Meningitis por Listeria monocytogenes en adultos

Isolated De Novo Headache as the Presenting Symptom of Listeria Meningitis: A Report of 2 Cases

“…For instance, Listeria may manifest as a subacute syndrome, 7 and, though controversial, 1,4,9,10 some series suggest a lower frequency of the classic triad (fever, nuchal stiffness and impaired consciousness) at presentation 2 . Notably, up to 50% of immunocompetent patients did not show meningeal signs at the beginning in one series, 3 ranging among 20%‐25% in others 1,4,10 . Fever is the most frequent symptom in all series, and only 10%‐15% of cases debut feverless 1,3,10 .…”

“…Headache is the main rationale for this report, but other points are worth commenting on these cases. Both of them were immunocompetent individuals, that, although in minority, are represented in almost all series 1,2,4,11 . They had chronic illnesses considered Listeria predisposing: 2,3,9 an autoimmune condition such as ulcerative colitis in the first case, and alcoholism and diabetes mellitus type 2 in the second one.…”

“…Gram staining of the CSF was positive just in 1 case. It is known to have little sensitivity, while culture in suitable media are reported to be positive in a high percentage 1,2,4 . Blood culture positivity is rare, but mortality is higher in those who present with bacteriemia 8 .…”

“…The occurrence of this type of headache is explained by both the stimulation of terminal nerve fibers by meningeal inflammation and intracranial hypertension. 6 Headache occurs in a high percentage of patients with Listeria meningitis; [1][2][3][4] however, in the vast majority of cases, it is accompanied by other signs or symptoms of meningitis, and there are no descriptions of isolated headache as the only presenting symptom or sign of this disorder. Although other neurological alterations were added during the clinical course in both cases, they were delayed for 1 and 8 days, respectively.…”

“…There are no descriptions in the literature of headache as the only presenting symptom of Listeria meningitis. Headache has been reported among the initial symptoms in 50 to 90% of cases, depending on the series, [1][2][3][4] but this is obviously a nonspecific symptom and is accompanied by other signs or symptoms such as fever, confusion or meningeal signs. Two of these 4 symptoms occur in up to 97% of cases of Listeria meningitis, 1 similar to other bacterial meningitis.…”