Central nervous system infection with Listeria monocytogenes

Abstract

The foodborne pathogen Listeria monocytogenes has a particular tropism for the central nervous system and can produce infection in the meninges and brain substance. Well-recognized clinical syndromes include meningitis, brain abscess, rhombencephalitis, and spinal cord abscess; simultaneous infection of the meninges and brain is common. Although it is an uncommon cause of infection in the population at large, L. monocytogenes is an important cause of central nervous system infection in those with impaired cell-mediated immunity, whether due to underlying disease or treatment with immunosuppressive therapeutic agents; it is the etiology in 20% of bacterial meningitis cases in neonates and in 20% of cases in those older than 50 years. Ampicillin is considered the treatment of choice, and trimethoprim-sulfamethoxazole is recommended for those allergic to penicillin. At-risk patients should be advised to avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products.

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

“…A mononuclear cell predominance in the CSF is found more frequently than for other types of bacterial meningitis (74). For patients with listerial brainstem encephalitis, the CSF typically shows lowgrade pleocytosis, with a lymphocytic predominance and slightly elevated protein levels.…”

“…monocytogenes is spread by contaminated food, which was discovered after outbreaks of listeriosis in the 1980s, but is also found in soil, water, and sewage (51,108,194). Risk factors for listerial infection include the extremes of age (infants less than 1 month of age and adults older than 50 years of age), alcoholism, malignancy, the use of corticosteroid therapy, immunosuppression, diabetes mellitus, liver disease, chronic kidney disease, collagen-vascular diseases, and conditions associated with iron overload (47,74,195,226). Listeria meningitis has also been reported after the administration of anti-tumor necrosis factor alpha (TNF-␣) agents such as infliximab and etanercept (168,184).…”

“…Ampicillin and penicillin are highly effective against L. monocytogenes, and one of these antibiotics should therefore be included in empirical therapy for immunocompromised and elderly patients with suspected or proven bacterial meningitis (47,74,226,320). Expanded-spectrum cephalosporins are not effective against this organism.…”

Neurological complications of solid organ transplantation

“…After the first month, viral infections predominate. Tardive infections may include: Mycobacterium tuberculosis, Trypanosoma cruzi, Leishmania species, Strongyloides stercoralis, Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides and species of Paracoccidioides 6,7,8,9 . …”

Listeriosis – a dangerous, contagious disease. Meningitis caused by Listeria monocytogenes – case report

“…Z kolei u przeżywających noworodków zakażonych wskutek kontaktu z L. monocytogenes podczas porodu, w ciągu pierwszych 2 tygodni życia zwykle rozwija się zapalenie opon mózgowo-rdzeniowych wraz z posocznicą, których następstwem jest opóźnienie rozwoju dziecka [3]. Szacuje się, że neuroinfekcja występuje u 28-79% osób dorosłych i do 44% noworodków z inwazyjną postacią zakażenia [7,8]. Szczególnie duże powinowactwo obejmuje pień mózgu i opony mózgowe.…”