Cases reported "Meningitis, Listeria"

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1/3. Apurulent bacterial meningitis (compartmental leucopenia in purulent meningitis).

    Meningococci and haemophilus influenzae may invade the subarachnoid space during the bacteriaemic phase without impairment of the blood-CSF barrier and in the absence of any leucocyte reaction. In pneumococcal meningitis the CSF may also contain less than 100 cells/microliter despite the presence of "pure bacterial cultures", but the barrier is completely broken when the serum/CSF concentration ratio is below 10. A clinical analysis of eight patients with fewer than 100 cells/microliter revealed that the first symptoms of meningitis appeared at least 3 days prior to the diagnostic lumbar puncture. There was a strong neutrophilic reaction in the blood with a prevalence of juvenile forms in most cases, indicating intact antibacterial defence mechanisms. Within 24 h after the start of antibiotic therapy the cell number rose above 2000/microliter accompanied by disappearance of pneumococci. Six of the eight patients died. In three cases autopsy revealed thick layers of pus over the convexities, indicating a compartmental separation of the ventricles and the spinal subarachnoid space. In one case of late diagnosed bacterial meningitis with a pleocytosis of 430/microliter the CSF lysozyme level was seven times higher than compatible with this cell number. Hyperphagocytosis and cellular disintegration is thought to cause the leucopenia within the spinal CSF compartment. "Apurulent bacterial meningitis" can be seen as a disease entity that is a diagnostic pitfall and also a prognostic sign.
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2/3. listeria monocytogenes meningitis.

    Presented is the case of a 42-year-old, previously healthy man with meningitis secondary to listeria monocytogenes. Following lumbar puncture, empiric therapy with intravenous penicillin was started and he was hospitalized. Subsequently L monocytogenes was proven to be the causative organism and antibiotic therapy was changed to ampicillin and gentamicin. The patient's condition improved. He was discharged and continues to do well. There was no evidence at any time of underlying predisposition to infection. Listeria meningitis in healthy patients and in patients with underlying disease is discussed, along with possible implications about choice of empiric antibiotics.
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3/3. Listeria meningitis presenting as enteritis in a previously healthy infant: a case report.

    A previously healthy 1-year-old infant was admitted with pyrexia and mild gastro-intestinal symptoms. A blood culture, taken on admission, showed growth of listeria monocytogenes (serotype 4b) on the 3rd day, at which time a lumbar puncture revealed a listeric meningitis. Despite the delay of antibiotic treatment, the infant never showed any neurological symptoms. She recuperated without any residual effects.
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