Listeria Monocytogenes Meningitis in an Immunocompetent Adult

Abstract

A 60-year-old male presented to The Ottawa Hospital Emergency Department on June 24th, 2011 with headache, fever, and decreased level of consciousness. His past medical history was unremarkable, and he was not taking any medications. Six days prior to presentation, he had returned from a three-week trip to France, followed by a four-week cruise touring Italy, Spain, and some Adriatic states. Collateral history noted that he had ingested large quantities of soft cheeses in rural areas of these countries. He experienced a bout of diarrhea and suffered mild intermittent headaches over the course of the trip.He had presented to a walk-in clinic the prior evening with fever and increasing headache. Routine bloodwork and malaria screen were negative. He was diagnosed with a viral illness and sent home. The following morning, his spouse found him increasingly drowsy and confused. She called 911 and he was brought to the emergency department by ambulance.On examination the patient was obtunded, with a Glascow Coma Scale (GCS) score of 11 (M5V2E4), and febrile with an oral temperature of 39.7 0C. No focal neurological signs were present. The cardiovascular, respiratory, and abdominal exams were unremarkable. Over a two-hour period the patient's GCS decreased to a level of 6. The patient was then intubated for airway protection and admitted to the intensive care unit. /L, platelets 193×10 9 /L, ESR 20 mm/hr, total bilirubin 27 µmol/L, lactate 2.6 mmol/L. His serum electrolytes, blood glucose, and liver enzymes were all within normal limits. Chest X-ray showed increased interstitial markings and perihilar opacities. Computed tomography scan of the head was normal. A blood culture was performed and the patient was started on IV acyclovir, vancomycin, ceftriaxone, and ampicillin empirically. The first lumbar puncture performed was unsuccessful. A lumbar puncture performed the following day was successful. The patient's cerebrospinal fluid (CSF) was clear and colourless. It showed a marked pleocytosis (leukocyte count 686×10 6 /L, neutrophils 0.41), RBC 41×10 6 /L, protein level 1.33 g/L, glucose level 3.0 mmol/L. Gram stain of the CSF smear did not demonstrate any microorganisms. Magnetic resonance imaging (MRI) was not included in the work-up. His blood culture then grew Listeria monocytogenes in one aerobic bottle. Treatment was subsequently restricted to ampicillin only. Gentamicin was omitted as the patient had already been on ampicillin for two days and responding favourably to treatment. The patient was extubated two days later. He was neurologically intact and improved back to his premorbid condition. A peripherally inserted central catheter line was introduced and the patient kept on IV ampicillin for a total of three weeks. Literature Search CASE REPORT AbstractListeria is an uncommon cause of acute bacterial meningitis. It usually affects neonates, elderly, immunocompromised, and pregnant women with only a few cases among healthy, immunocompetent adults. Food exposure also represents an important risk factor for i...

Listeria monocytogenes meningitis in elderly patient

“…La presentación de meningitis por L. monocytogenes es relativamente rara. En Canadá, las tasas de incidencia de meningitis oscilan entre 3,37-3,66 por 100,000, con L. monocytogenes responsable de aproximadamente el 3-10% de los casos, siendo el número de casos más altos en el embarazo, neonatos y, como en el presente caso, en mayores de 60 años (6) .…”

“…Tiene buena penetración de la barrera hematoencefálica, con bajas tasas de resistencia (menos del 10%). Como señala Reardon et al (6) , es imperativo que este antibiótico se agregue al régimen de tratamiento si hay alguna posibilidad de que L. monocytogenes sea la fuente de infección. Existe un efecto sinérgico de los aminoglucósidos y la ampicilina en la listeriosis, con incrementos de hasta 100 veces en la actividad bactericida.…”

“…El retraso en el tratamiento adecuado puede conducir a resultados deficientes con una tasa de mortalidad de hasta 28% (6) .…”