Brain stem encephalitis in listeriosis

Abstract

Infection with Chlamydia pneumoniae has been suggested to play a role in the development and maintenance of atherosclerosis. However, the course of C. pneumoniae infection is not clarified. Thus, both the persistence of C. pneumoniae DNA in blood and the tendency to recurrence have not been studied. We determined the prevalence of C. pneumoniae DNA in the white cells of the peripheral blood in 98 dialysis patients and in 52 healthy subjects. Blood samples were collected approximately 6 times from each subject during a period of 1 y with an interval of approximately 2 months and analysed with a polymerase chain reaction. C. pneumoniae DNA was detectable in 47 out of 150 subjects at least once during a y. Reinfection was a rare phenomenon and the presence of C. pneumoniae DNA in blood was of less than 2 months' duration in almost all patients. There was a significant association between the presence of C. pneumoniae DNA during 1 y and the presence of atherosclerosis in the legs of dialysis patients (OR=3.50, p=0.03). Additionally, a significant association was found between the presence of C. pneumoniae DNA and an abnormal electrocardiogram (ECG) (OR=3.16, p=0.01). These findings may support the hypothesis of an association between infection with C. pneumoniae and the presence or development of atherosclerosis.

Encefalitis del tallo cerebral y mielitis por Listeria monocytogenes: caso clínico y revisión del tema

“…Frecuentemente, se encuentra como agente causal de casos esporádicos de meningitis (±0,5 por 100.000 al año), la mayoría asociados a consumo de alimentos contaminados, con una incidencia anual de 1 a 10 casos por millón. Tiene una tasa de mortalidad de 24 a 62 %, a pesar del tratamiento antimicrobiano adecuado (10,11).…”

“…Si no se trata rápidamente es fatal, pero aun con tratamiento deja secuelas neurológicas en el 62 % de los casos (11,12). La encefalitis del tallo cerebral ocurre en, al menos, 10 % de los casos de listeriosis en humanos (13).…”

“…Ninguno de estos casos tenía como diagnóstico original la romboencefalitis, esto tal vez debido al escaso conocimiento de la condición, la presentación clínica variable del compromiso del tallo cerebral, el examen neurológico insuficiente y la identificación microbiológica tardía de L. monocytogenes (11). De manera similar ocurre en nuestra población, lo que no permite un tratamiento temprano y favorece una alta mortalidad.…”

“…Además, en el líquido cefalorraquídeo se puede encontrar pleocitosis moderada con predominio de células mononucleares, que puede sugerir una infección viral (11). El paciente se comportó en forma similar a lo descrito en la literatura; en los exámenes paraclínicos al ingreso, se observó leucopenia que fue persistente durante el seguimiento.…”

Listerial brainstem encephalitis – treatable, but easily missed

“…[35] Cases are often undetected. [5] It is characterised by a prodromal febrile illness followed within 4 10 days by the abrupt onset of cranial nerve deficits associated with encephalopathy, hemiparesis, hemisensory loss and/ or cerebellar signs. [35] Unlike the other forms of central nervous system (CNS) listeriosis, LBE is striking in respect of the stepwise development of brainstem signs in the absence of meningism.…”