Listeriosis invasiva. Presentación de un caso clínico y revisión de la literatura / Invasive listeriosis. A clinical case and literature review

Resumen Listeria monocytogenes es una bacteria grampositiva, considerada oportunista, que produce enfermedad en huéspedes susceptibles y excepcionalmente en pacientes inmunocompetentes. Se incluye dentro de las enfermedades trasmitidas por alimentos (ETA). Su importancia radica en la dificultad diagnóstica, la alta mortalidad pese a la sensibilidad de la bacteria a la ampicilina, y a las medidas de prevención que pueden evitar la transmisión al hombre. Presentamos el caso clínico de una niña de 9 años previamente sana que cursó una infección grave y de evolución fatal.

Summary Listeria monocytogenes is a gram-positive opportunistic bacteria that can cause a disease in vulnerable hosts and exceptionally, in immunocompetent patients. The infection caused by it is included in the foodborne diseases group. The condition is relevant given its diagnostic difficulties and its high mortality, in spite of it being sensitive to ampicillin and the prophylactic measures defined to avoid it being transmitted to humans. The study presents the case of a previously healthy 9 year old girl, who suffered a severe infection and died.

Listeria monocytogenes meningitis in an immunocompetent adult: a case report / Listeria monocytogenes meningite em um adulto imunocompetente: relato de caso

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.

Meningoencefalite por Listeria monocytogenes em ovinos / Meningoencephalitis in sheep caused by Listeria monocytogenes

São descritos sete casos de doença neurológica em ovinos por Listeria monocytogenes no Rio Grande do Sul e Paraná entre 2000 e 2007. Foram afetados ovinos com idades entre 12-24 meses. Os casos ocorreram no verão e início da primavera e os índices gerais de morbidade e letalidade foram de 3,15 por cento e 100 por cento, respectivamente. Quando essa informação estava disponível, nenhum dos ovinos afetados era alimentado com silagem. Em três propriedades havia contato próximo dos ovinos afetados com outras espécies. A evolução do quadro clínico foi de 12 horas a três dias e os sinais clínicos foram caracterizados por decúbito (7/7), desvio da cabeça (4/7), incoordenação (3/7), depressão (3/7), andar em círculos (2/7), cegueira unilateral, emagrecimento progressivo, febre, midríase, movimentos de pedalagem, nistagmo lateral, opistótono, paralisia flácida dos membros pélvicos ou dos quatro membros, salivação excessiva e tremores (1/7 cada). Histologicamente observou-se encefalite com microabscessos, predominantemente unilateral com variáveis graus de gliose e alterações degenerativas como esferóides axonais e infiltração de células Gitter. As lesões se estendiam desde a medula oblonga até o mesencéfalo. Antígenos de Listeria monocytogenes foram detectados por imuno-histoquímica em seções de tronco encefálico de todos os ovinos afetados. O diagnóstico foi realizado com base nos achados epidemiológicos e clinico-patológicos, e confirmado pela imuno-histoquímica (IHQ) utilizando anticorpo policlonal anti-L. monocytogenes.

Seven cases of neurological disease in sheep caused by Listeria monocytogenes in Rio Grande do Sul and Paraná state, southern Brazil are described. The cases occurred between 2000 and 2007 and 12-24-month-old sheep were affected. Overall morbidity and lethality rates were 3.15 percent and 100 percent, respectively. Cases occurred in the summer and early spring. When this information was available, affected sheep had not been fed with silage. In three farms there were close contact among affected sheep and other species. Clinical signs were characterized by recumbency (7/7), head tilt (4/7), incoordination (3/7), depression (3/7), circling (2/7), unilateral blindness, wasting, fever, midriasis, paddling, opisthotonus, hind or hind and fore limb paralysis, drooling, and muscle tremors (1/7 each). Clinical evolution varied from 12 hours to three days. Histological findings consisted of predominantly unilateral, microabscedative encephalitis with variable degrees of gliosis and degenerative lesions characterized by axonal spheroids and infiltration by Gitter cells. These lesions were observed extending from medulla oblongata to mesencephalon. Listeria monocytogenes antigen was showed by imunohistochemistry in routinely processed sections of brainstem from all seven affected sheep. The diagnostic was based on epidemiological, clinical, and pathological findings and confirmed by immunohistochemistry (IHQ) using polyclonal anti-L. monocytogenes antibody.

Neurolisteriosis: descripción de siete casos / Neurolisteriosis: description of seven cases

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.

Listeria monocytogenes meningitis: an uncommon opportunistic infection in HIV/AIDS.

OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes meningitis in an HIV seropositive individual. MATERIALS & METHODS: A previously healthy 45 years old HIV seropositive man, presented with atypical clinical features of meningitis. Blood and Cerebrospinal fluid (CSF) were obtained for biochemical and microbiological investigations. RESULTS: CSF analysis showed pleocytosis with lymphocytic predominance. Gram stain of CSF was negative; however culture yielded growth of gram positive bacilli with tumbling motility. Based on relevant biochemical tests the isolate was identified as Listeria monocytogenes. Patient was treated with i.v. ampicillin and recovered completely. CONCLUSION: Listeriosis is relatively rare in HIV/AIDS among the immunodeficient populations. Atypical clinical and laboratory findings make the diagnosis difficult and these infections may go undiagnosed. Since it is easily treated with readily available antibiotics, it is important to diagnose them at the earliest and thereby prevent treatment failure.

Listeriosis and AIDS: case report and literature review

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