ABSTRACT
Listeria meningoencephalitis is a rare condition, occurring mainly in immunocompromised patients. We present two cases of Listeria monocytogenes meningoencephalitis in immunocompetent children, with successful treatment with betalactam/aminoglycoside combination. Unpasteurized cheese was postulated as the source of infection.
La meningoencefalitis por Listeria spp. es una infección infrecuente, principalmente en pacientes con algún tipo de inmunosupresión. Presentamos dos casos clínicos de meningitis por Listeria monocytogenes en niñas inmunocompetentes con tratamiento exitoso con β lactámicos combinados con aminoglucósidos; se identificó la ingesta de queso no pasteurizado como probable fuente de infección.
Subject(s)
Child, Preschool , Female , Humans , Infant , Cheese/poisoning , Foodborne Diseases/microbiology , Immunocompetence , Meningitis, Listeria/etiology , Pasteurization , Aminoglycosides/therapeutic use , Cheese/microbiology , Meningitis, Listeria/drug therapy , beta-Lactamase Inhibitors/therapeutic use , beta-Lactams/therapeutic useABSTRACT
Listeria monocytogenes (L. monocytogenes) is an uncommon cause of bacterial meningitis in immunocompetent adults. Patients with immunosuppression are at increased risk of developing serious invasive diseases, particularly meningitis. We describe a case of meningitis caused by L. monocytogenes in an immunocompetent and previously healthy 34-year-old adult. The patient received treatment with intravenous ampicillin plus amikacin and made a full recovery. L. monocytogenes should be suspected in immunocompetent adults with bacterial meningitis who fail to respond to empirical antibiotic treatment.
Listeria monocytogenes (L. monocytogenes) é uma causa rara de meningite bacteriana em adultos imunocompetentes. Pacientes com imunossupressão têm maior risco de desenvolver graves doenças invasivas, especialmente a meningite. Descrevemos um caso de meningite por L. monocytogenes em um adulto imunocompetente e previamente sadio com idade de 34 anos. O paciente recebeu tratamento com ampicilina intravenosa mais amicacina e fez uma recuperação completa. L. monocytogenes deve ser suspeitada em imunocompetentes adultos com meningite bacteriana que não respondem ao tratamento antibiótico empírico.
Subject(s)
Adult , Humans , Male , Amikacin/therapeutic use , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Meningitis, Listeria/diagnosis , Drug Therapy, Combination , Immunocompetence , Meningitis, Listeria/drug therapyABSTRACT
Listeria Monocytogenes is a gram-positive Bacillus that affects immunocompromised patients, newborn, pregnant women and persons over 65 years. Infection is acquired through contaminated food. The Bacillus has predilection for the central nervous system. Its presents most commonly as an acute meningitis, it also presents as a chronic meningitis, cerebritis, rhomboencephalitis, brain and spinal abscess. Diagnosis for L. monocytogenes is made through positive cultures in blood and cerebrospinal fluid (CSF). Magnetic Resonance (MR) also helps to in the diagnosis of neurolisteriosis lesions. We described seven cases with L. Monocytogenes infection during 2007 and 2008, with four cases over the aged of 65 years old. Five presented acute meningitis; two rhomboencephalitis and one patient had meningoencephalitis. Six cases showed inflammatory CSF with pleocytosis with polymorphonuclear prevail and normal glycorrachia. MR showed inflammatory findings in five patients and focal brainstem lesions in two cases, one had acute hydrocephalus due arachnoiditis. Five patients improve clinically and two fatal cases were described. Listeriosis is the third cause of meningitis and should be consider in the differential diagnosis of meningitis with clear fluid, especially with pleocytosis and normal glycorrachia. Other clues of the diagnosis are dizziness with or without nystagmus and brainstem compromise. Arachnoiditis should be avoided with steroidal use. The diagnostic imaging test of choice for brain stem compromise is MR.
