Listeria monocytogenes Brain Abscess: Controversial Issues for the Treatment—Two Cases and Literature Review

Abstract

Listeria monocytogenes (LM) is an opportunistic pathogen, and the most common central nervous system manifestation is meningitis while listerial brain abscesses are rare. We describe 2 cases of brain abscess due to LM and a literature review. Only 73 cases were reported in the literature from 1968 to 2017. The mean age was 51.9, and the mortality rate was 27.3%. In 19% of cases, no risk factors for neurolisteriosis were identified. Blood cultures were positive in 79.5% while CSF or brain abscess biopsy material was positive in 50.8%. In 40% was started a monotherapy regimen while in 60% a combination therapy without substantial differences in mortality. Fifty-two percent underwent neurosurgery while 45.3% has been treated only with medical therapy. The mortality rates were, respectively, 13% and 38.2%. Only 25% of patients who were treated for ≤6 weeks underwent neurosurgery, while 80% of those who were treated for ≥8 weeks were operated. The mortality rates were, respectively, 12.5% and 0%, suggesting that a combined approach of surgery and prolonged medical therapy would have an impact on mortality. We believe that it is essential to carry out this review as brain abscesses are rare, and there are no definitive indications on the optimal management, type, and duration of therapy.

Multiple Listeria Abscesses in an Immunocompetent Patient

“…In microbiology studies, we found positive blood culture associated with negative CSF culture, consistent with the previous findings [7]. Our CSF was further analyzed with a nucleic acid amplification test (NAAT), a BioFire® ME panel, which was positive for Listeria DNA, and tailored our empiric antibiotic regimen to cover Listeria.…”

“…Neurological sequelae are common, which depends on the severity and location of the lesion. Mortality is higher than in patients with nonlisterial abscess, but there seems to be no significant difference in mortality between patients with single or multiple listerial abscesses, neither between patients treated with monotherapy or combination therapy [6,7].…”

Listeria monocytogenes brain abscess in an immunocompromised patient: a case report

“…Brain abscess is a rare manifestation of Listeria monocytogenes with approximately 80 cases described in literature. [4][5][6] Listeria brain abscesses are characteristically located in the sub-cortical grey matter especially in basal ganglia, thalamus or pons. 4,7 Apart from its sub-cortical location, the diagnosis is usually based on a positive blood culture yielding Listeria monocytogenes which may be positive in up to 85% of cases.…”

Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis

“…The recommended duration of antimicrobial therapy ranges from 3 to 8 weeks depending on the type of CNS involvement: for example, meningitis vs abscess, as well as patient’s immunological status. 9 – 11 According to a recent consensus study, antimicrobial therapy for brain abscess should last 6–8 weeks. 4 Immunocompromised patients should continue treatment for at least 6–8 weeks with antibiotics until the culture is negative and/or the imaging of the brain is improved.…”