Three-year multicenter surveillance of community-acquired listeria monocytogenes meningitis in adults

Abstract

BackgroundListeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series.MethodsA descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital.ResultsTwo hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosupression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome.ConclusionsElderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

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

“…En un estudio español prospectivo multicéntrico, publicado en el 2010, encontraron que la combinación de ampicilina y aminoglucósidos se asoció a un resultado desfavorable (67 % Vs. 28%; p=0,024) y a un aumento de la mortalidad (67 % Vs. 32 %; p=0,040), por lo cual recomiendan no utilizar el tratamiento combinado con aminoglicósidos (18).…”

Listeria Monocytogenes Meningitis in an Immunocompetent Adult

“…[8][9][10] CSF findings are typical of acute bacterial meningitis with a pleocytosis, increased protein level and a decreased CSF/serum glucose ratio. 8 However, further multivariate analysis found only the CSF/serum glucose ratio to be independently associated with Listeria meningitis. 8 The state of immunity may also influence the case presentation in Listeria meningitis.…”

“…[8][9][10] The rate of the classic triad presentation for bacterial meningitis (fever, neck stiffness, and altered mental status) is approximately 50%. [8][9][10] CSF findings are typical of acute bacterial meningitis with a pleocytosis, increased protein level and a decreased CSF/serum glucose ratio. 8 However, further multivariate analysis found only the CSF/serum glucose ratio to be independently associated with Listeria meningitis.…”

“…However, the largest observational studies of listeria meningitis to date demonstrate that an immunocompromised state plays a role in up to 70% of cases, with relatively few cases being described among healthy, immunocompetent adults. [8][9][10] L. monocytogenes infection is frequently contracted through consumption of contaminated food. Raw vegetables, unpasteurized dairy products, meat, and ready-to-eat foods are of particular concern as a result of their source and processing methods.…”

Listeria monocytogenes meningitis in an immunocompetent adult: a case report

“…The incidence of L. monocytogenes meningitis among all episodes of community-acquired acute meningitis among adults in North America and Europe was reported at 5% to 10% or more 4 . It is characterized by a high case fatality rate of 24% to 62% even with appropriate antibiotic therapy 5 .…”