The Brief Case: Neonatal Meningitis Caused by Listeria monocytogenes Diagnosed by Multiplex Molecular Panel

Abstract

c CASE On his 23rd day of life (DOL), a baby boy was transferred to our medical center from a community emergency department for treatment and management of presumed neonatal sepsis and meningitis.He was born full term via normal spontaneous vaginal delivery. His mother was primigravida with no medical complications during her pregnancy. Her prenatal lab results were negative for group B streptococci (GBS) at 36 weeks of gestation, and testing for HIV, syphilis, gonorrhea, chlamydia, and hepatitis B and C was negative. She reported no history of herpes simplex virus (HSV) infection, and no genital lesions were noted on examination. She did not recall having any fever or influenza-like symptoms at any point during her pregnancy. The baby emerged vigorous, was discharged after 2 days in the hospital, was exclusively breastfed, and regained his birth weight by DOL 14.One day prior to his admission on DOL 22, the patient developed a tactile fever, decreased feeding, and fussiness. He was taken to his outpatient pediatrician, who noted an afebrile, well-appearing baby. The baby was given acetaminophen and discharged from the clinic. Over the subsequent night, the patient became fussier and again had tactile fevers. His mother then took him to an emergency department, where he was found to be irritable, tachycardic, and febrile to 39.2°C. No other abnormal examination findings were identified.Blood and cerebrospinal fluid (CSF; obtained by lumbar puncture [LP]) were collected prior to administration of antimicrobials and submitted for culture and laboratory studies (Table 1). His initial CSF was significant for a pleocytosis, as well as abnormally elevated protein (143 mg/dl) and low glucose (16 mg/dl), highly suggestive of bacterial meningitis. The patient was empirically started on intravenous ampicillin (300 mg/kg/day, 4 divided doses), gentamicin (7.5 mg/kg/day, 3 divided doses), and acyclovir (60 mg/kg/day, 3 divided doses) and transferred to our medical center. Upon arrival, he was fussy but afebrile. As the Gram stain was negative for a causative organism, his gentamicin was exchanged for cefotaxime (300 mg/kg/day, 4 divided doses) for more complete empirical Gram-negative coverage and he was continued on ampicillin for empirical treatment of GBS and Listeria, as well as on acyclovir for HSV. Magnetic resonance imaging with contrast of his brain was performed on DOL 24, and mild enhancement of the leptomeninges was noted without any other findings such as abscess or infarction.Blood cultures and CSF cultures remained negative at the community medical center, and an HSV CSF PCR assay was also negative. Repeat blood cultures and CSF were collected on DOL 25. One aerobic blood culture bottle (BD Bactec Peds Plus/F) was collected and incubated in the Bactec automated blood culture system (Becton Dickinson, Franklin Lakes, NJ, USA), and no growth was detected after 5 days. Gram staining of the CSF revealed many white blood cells and no organisms. The specimen was inoculated onto 5% sheep blood agar (blood agar plate...

Implementation of the FilmArray ME panel in laboratory routine using a simple sample selection strategy for diagnosis of meningitis and encephalitis

“…In addition, we could increase the amount of bacterial pathogens to 53% of the specimens, again this is more than in other published studies that observed positive ranges for bacterial pathogens between 15-37% [6,7,32,33]. Indeed, bacteria were the most abundant In concordance with other studies [6,7,[9][10][11][12][34][35][36][37][38], S. pneumoniae (17/30) In four samples, potentially false positive results of FilmArray ME panel occurred, including three samples tested positive for bacterial pathogens by multiplex PCR that remained culture negative.…”

“…Using this selection criteria we selected 171/4623 CSF specimens for additional syndromic molecular testing. Overall we observed positive results in 56/171 (32%), which is higher than in other published studies [6,7,[9][10][11][12][34][35][36][37][38] and substantially higher compared to the multicenter evaluation study [6] and three other studies [7,32,33], that reported positivity rates of under 15% (p<0.0001). In addition, we could increase the amount of bacterial pathogens to 53% of the specimens, again this is more than in other published studies that observed positive ranges for bacterial pathogens between 15-37% [6,7,32,33].…”

Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy

“…Patients who were positive for respiratory viruses were also less likely to be discharged with oral antimicrobial therapy (26). We previously described two cases in which rapid diagnosis of bacterial meningitis, attributable to Listeria monocytogenes and Haemophilus influenzae, with a molecular panel assay allowed definitive diagnosis and optimization of antimicrobial therapy (27)(28)(29). In this study, the availability of the HSV PCR results on a 24-h/7-day basis resulted in a significant reduction in the duration of acyclovir treatment in the postimplementation arm.…”

Prevalence, Aetiological Agents, and Antimicrobial Sensitivity Pattern of Bacterial Meningitis Among Children Receiving Care at KCMC Referral Hospital in Tanzania

“…The diagnosis is challenging with convectional culture methods; PCR makes the isolation possible, as shown in previous case studies in neonates. 26,27 If not recognized and treated properly, L. monocytogenes can lead to meningitis and hydrocephalus, as complication 27 ; therefore, this bacteria should be considered in neonates with sepsis and meningitis. The second bacteria identified by conventional methods in a child aged above 12 months was S. pneumonia (n=1).…”