Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia

Listeria Rhombencephalitis and Infratentorial Brain Abcesses ın a Young Adult with Stroke Like Presentation

Rhombencephalitis refers to the inflammation of rhombencephalon, and Listeria monocytogenes is one of the causes of infectious rhombencephalitis. Listeria rhombencephalitis is a rare and severe infection with high mortality and morbidity. As the disease can present with a variety of neurological symptoms and nonspecific laboratory tests, it can easily be misdiagnosed. Sudden onset of neurological signs without fever can resemble stroke. Magnetic resonance imaging can be useful in patients for confirmation of the diagnosis and during the follow-up. Early diagnosis and treatment are especially important for improvement of the outcomes. Here we report a case with stroke-like presentation that was diagnosed as Listeria rhombencephalitis in follow-up and present the serial brain magnetic resonance imaging features.

Case Report: Severe Listeria Encephalitis With Complicated or Secondary Autoimmune Encephalitis and CNS Demyelinating Diseases

Background

Listeria monocytogenes is an important food-borne bacterium. It rarely infects patients with complete immunity and causes meningocephalitis. Patients with severe Listeria encephalitis always experience a bad prognosis.

Case Presentation

A 39-year-old male patient was admitted to our hospital due to fever for more than 10 days and disturbance of consciousness accompanied by convulsions for 2 days. Metagenomic next-generation sequencing (mNGS) results showed L. monocytogenes in both cerebrospinal fluid (CSF) and blood, indicating L. monocytogenes encephalitis. Autoimmune encephalitis and central nervous system (CNS) demyelinating autoantibodies in the CSF also showed positive results. The case was finally diagnosed as severe Listeria encephalitis with complicated or secondary autoimmune encephalitis and CNS demyelinating diseases.

Conclusions

It is necessary to carry out infection and immunity screening in patients with severe encephalitis, especially for immunocompromised patients. mNGS plays a pivotal role in screening patients with severe and difficult neurological diseases.

Presence of Listeria monocytogenes in Ready-to-Eat Artisanal Chilean Foods

Ready-to-eat (RTE) artisanal foods are very popular, but they can be contaminated by Listeria monocytogenes. The aim was to determine the presence of L. monocytogenes in artisanal RTE foods and evaluate its food safety risk. We analyzed 400 RTE artisanal food samples requiring minimal (fresh products manufactured by a primary producer) or moderate processing (culinary products for sale from the home, restaurants such as small cafés, or on the street). Listeria monocytogenes was isolated according to the ISO 11290-1:2017 standard, detected with VIDAS equipment, and identified by real-time polymerase chain reaction (PCR). A small subset (n = 8) of the strains were further characterized for evaluation. The antibiotic resistance profile was determined by the CLSI methodology, and the virulence genes hlyA, prfA, and inlA were detected by PCR. Genotyping was performed by pulsed-field gel electrophoresis (PFGE). Listeria monocytogenes was detected in 7.5% of RTE artisanal foods. On the basis of food type, positivity in minimally processed artisanal foods was 11.6%, significantly different from moderately processed foods with 6.2% positivity (p > 0.05). All the L. monocytogenes strains (n = 8) amplified the three virulence genes, while six strains exhibited premature stop codons (PMSC) in the inlA gene; two strains were resistant to ampicillin and one strain was resistant to sulfamethoxazole-trimethoprim. Seven strains were 1/2a serotype and one was a 4b strain. The sampled RTE artisanal foods did not meet the microbiological criteria for L. monocytogenes according to the Chilean Food Sanitary Regulations. The presence of virulence factors and antibiotic-resistant strains make the consumption of RTE artisanal foods a risk for the hypersensitive population that consumes them.

Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn's disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.

Clinical Presentation and Cranial MRI Findings of Listeria monocytogenes Encephalitis: A Literature Review of Case Series

BACKGROUND

Listeria monocytogenes-associated encephalitis is a severe clinical condition that can also be seen in immunocompetent patients. Clinical manifestation and radiologic features of this entity need to be elaborated.

REVIEW SUMMARY

We searched the medical literature during the period spanning from 1991 to 2017 using the keyword "listeria AND [abscess odds ratio (OR) brainstem OR encephalit* OR magnetic* OR imaging*]." We included in the review well-documented adult cases with a definitive diagnosis and having magnetic resonance imaging data. Confusion, hemiparesis, cerebellar ataxia, facial paralysis, and gait disturbance were the most frequent findings, detected in >30% of patients during admission. The high rate of facial paralysis was of particular interest. T2 hyperintensity (80/82), contrast enhancement (60/82), and ring-enhancing lesions, which are considered as brain abscess, were found in 46/82 patients. The mortality and neurological sequel rates were 20% and 68%, respectively.

CONCLUSIONS

Listeria encephalitis is a severe disease and should be remembered in cases admitted with symptoms related to the brainstem and cranial nerve dysfunction. Cranial magnetic resonance imaging with brainstem and cerebellum involvements and contrast enhancement with or without abscess are particularly suggestive of the listeria-related infection.