria monocytogenes in a female patient with AIDS. A review of recent medical literature indicates that association of listeriosis and AIDS may be more common than it seems. Recent research in host-parasite interaction in listerial infection suggests an important role for tumor necrosis factor (TNF) and for integralin, a bacterial protein, in modulating listerial disease in AIDS patients. Inadequate diagnosis may be in part responsible for the scarcity of reports. ( info) |
10/84. Listerial meningitis. Which patients are vulnerable? The physician's index of suspicion for infection with listeria monocytogenes should be elevated if a patient presents with symptoms of meningitis and has impaired cell-mediated immunity. Although diagnosis is aided by detection of an elevated white blood cell count and protein level in the cerebrospinal fluid, it requires isolation of the organism from the cerebrospinal fluid. Appropriate antibiotic treatment leads to recovery in most cases. ( info) |