Listerial rhombencephalitis in an immunocompetent young adult

Kayaaslan, Bircan; Akıncı, Esragül; Bilen, Şule; Gözel, Mustafa Gökhan; Erdem, Deniz; Çevik, Mustafa Aydın; Bodur, Hürrem

doi:10.1016/j.ijid.2008.06.026

Cited by 34 publications

(29 citation statements)

References 11 publications

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“…In various studies, patients with no history of immunosuppression account for 42–92% of the examined patients with listerial rhombencephalitis [14–16]. The disease has usually biphasic course [10]. The prodromal phase lasts for 0 to 16 days and manifests with fever, headache, vomits, or nausea.…”

Section: Discussionmentioning

confidence: 99%

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Listerial Rhombencephalitis in an Immunocompetent Woman

Czupryna

Zajkowska

Garkowski

et al. 2014

Case Reports in Neurological Medicine

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Listeriosis usually affects immunocompromised patients including elderly people and pregnant women, but it may also affect otherwise healthy individuals. In our report, we present a case of a rare and very severe form of listeriosis-rhombencephalitis in a 61-year-old female with no history of immunosuppression, who, because of history, clinical picture, and laboratory results as well as negative cultures, was at first diagnosed with viral encephalitis. This paper underlines that Listeria monocytogenes infection should be taken into consideration in case of lymphocytic encephalitis even in immunocompetent patients. Typical MRI picture may be crucial in establishing a proper diagnosis as the lab results may be misleading.

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Section: Discussionmentioning

confidence: 99%

“…The overall mortality of listeriosis is 20–30% [9] and in listerial brainstem encephalitis may be as high as 51% [10]. …”

Section: Introductionmentioning

confidence: 99%

Listerial Rhombencephalitis in an Immunocompetent Woman

Czupryna

Zajkowska

Garkowski

et al. 2014

Case Reports in Neurological Medicine

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“…The listeria rhombencephalitis is an uncommon and severe infection of the brainstem, usually occurring in healthy adults with a typical biphasic picture 1 . A prodrome of fever, headache, nausea and vomiting followed by abrupt neurological symptoms 2 .…”

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confidence: 99%

Rhombencephalitis caused by Listeria monocytogenes with striking involvement of trigeminal nerve on MR imaging

Moro

Albino

Bresciani

et al. 2011

Arq. Neuro-Psiquiatr.

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The listeria rhombencephalitis is an uncommon and severe infection of the brainstem, usually occurring in healthy adults with a typical biphasic picture 1 . A prodrome of fever, headache, nausea and vomiting followed by abrupt neurological symptoms 2 . A stiff neck is present in half of the cases and positive culture in cerebrospinal fluid (CSF) in about 40% of the cases. Mortality is high and serious sequelae are common 2 . We report a case of a patient with involvement of the brainstem and a favorable outcome. CASEA 65-year-old man presented with pain in right jaw, nuchal pain and right facial palsy, following gastroenteritis. The neurological exam revealed a palsy of VI and VII right cranial nerves, right hemifacial hypoesthesia, strength grade 3, hyperreflexia, Babinski sign bilaterally, neck stiffness and axial ataxia. The CSF showed: 100 cells/mm 3 (95% lymphocytes); protein 63 mg/dL; glucose 95 mg/dL; negative cultures for bacteria, fungi and acidfast bacilli. Magnetic resonance imaging (MRI) showed bilateral and asymmetric lesions involving the brainstem with a striking enhancement along the right trigeminal nerve and ipsilateral spinal trigeminal nucleus (Figure).With the diagnostic suspicion of herpes zoster encephalitis, the patient was treated with acyclovir and was transferred to an intensive care unit due to respiratory failure 24 hours later.Blood cultures showed the presence of Listeria monocytogenes later. Acyclovir was interrupted and intravenous ampicillin plus dexamethasone were initiated. The infection improved but the patient remained with severe neurological sequelae. The second MRI showed multiple hemorrhagic foci in the cerebellar hemispheres, brainstem, basal ganglia nuclei and capsular region. Mild signal abnormalities remained in the brainstem and cerebellar peduncles.At four months he began walking and making sounds that were gradually replaced by full speech. DISCUSSIONListeria monocytogenes is a Gram-positive organism transmitted by consumption of contaminated food. The diagnosis can be delayed if no meningeal signs are presented in the beginning of the disease 4 as in our patient. Cultures of CSF and blood are positive in 41% and 61% of cases, respectively 3 . In our case only the blood culture was positive.The CSF typically reveals an increased leukocyte count, with predominance of polymorphonuclear cells, increased protein, and normal glucose levels 5 . Our patient presented only a predominance of lymphomononuclear cells, maybe due to precoceous CSF examination.MRI is important for the early detection of parenchymal lesions, therefore, being crucial for early diagnosis and follow-up

