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Objective@#To summarize the clinical characteristics of Listeria monocytogenes meningitis (LMM) with complications, and analyze the outcomes of next generation sequencing.@*Methods@#Clinical characteristics, laboratory findings, imaging features, antibiotics treatment, and next generation sequencing of cerebrospinal fluid were analyzed in 3 LMM patients who were hospitalized in the Department of Infectious Diseases of Beijing Children′s Hospital Affiliated to Capital Medical University from July 2015 to November 2017.@*Results@#The three patients were 1-year-old girl, 2-year-old girl, and 9-year-old boy, with normal immune function. They had eaten refrigerated food, milk or dairy products before onset. Symptoms included fever, headache, abdominal pain, diarrhea, vomiting, and convulsions, etc. The complications of two cases (case 2 and 3) were appendicitis and Meckel′s diverticulitis. The other one (case 1) was with sepsis and pneumonia. Leukocyte counts in cerebrospinal fluid were elevated in all the three cases, and cranial magnetic resonance imaging showed meningeal or periventricular involvement. All the children were diagnosed with LMM by positive CSF culture. CSF for next generation sequencing was sent after carbapenem antibiotics using, yet all the results were positive. The positive results were returned 2, 9, and 9 days earlier than culture results, respectively. The gene coverage was 5.00%, 7.00%, 0.04%, and the reads was 2 561, 1 011 and 8, respectively. All the three children had recurrent fever despite using cephalosporin. Levels of leukocytes in the blood and CSF further elevated. After using carbapenem antibiotics, patients improved eventually and were discharged from hospital.@*Conclusions@#LMM can occur in children with normal immune function and is usually associated with digestive system symptoms. Listeria monocytogenes can be detected quickly and accurately by the next generation sequencing technology, without being limited to sampling time and antibiotics application.
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Objective To investigate the clinical features and antimicrobial susceptibility of neonatal Listeria septicemia.Methods Eleven cases of neonatal Listeria septicemia that were treated in the Huzhou Maternity and Children Health Hospital from March 2013 to March 2017 were enrolled in this study.Clinical data including the results of bacterial culture,antimicrobial susceptibility test and antibiotic treatment were collected and retrospectively analyzed.Moreover,maternal history of Listeria monocytogenes (LM) infection before delivery was retrieved.Results All of the 11 mothers had fever before delivery and nine of them showed different grades of amniotic fluid contamination during delivery.Clinical symptoms of the 11 neonates included dyspnea (11 cases),fever (ten cases),apnea (nine cases),slow response and feeding difficulty (nine cases),convulsion (six cases),vomiting and abdominal distension (two cases),pulmonary hemorrhage (one case),progressive jaundice (one case) and systemic skin bleeding point (one case).All cases showed abnormal results of blood routine test and increased calcitonin and C-reactive protein.Ten cases received cercbrospinal fluid examination,seven of which were abnormal.Altogether 17 strains of LM were isolated from various specimens.These strains were all sensitive to piperacillin-tazobactam,ampicillin-sulbactam,meropenem,vancomycin,cotrimoxazole,ciprofloxacin and gentamycin,but resistant to oxacillin.Strains those were sensitive to penicillin,ampicillin,erythromycin and clindamycin accounted for 10/17,11/17,9/17 and 8/17,respectively.The 11 neonates were treated with piperacillin-tazobactam,meropenem or vancomycin.All of them improved (11/11)and ten were cured (10/11).All cases were followed up through phone calls at one week and one month after discharge.Two were lost to follow-up,while thc others were all in good condition.Conclusions Neonatal Listeria septicemia is usually a severe disease characterized by rapid progression and mainly presented with dyspnea and fever,besides there is a high possibility of purulent meningitis.Some LM strains are resistant to single-agent penicillin antibiotics.However,antibiotics such as piperacillin-tazobactam,meropenem and vancomycin are effective in the treatment of neonatal Listeria septicemia.
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Objective To summarize the clinical characteristics of SLE patients complicated with Listeria monocytogenes meningitis (LMM).Methods The clinical manifestations,systemic involvements,laboratory tests,cerebrospinal fluid (CSF) examinations,treatment and prognosis of SLE inpatients combined with LMM in Peking Union Medical College Hospital during Janurary 2000 to December 2015 were retrospectively analyzed.Results Eight SLE patients with LMM accounted for 0.14％ of the 5 675 hospitalized SLE patients.Seven were female and 1 was male,with the mean age of (35±16) year.Headache (7/8) was the most common neurological symptom followed by positive meningeal irritation sign (5/8),unconsciousness (3/8) and nausea or vomiting (2/8).Increased intracranial pressure was found in 7 cases and 4 of them were even higher than 330 mmH2O.CSF protein elevated in 6 cases and CSF glucose decreased in 6 cases.LMM often occurred in inactive or mild active SLE with the average SLE disease activity index (SLEDAI) score of 4.7±1.5.Systemic manifestations included hematologic changes (6/8),rashes (4/8),renal involvement (4/8) and arthritis (3/8),etc.Treated by autibiotics such as penicillin and medications for SLE,7 patients achieved clinical improvements,1 patient died.Conclusion LMM is one of the opportunistic infections in SLE patients and tends to occur in inactive lupus cases.There are unspecific clinical and laboratory features and CSF changes which maybe overlap and mix up with systemic manifestations of SLE.That's why it is necessary to take continuous cultures of CSF.Early identification and appropriate treatment lead to prognostic improvement of these patients.