Recurrent Listeria monocytogenes bacteraemia in a liver transplant patient

Mortality risk factors related to listeriosis - A meta-analysis

BACKGROUND

Relatively few studies have focused on mortality risk factors for listeriosis in the literature. Information on the mortality of populations with listeriosis is needed. We aimed to explore the mortality risk factors related to listeriosis in this meta-analysis.

METHODS

The studies were considered eligible for inclusion only if they directly compared the mortality risk factors for listeriosis between dead patients and surviving patients. The mortality risk factors included clinical predisposing factors and predisposing comorbidities.

RESULTS

Thirteen studies were included in this study. There were 12,265 listeriosis patients, including 2863 (23.3%) dead patients. The meta-analysis provided evidence that the mortality risk factors related to listeriosis were as follows: 1. Clinical predisposing factors included age ≥ 60 years, primary bacteremia and central nervous system involvement; 2. Predisposing comorbidities included non-hematological malignancies, alcoholism, chronic kidney disease, cardiovascular disease, and pulmonary disease. In addition, autoimmune disease comorbidity had a protective effect against listeriosis.

CONCLUSION

The presence of older patients, primary bacteremia, central nervous system involvement, non-hematological malignancies, alcoholism, chronic kidney disease, cardiovascular disease, and pulmonary disease should alert physicians to the higher risk of mortality.

Molecular evidence of Listeria monocytogenes infection relapse in a severe case of endocarditis

Introduction. Endocarditis is a rare complication of bacteraemia due to Listeria monocytogenes and is characterized by a high fatality rate (37–50 %). Recurrent infection by Listeria monocytogenes occurs even more rarely.

Case presentation. We report a case of recurrent Listeria monocytogenes infection that resulted in severe endocarditis in a 66-year-old patient with an aortic valve prosthesis. Relapse was confirmed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST).

Conclusion. Our case highlights that the molecular subtyping approach is an important tool for the detection of microbial reinfections and for the support of clinical diagnosis.

Infections of the Liver

The portal vein carries blood from the gastrointestinal tract to the liver and in so doing carries microbes as well. The liver may therefore be involved in infections with a myriad number of microbial organisms. While some of these infections most commonly occur in the immunocompromised host, others affect the immune competence. Hepatic infections may be primary in nature or secondary, as part of systemic or contagious disease. The purpose of this chapter is to provide a brief overview of the various infections of the liver in the pediatric patient.

Orthotopic Liver Transplantation: Is There a Risk for Listeria monocytogenes Infection?

Immunosuppression of any kind is a known risk factor for infection with Listeria monocytogenes (L. monocytogenes). Particularly, patients with impaired liver function are at increased risk of developing an aggravated course of infection with this bacterial pathogen (see Nolla-Salas et al.; 2002 and Cabellos et al.; 2008). It is a well-known pathogen in immunocompromised patients, but has only seldom been reported following orthotopic liver transplantation. Invasion of the central nervous system presenting as meningitis or meningoencephalitis and bacteremia are the principal clinical manifestations of listerial infections (see Brouwer et al.; 2006). We present an account of a case of a patient who developed L. monocytogenes meningitis during the early period after liver transplantation.

Early invasive Listeria monocytogenes infection after orthotopic liver transplantation: case report and review of the literature

Infection with Listeria monocytogenes is rare, with a reported annual incidence of 4.4 cases per million individuals. It is caused by a gram-positive rod-shaped bacterium (Listeria monocytogenes) that can be found in soil, vegetation, water, sewage, and silage and in feces of humans and animals. It is a facultative intracellular pathogen with the ability to survive and multiply in phagocytic host cells, even in adverse environmental circumstances. Listeriosis has rarely been reported after orthotopic liver transplantation, and transplant physicians are often unfamiliar with the clinical presentation of this rare but virulent infection, which accounts for 20%-30% mortality in affected individuals. We present a case of invasive Listeria infection causing bacteremia and peritonitis in the early postoperative period after cadaveric liver transplantation in a previously asymptomatic patient.

Listeria monocytogenes following orthotopic liver transplantation: Central nervous system involvement and review of the literature

Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals, including solid organ transplant recipients, but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy, and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous ampicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis, and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.

Infection with Listeria monocytogenes following orthotopic liver transplantation: case report and review of the literature

Infection with Listeria monocytogenes is rare with a reported annual incidence of 4.4 cases/million individuals. Epidemiological data have identified certain groups to be higher risk of developing listeriosis, including neonates, pregnant women, adults older than 60 years of age, individuals afflicted with hematologic malignancies, acquired immunodeficicency syndrome, cirrhosis, and those receiving corticosteroid therapy and organ transplants. Within this last group, multiple cases have been described following bone marrow and renal transplantation, but only a few following liver transplantation. We report a case of a 66-year-old woman presenting with Listeria monocytogenes bacteremia at 32 months following orthotopic liver transplantation.

Recurrent Listeria monocytogenes infection: relapse or reinfection with a unique strain confirmed by molecular subtyping

We report a case of recurrent listeriosis for which molecular subtyping by automated ribotyping and pulsed-field gel electrophoresis confirmed either relapse of infection or reinfection due to a common source almost 9 months after initial infection due to a unique Listeria monocytogenes strain in a patient with colorectal cancer. This case report illustrates the potential use of molecular subtyping to further understand the pathogenesis and epidemiology of listeriosis and the potential for relapse of Listeria infections in humans.

Listeria monocytogenes tricuspid valve endocarditis with septic pulmonary emboli in a liver transplant recipient

Listeria monocytogenes has long been known as a pathogen of immunocompromised hosts, including solid organ and bone marrow transplant recipients. Its principal manifestations include bacteremia and meningitis. Endocarditis due to Listeria is far less common and in general affects the left side of the heart. We here report an unusual case of Listeria tricuspid valve endocarditis and septic pulmonary emboli in a sulfa-intolerant liver transplant recipient with a history of relapsing cytomegalovirus (CMV) hepatitis and an indwelling Hickman catheter. The literature on Listeria endocarditis and infections in transplant recipients is reviewed. The possible relationship between susceptibility to Listeria infection and the discontinuation of trimethoprim-sulfamethoxazole prophylaxis is of interest.

Listeria infection after liver transplantation: report of a case and review of the literature

Listeria monocytogenes is a well-recognized cause of bacteremia and meningitis in immunocompromised individuals, including recipients of solid organ transplants, but has only rarely been reported following orthotopic liver transplantation (OLT). Most previously reported cases of listeriosis occurred months to years following liver transplantation; we describe a case of listeriosis that occurred within 1 wk of liver transplantation, shortly after discontinuation of trimethoprim-sulfamethoxazole prophylaxis, and review the English literature on Listeria infection after OLT. The patient developed abdominal pain and fever that suggested a bile leak, but was definitively diagnosed with Listeria infection by blood culture. The infection was successfully treated with 3 wk of intravenous ampicillin. We conclude that serious systemic infection with Listeria monocytogenes is uncommon following OLT, may occur early in the postoperative period, and responds well to treatment with high dose ampicillin.