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“…En este caso, se encontró que la causa de la encefalitis del tallo y la mielitis fue L. monocytogenes; en la literatura científica hay pocos reportes de casos de encefalitis del tallo por esta causa en pacientes sin compromiso del sistema inmunitario (1)(2)(3)(4)(5)(6)(7)(8). En una búsqueda de las bases de datos, Pubmed y Lilacs, no hubo reportes de combinación con mielitis.…”

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Encefalitis del tallo cerebral y mielitis por Listeria monocytogenes: caso clínico y revisión del tema

et al. 2013

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La romboencefalitis por Listeria monocytogenes es una presentación poco común de la listeriosis del sistema nervioso central; sin embargo, es la presentación más común en personas inmunocompetentes. Aun más rara es la combinación de romboencefalitis con mielitis causada por L. monocytogenes; no obstante, en este artículo se reporta un caso de encefalitis del tallo y mielitis grave en un paciente sin compromiso del sistema inmunitario. Se presenta un paciente de 21 años de edad, sin deficiencias del sistema inmunitario, que consumió productos lácteos no pasteurizados y, posteriormente, presentó un cuadro de cefalea, vómito, deterioro de su estado general y, finalmente, alteración del estado de conciencia y muerte. Consultó al Instituto Neurológico de Colombia y se hizo diagnóstico de encefalitis del tallo y mielitis por L. monocytogenes. Se discuten las diferencias entre el caso presentado y los reportados en la literatura científica. Ante un paciente con signos de compromiso del tallo cerebral, de posible origen infeccioso, es prudente iniciar tratamiento antibiótico para L. monocytogenes y, en caso de poca respuesta, escalar rápidamente en dicho tratamiento. También lo es extender el estudio radiológico hacia la columna vertebral, con el fin de descartar compromiso de la médula espinal. Brainstem encephalitis and myelitis due to Listeria monocytogenes: a case report and literature reviewBrainstem encephalitis caused by Listeria monocytogenes is an uncommon form of central nervous system listeriosis; however, it is the most common presentation in immunocompetent individuals. Here, we describe an even more rare combination of rhombencephalitis with severe myelitis caused by L. monocytogenes in an immunocompetent patient. We report the case of a 21-year-old immunocompetent patient who consumed unpasteurized dairy products and experienced headache and vomiting that progressed to an impaired general condition, altered consciousness and ultimately death. The patient had presented to the Neurological Institute of Colombia (INDEC in Spanish) for consultation and was diagnosed with brainstem encephalitis and myelitis caused by Listeria monocytogenes. The differences between this particular case and those reported in the literature will be discussed. It is advisable to initiate antibiotic treatment for Listeria monocytogenes if a patient shows signs of brainstem compromise of possible infectious origin and quickly intensify treatment if there is no or minimal response. It is also necessary to extend radiological assessment to include the spinal column to rule out spinal cord involvement. Keywords Contribución de los autores:Aracelly Castro, Olga Hernández y Carlos Santiago hicieron la revisión del tema y la escritura del artículo. Alejandro Guerra facilitó el caso del paciente. Piedad Urueña facilitó la revisión de las imágenes y su interpretación específica para este artículo.Listeria monocytogenes es un bacilo Gram positivo que infecta al ser humano principalmente por el consumo de alimentos contaminados y que ha mos...

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Listerial rhombencephalitis in an immunocompetent young adult

Cited by 34 publications

References 11 publications

Listerial Rhombencephalitis in an Immunocompetent Woman

Listerial Rhombencephalitis in an Immunocompetent Woman

Rhombencephalitis caused by Listeria monocytogenes with striking involvement of trigeminal nerve on MR imaging

Encefalitis del tallo cerebral y mielitis por Listeria monocytogenes: caso clínico y revisión del tema

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