[Listeria monocytogenes meningitis in immunocompetent children. [a case report]]

Introduction: Listeria monocytogenes is, increasingly, recognised as a cause of life-threatening disease mainly in immunocompromised persons, but it is an uncommon cause of bacterial meningitis beyond the newborn period in healthy subjects

Report: We present the case of a 10-year-old previously healthy child who was admitted at a general pediatric unit for high fever, impaired consciousness and intra cranial hypertension syndrome. Cerebrospinal fluid examination revealed 980 cells/mm3 in mixed formula [neutrophils = 50 per cent, lymphocytes = 50 per cent], decreased glycorrachia [1.5 mmol/l], increased albuminorrachia [2g/l] and normal chlorurachia. Gram's stain was negative. initial parenteral antibiotics combining cefotaxime and vancomycin didn't lead to clinical improvement. In fact, after 48 hours, the temperature was usually high and the patient remained obnubilated and, also, developed bilateral convergent strabismus. The second cerebrospinal fluid sample showed lymphocytic meningitis [125 cells/mm3, neutrophils = 5 per cent, lymphocytes = 95 per cent], decreased glycorrachia [0.5 mmol/l], increased albuminorrachia [1.2 g/l], normal chlorurachia and negative soluble antigens. Gram's stain showed Gram positive bacilli. Subsequent culture yielded Listeria monocytogenes. The patient was so treated with parenteral ampicillin for fifteen days and showed uneventful recovery. No immunocompromised conditions were identified in this patient

Discussion: In its most severe form, listeriosis is an invasive disease that affects not only immunocompromised but also immunocompetent persons in whom the neuromeningeal form is the most frequent

Conclusion: L. monocytogenes should be considered among the aetiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly even if they are immunocompetent and non-neonates

Beta-haemolytic streptococci in acute pharyngitis

To determine the role and importance of beta-haemolytic streptococci in acute pharyngitis and its relative susceptibility to antibiotics, we cultured samples from 143 patients [age range: 3-72 years] who presented over a 5-month period in 2001 at three primary health care centres in Sousse, Tunisia. The cultures yielded 80 beta-haemolytic streptococci [59 group A streptococci and 21 non-group A streptococci]. All strains were susceptible to benzylpenicillin, amoxicillin, chloramphenicol, rifampicin and pristinamycin. Susceptibility was variable in erythromycin, tetracycline, fosfomycin, telithromycin and levofloxacin. Minimum inhibitory concentrations were determined by E-test for penicillin, erythromycin and levofloxacin. Our results confirm that penicillin is still the reference treatment for acute pharyngitis. However, to minimize the potential for complications arising from its use, continued vigilance is required

Listeriose humaine: deux nouveaux cas en Tunisie et revue de la litterature

The diagnosis of human listeriosis is frequently evokated but rarely confirmed. The authors report two cases of neonatal Listeriosis and present the characteristics of the isolated Listeria monocytogenes. They review the typical features of this rarely diagnosed disease in Tunisia