La Listeria Monocytogenes es un bacilo Gram-positivo que afecta a pacientes inmunocomprometidos, a niños, embarazadas y personas mayores de 65 años. El modo de adquirirla es la ingestión de alimentos contaminados. El bacilo tiene predilección por el sistema nervioso central, donde su expresión más frecuente es la meningitis aguda, también puede presentarse como meningitis crónica, cerebritis, rombencefalitis, abscesos cerebrales y espinales. El cultivos positivos de L. monocytogenes en muestras de sangre o líquido cefalorraquídeo, permite confirmar el diagnóstico. La Resonancia Magnética de cerebro también contribuye al diagnóstico de las lesiones por neurolisteriosis. Se analizan siete casos de neurolisteriosis ocurridos los a±os 2007 y 2008, entre ellos cuatro pacientes mayores de 65 años. La meningitis aguda fue la forma de presentación en cinco de ellos, dos evolucionaron como rombencefalitis y uno como meningoencefalitis. El LCR fue inflamatorio en seis de los pacientes, con pleocitosis depredominio polinuclear, pero glucorraquia normal. La RM mostró imágenes de aspecto inflamatorio en cinco de los enfermos, dos de ellos tenían lesiones focales del tronco cerebral, uno hizo un hidrocéfalo agudo por aracnoiditis. Cinco pacientes presentaron una evolución clínica favorable y dos fallecieron. Siendo la listeriosis la tercera causa etiológica de meningitis, debe ser considerada en el diagnóstico diferencial de meningitis a líquido claro, especialmente en LCR con abundantes polinucleares y glucosa en rangos normales. Otras claves son la sensación vertiginosa con o sin nistagmus y el compromiso de nervios craneales de origen protuberancial. Debe prevenirse las aracnoiditis con el uso precoz de corticoides. Es obligatorio el estudio con RM en toda sospecha de neurolisteriosis.
Subject(s)
Humans , Male , Adolescent , Female , Middle Aged , Meningitis, Listeria/diagnosis , Meningitis, Listeria/etiology , Meningitis, Listeria/drug therapy , Acute Disease , Anti-Bacterial Agents/therapeutic use , Clinical Evolution , Cerebrospinal Fluid/microbiologySubject(s)
Humans , Male , Pregnancy , Infant, Newborn , Female , Listeria monocytogenes/pathogenicity , Meningitis, Listeria/diagnosis , Pregnancy Complications, Infectious , Disease Transmission, Infectious , Cerebrospinal Fluid/microbiology , Listeria monocytogenes/isolation & purification , Listeria monocytogenes/ultrastructure , Listeriosis/classification , Listeriosis/diagnosis , Listeriosis/physiopathology , Meningitis, Listeria/cerebrospinal fluid , Meningitis, Listeria/congenital , Meningitis, Listeria/drug therapy , Sepsis/diagnosis , Signs and SymptomsABSTRACT
Listeriosis is a not uncommon infection in humans, usually associated with immunodeficient states and with newborns. However, relatively few cases have been reported in HIV-infected patients. This scarcity of reported cases has aroused interest in the association of listeriosis and AIDS. In this paper we present a case of meningitis and septicemia caused by Listeria monocytogenes in a female patient with AIDS. A review of recent medical literature indicates that association of listeriosis and AIDS may be more common than it seems. Recent research in host-parasite interaction in listerial infection suggests an important role for tumor necrosis factor (TNF) and for integralin, a bacterial protein, in modulating listerial disease in AIDS patients. Inadequate diagnosis may be in part responsible for the scarcity of reports
Subject(s)
Humans , Female , AIDS-Related Opportunistic Infections/diagnosis , HIV-1 , Meningitis, Listeria/diagnosis , Sepsis/diagnosis , Adult , AIDS-Related Opportunistic Infections/drug therapy , Ampicillin/administration & dosage , Diagnosis, Differential , Meningitis, Listeria/drug therapy , Sepsis/drug therapy , Substance Abuse, Intravenous/complicationsABSTRACT
A Listeria monocytogenes constitui uma importante causa de bacteriemia e meningite em pacientes imunossuprimidos 1, 2, 3. Trata-se de um bacilo gram-positivo, que cresce facilmente na maioria dos meios de cultura. Ganhou seu nome devido a sua habilidade de produzir importante monocitose em coelhos. A maioria dos casos de infecçäo por Listeria monocytogenes têm sido reportados em pacientes imunossuprimidos, principalmente naqueles com diminuiçäo da imunidade celular, resultante da presença de doença maligna linforreticular ou em uso de drogas quimioterápicas. Neste trabalho, nós descreveremos um caso de meningite por Listeria monocytogenes, ocorrido em nosso hospital, em um paciente com Doença de Hodgkin. Fazemos uma revisäo da literatura e discutimos a eficácia dos esquemas terapêuticos empregados