Central Nervous System Infection with Listeria monocytogenes : 33 Yearsʼ Experience at a General Hospital and Review of 776 Episodes from the Literature

Abstract

We reviewed 776 previously reported and 44 new cases of CNS listeriosis outside of pregnancy and the neonatal period, and evaluated the epidemiologic, diagnostic, and therapeutic characteristics of this infection. Among patients with Listeria meningitis/meningoencephalitis, hematologic malignancy and kidney transplantation were the leading predisposing factors, but 36% of patients had no underlying diseases recognized. The infection occurred throughout life, with a higher incidence before the age of 3 and after the age of 45-50 years. Fever, altered sensorium, and headache were the most common symptoms, but 42% of patients had no meningeal signs on admission. Compared with patients with acute meningitis due to other bacterial pathogens, patients with Listeria infection had a significantly lower incidence of meningeal signs, and the CSF profile was significantly less likely to have a high WBC count or a high protein concentration. Gram stain of CSF was negative in two-thirds of cases of CNS listeriosis. One-third of patients had focal neurologic findings, and approximately one-fourth developed seizures over their course. Mortality was 26% overall, and was higher among patients with seizures and those older than 65 years of age. Relapse occurred in 7% of episodes. Ampicillin for a minimum of 15-21 days (with an aminoglycoside for at least the first 7-10 days) remains the treatment of choice. Cerebritis/abscess due to L. monocytogenes, without meningeal involvement, is less common but may be diagnosed by blood cultures and CNS imaging, or by stereotactic biopsy. Longer antibiotic therapy (at least 5-6 weeks) is needed in the presence of localized CNS involvement.

Listeria monocytogenes infection in ruminants: Is there a link to the environment, food and human health? A review

“…primarily affect the brainstem, and only exceptionally as meningitis or meningoencephalitis (Charlton and Garcia, 1977). This is in contrast to humans, where CNS infections most often manifest as diffuse meningitis and meningoencephalitis, and less commonly as rhombencephalitis or abscesses in the cerebrum and cerebellum (Mylonakis et al, 1998;Bartt, 2000). This discrepancy may be an indicator for a different pathogenesis in ruminants and humans.…”

Listeria monocytogenes meningitis in an immunocompetent adult: a case report

“…However, some clinical differences exist. Patients with L. monocytogenes meningitis have a significantly lower incidence of meningeal signs compared with patients with acute meningitis due to other bacterial pathogens 4 . L. monocytogenes may cause other forms of CNS infection, including meningoencephalitis, cerebritis, rhombencephalitis, and intracranial abscess.…”

“…A second lumbar puncture was performed on the 13 th hospital day and the CSF findings improved significantly (Table 1). Comprehensive immunological investigations, including autoantibody tests, serum immunoglobulin and complement levels, human immunodeficiency virus test, and cell-mediated immunity tests (CD 3 , CD 4 , CD 8 , CD 4 / CD 8 , and CD 19 ), were normal. Repeat cultures of CSF were sterile.…”

“…The incidence of L. monocytogenes meningitis among all episodes of community-acquired acute meningitis among adults in North America and Europe was reported at 5% to 10% or more 4 . It is characterized by a high case fatality rate of 24% to 62% even with appropriate antibiotic therapy 5 .…”

A 66-year-old Man With Fever and Altered Mental Status: A Case Report

“…The typical triad of fever, neck stiffness, and altered mental status is described only in 44% of patients with meningitis, but 95% has at least two of the four symptoms among headache, fever, neck stiffness, and altered mental status [12]. However, the incidence of meningeal signs among patients with L. monocytogenes is lower than that among cases of meningitis due to other causes of bacterial meningitis [13].…”