RESUMO
We report an unusual case of concurrent meningitis and infectious monoarthritis due to Listeria monocytogenes in a 65-year-old woman presenting to our department with a transient gastrointestinal tract illness. During hospitalization the patient's neurological status deteriorated, presenting signs of meningeal irritation along with signs of inflammation and oedema of the right knee. Blood cultures and cultures of the cerebrospinal fluid and of the sinovial fluid aspirate showed growth of L. monocytogenes gram positive rods. The patient received a three-week course of intravenous meropenem with significant improvement. To the best of our knowledge this is the first case of concurrent listerial meningitis and arthritis in an immunocompetent patient. Despite the rarity of the disease in healthy individuals a high index of suspicion is required for unusual manifestations of listerial infections especially among high risk groups such as the elderly.
Assuntos
Antibacterianos/uso terapêutico , Artrite/diagnóstico , Artrite/tratamento farmacológico , Listeria monocytogenes/patogenicidade , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Tienamicinas/uso terapêutico , Idoso , Artrite/microbiologia , Feminino , Humanos , Imunocompetência , Listeria monocytogenes/isolamento & purificação , Listeriose/complicações , Meningite por Listeria/líquido cefalorraquidiano , Meningite por Listeria/microbiologia , Meropeném , Resultado do TratamentoRESUMO
The aim of this study was to analyse data relating to the liver function profile during acute infection from murine typhus in the city of Chania in the island of Crete (Greece). A retrospective study of the files of all the cases with a diagnosis of murine typhus admitted to the Saint George General Hospital of Chania over a 15-year period (1993-2008) was performed. Variations in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels were recorded from three consecutive examined serum samples. A total of 165 patients were diagnosed with murine typhus during the above time period. Serum aminotransferase and lactate dehydrogenase were abnormal in most of the first examined samples. Remarkably on admission, serum levels of AST, ALT, and LDH recorded an increase above the cut-off point in 142 (86%), 114 (69%) and 136 (82.4%) patients respectively. More than two out of every ten patients presented hepatomegaly. In conclusion, liver dysfunction occurs frequently in patients with murine typhus. A high level of physicians' awareness is required for the liver biochemical abnormalities caused by this worldwide zoonotic disease, especially in endemic areas such as Greece.
