Clues to diagnosing culture negative<i>Listeria</i>rhombencephalitis

O'Callaghan, Marguerite; Mok, Tzehow; Lefter, Stela; Harrington, Hugh

doi:10.1136/bcr-2012-006797

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…Real-time PCR (RT-PCR) has been shown to be a highly promising diagnostic modality in identifying the presence of the organism in the CSF. e highly conserved and specific hyl gene proved to be a reliable replication target with no false-negative results shown, and the turnaround time for RT-PCR is 2 hours [10]. For instance, the early availability of serum PCR results in our patient (four full days ahead of culture and sensitivity results) informed crucial treatment decisions and was potentially lifesaving.…”

Section: Discussionmentioning

confidence: 79%

Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient

Adjei

2020

Case Reports in Infectious Diseases

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A 54-year-old male, five months postorthotopic heart transplantation, presented with intermittent fevers, headaches, and “soupy” stools. Prior to presentation, he had low-level cytomegalovirus (CMV) viremia for two straight weeks. Given his immunosuppression, diarrhea, and low-level CMV viremia, he was presumed to have cytomegalovirus and/or C. difficile colitis and treated empirically for both on hospital day one. However, he developed neck pain/stiffness, diaphoresis, and worsening fevers on hospital day three. Blood cultures eventually grew Listeria monocytogenes; MRI of the brain with gadolinium showed left brain meningoencephalitis with early cerebral abscess formation. Lumbar puncture revealed elevated opening pressure, CSF neutrophilic pleocytosis, and elevated CSF protein and lactate but negative gram stain and cultures. First-line agent for Listeria meningoencephalitis is ampicillin. However, he reported amoxicillin allergy. Desensitization to ampicillin failed because ampicillin was too unstable per the allergist. He was therefore treated with penicillin monotherapy for eight weeks with complete resolution of his brain lesions and without any residual neurologic deficits.

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Section: Discussionmentioning

confidence: 79%

Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient

Adjei

2020

Case Reports in Infectious Diseases

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“…Confirmation of L. monocytogenes as the etiological agent in rhombencephalitis can be problematic because blood and CSF cultures are only positive in 61% and 11–41% of cases respectively [3] . Culture-negative cases of LRE may be diagnosed by PCR, or suspected, based upon the combination of the clinical presentation, MRI and CSF findings and response to treatment [15] , [16] . Blood cultures were positive in the first case, which led to the diagnosis being made and effective antimicrobials being commenced.…”

Section: Discussionmentioning

confidence: 99%

“…Both of our patients had a CSF neutrophilia. Cerebrospinal fluid PCR is now recognized as an important diagnostic tool in the diagnosis of many neurological infections [18] , [19] , including LRE [15] . However, although PCR is thought to have greater sensitivity than CSF culture, PCR may still be negative in LRE [16] .…”

Section: Discussionmentioning

confidence: 99%

Two cases of listeria rhombencephalitis

Mansbridge

Grecu

Chong

et al. 2018

IDCases

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Listeria rhombencephalitis (LRE) is a rare encephalitis of the hindbrain that can present with a variety of neurological symptoms. It is a diagnostic challenge, but prompt antimicrobial therapy is important to prevent high rates of mortality and morbidity. We report two cases of LRE, with several contrasting clinical features and different disease courses. Despite being rare, it is important to consider listeria in patients with possible meningoencephalitis, even if cultures are negative. Empirical treatment of meningoencephalitis should provide coverage for listeria, especially if the patient is at risk of listeriosis or there is a potential history of listeria exposure.

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“…However in most cases one or more of the diagnostic modalities (CSF Gram stain, CSF culture, and blood cultures) are positive for LM. Reports have also been on patients diagnosed with molecular methods in the form of PCR, identifying DNA from LM meningitis [ 3 , 9 ]. The literature has previously reported the need of reevaluation with follow-up spinal tap of initially microscopy/culture negative patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Culture NegativeListeria monocytogenesMeningitis Resulting in Hydrocephalus and Severe Neurological Sequelae in a Previously Healthy Immunocompetent Man with Penicillin Allergy

Gaïni

Karlsen

Nandy

et al. 2015

Case Reports in Neurological Medicine

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A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. The cerebrospinal fluid showed negative microscopy for bacteria, no bacterial growth, and negative polymerase chain reaction for bacterial DNA. The patient developed hydrocephalus on a second CT scan of the brain on the 5th day of admission. An external ventricular catheter was inserted and Listeria monocytogenes grew in the cerebrospinal fluid from the catheter. The patient had severe neurological sequelae. This case report emphasises the importance of covering empirically for Listeria monocytogenes in all patients with penicillin allergy with suspected bacterial meningitis. The case also shows that it is possible to have significant infection and inflammation even with negative microscopy, negative cultures, and negative broad range polymerase chain reaction in cases of Listeria meningitis. Follow-up spinal taps can be necessary to detect the presence of Listeria monocytogenes.

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Clues to diagnosing culture negativeListeriarhombencephalitis

Cited by 12 publications

References 10 publications

Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient

Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient

Two cases of listeria rhombencephalitis

Culture NegativeListeria monocytogenesMeningitis Resulting in Hydrocephalus and Severe Neurological Sequelae in a Previously Healthy Immunocompetent Man with Penicillin Allergy

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