A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage: A review of treatment options and outcomes

Abstract

A B S T R A C TListeria monocytogenes is a gram-positive bacillus known to cause various human infections including central nervous system infections. The most common central nervous system manifestations are meningitis and rhomboencephalitis, however rare complications including hydrocephalus and intracerebral hemorrhage can occur and are associated with increased mortality and incidence of lasting neurologic sequelae. The mortality ranges from 17 % to greater than 30 % in patients with neurological involvement [1-3]. Various case reports have studied the differing treatment approaches and outcomes of patients who experienced these complications, and there is still no consensus on optimal treatment approaches. In this paper, we report a case of Listeria meningitis complicated by both acute hydrocephalus and intracerebral hemorrhage and analyze the factors that led to a favorable outcome by reviewing the existing literature.

Rhomboencephalitis

“…Abscess formation may necessitate longer duration of treatment and development of hydrocephalus or intraventricular haemorrhage, which occur in 10-15% and 5% cases respectively, necessitate consideration of neurosurgical intervention. 6 Intraventricular antibiotics may also be considered if there is poor response to standard therapy. 6 Tuberculosis CNS involvement occurs in approximately 10% patients with tuberculosis (TB), and approximately 5% of these have brainstem disease.…”

“…6 Intraventricular antibiotics may also be considered if there is poor response to standard therapy. 6 Tuberculosis CNS involvement occurs in approximately 10% patients with tuberculosis (TB), and approximately 5% of these have brainstem disease. Caseating granulomata can mimic bacterial abscesses and tumour necrosis on neuroimaging, although core T2-hypointensity with vivid peripheral contrast enhancement on MRI representing gliosis and monocyte invasion are suggestive.…”

“…Complications including hydrocephalus or haemorrhage may warrant neurosurgical management. 6 This is particularly relevant where the underlying cause of rhomboencephalitis is infective, most especially listeria and TB.…”

Analysis of Clinical and Microbiological Features of Listeria monocytogenes Infection

“…2 Listeriosis is a preventable and treatable foodborne disease transmitted primarily through the ingestion of infected food (99% of cases). 1 Although listeriosis is infrequent, invasive infections can cause some of the most severe syndromes such as self-limited febrile gastroenteritis, septicemia, stillbirth, spontaneous abortion, and neuroinvasive diseases, 3,4 with high hospitalization and mortality rates approaching 50%. 5 Liver disease, kidney disease, and gastrointestinal bleeding are the main predisposing conditions for L. monocytogenes infection.…”