11/84. Listeria meningitis associated with infliximab. OBJECTIVE: To report a case of listeria monocytogenes meningitis in a 73-year-old man receiving infliximab for rheumatoid arthritis. CASE SUMMARY: A 73-year-old white man taking infliximab for rheumatoid arthritis developed listeria meningitis following his second dose. He was receiving other immunosuppressants; however, these remained constant immediately prior to the infection. diagnosis was confirmed with L. monocytogenes isolated in the cerebrospinal fluid. The patient received 21 days of antibiotic therapy and recovered without any complications. DISCUSSION: L. monocytogenes is a gram-positive, non-spore-forming rod that has been associated with the ingestion of undercooked foods. This organism can cause sepsis or meningitis; however, immunocompromised patients, elderly patients, pregnant women, and neonates appear to be at greater risk for this type of infection. Tumor-necrosis factor-alpha (TNF-alpha) plays an important role in resistance to this type of infection, and listeria infections have been reported in 26 patients receiving TNF-alpha inhibitors. In our patient, the listeria infection occurred following his second course of infliximab, which provides a temporal relationship between the listeria infection and infliximab. However, his underlying rheumatoid arthritis and chronic steroid therapy would also increase his risk for a listeria infection. CONCLUSIONS: The listeria infection in our patient was a possible adverse event of infliximab according to the Naranjo probability scale. Because the majority of listeria infections occur in patients who are immunosuppressed, it would be reasonable to provide education for healthcare professionals on preventing these infections in all patients receiving immunosuppressants, including anti-TNF-alpha therapy. Those at risk due to their underlying health conditions should also be monitored closely. ( info) |
| We describe 3 previously healthy Costa Rican children who had listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly. ( info) |
| 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. ( info) |
| 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. ( info) |
15/84. A case of listerial meningitis treated with a regimen containing panipenem-betamipron. Although panipenem-betamipron, which is commercially available only in japan, is recommended for treatment of pediatric bacterial meningitis by some experts, only a limited number of clinical studies have been reported. In the present report, we describe a 2-year-old boy with meningitis caused by listeria monocytogenes who was treated with a regimen containing panipenem-betamipron and recovered without any apparent neurological sequelae. On the basis of our experience and previous reports, panipenem-betamipron appears to be effective for the treatment of listerial meningitis. ( info) |
| OBJECTIVE: To report an interesting case of meningitis caused by listeria monocytogenes in an immunocompetent adult. PATIENT AND methods: A previously healthy 25-year-old man presented with typical clinical features of meningitis. cerebrospinal fluid (CSF) was obtained on the day of admission for biochemical and microbiological investigations. In addition, blood was also taken for culture and hematological studies. Antibiotic susceptibility test was performed using the Etest method. Microscopic examination of the CSF showed pleocytosis, which was predominantly lymphocytic, while the biochemical investigation revealed raised concentrations of protein and lactic acid as well as decreased glucose concentration. A 24-hour culture yielded pure growth of gram-positive bacilli identified by standard methods as L. monocytogenes. It was susceptible to ampicillin and trimethoprim-sulfamethoxazole. The patient was treated with intravenous ampicillin combined with gentamicin and made a complete recovery. CONCLUSION: This presentation describes an unusual case of meningitis caused by L. monocytogenes in a previously healthy young adult with no risk factor. Only a few similar cases have been reported in the literature. ( info) |
| 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. ( info) |
18/84. Bio-hazards and drug reactions: a cautionary tale. Laboratory acquired infection with toxoplasmosis has been described. The clinical features in this situation can vary from asymptomatic to severe disease. Prophylactic therapy is recommended on the basis of clinical experience and case reports. We describe a case in a young man, where prophylaxis resulted in neutropenia complicated by subsequent Listeria meningitis. ( info) |
19/84. Listeria meningitis in transplant recipients. INTRODUCTION: meningitis is a rare complication following organ and stem-cell transplantation and can be caused by a variety of microorganisms. AIM: To retrospectively review the clinical course and outcome of five cases of listeriosis in four organ recipients and one stem-cell recipient during a seven-year period. patients AND methods: Patient records for more than 3500 patients undergoing organ or stem-cell transplantation at the university hospital of Innsbruck during a 27-year period were evaluated. Standard immunosuppression consisted of calcineurin inhibitor-based triple drug therapy with or without ATG or IL2 receptor antagonist induction. RESULTS: The first case affected a 35-year-old woman who received an allogenic bone marrow transplant for advanced breast cancer. Cases two and three related to two male heart recipients. Cases four and five were diagnosed in one male and one female renal recipient. listeria monocytogenes was isolated from blood in two cases and from cerebrospinal fluid in three. Treatment consisted of ampicillin in all cases with the addition of tobramycin (1), TMPS (1), meropenem (2) or imipenem/cilastatin (1). The deaths of two patients were directly related to L. monocytogenes. CONCLUSIONS: Although listeriosis is a rare complication following transplantation, this infection should be ruled out in individuals presenting with neurological symptoms and fever. ( info) |
| A strain of listeria monocytogenes recovered from blood and cerebrospinal fluid had no detectable catalase activity, a characteristic used for primary identification. The sporadic occurrence of pathogenic catalase-negative strains highlights the need for a reconsideration of diagnostic criteria and questions the role of catalase in the pathogenesis of listeria infection. ( info) |