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Yang H, Wang C, Wang H, Ding S. Listeria rhombencephalitis mimicking acute disseminated encephalomyelitis in a patient without predisposing medical conditions. J Neurovirol 2020; 26:976-979. [PMID: 32839947 DOI: 10.1007/s13365-020-00896-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/24/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
Listeria rhombencephalitis (L. rhombencephalitis) is an uncommon form of central nervous system infection caused by Listeria monocytogenes (LM). It often occurs to immunocompetent individuals. Here, we described the case of a 45-year-old female patient without medical histories, who presented for high-grade fever, headache, and focal neurological manifestations. She was initially empirically diagnosed with acute disseminated encephalomyelitis (ADEM) because of clinical symptoms, acute clinical course, and neuroimaging. However, the biochemical analysis of cerebral spinal fluid (CSF) questioned the diagnosis of ADEM. The final diagnosis of L. rhombencephalitis was based on CSF culture for LM. Thus, L. rhombencephalitis should be preferentially and empirically considered for a patient with significantly elevated lactic acid and moderately increased red cells in CSF at early time, accompanied with rapidly progressive neurological dysfunctions involved in the brain stem.
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Affiliation(s)
- Hongna Yang
- Department of Critical-care Medicine, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan, 250012, China.
| | - Cuilan Wang
- Department of Neurology, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan, 250012, China
| | - Hao Wang
- Department of Critical-care Medicine, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan, 250012, China
| | - Shifang Ding
- Department of Critical-care Medicine, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan, 250012, China
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Liang JJ, He XY, Ye H. Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage: A case report and review of the literature. World J Clin Cases 2019; 7:538-547. [PMID: 30842967 PMCID: PMC6397815 DOI: 10.12998/wjcc.v7.i4.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/25/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Listeria monocytogenes (L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L. monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage, which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.
CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance. His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus. Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage. Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.
CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.
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Affiliation(s)
- Jing-Jing Liang
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan 430060, Hubei Province, China
| | - Xiao-Yan He
- Department of Neurology, Shijiazhuang Second Hospital, Shijiazhuang 050200, Hebei Province, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Acewicz A, Witkowski G, Rola R, Ryglewicz D, Sienkiewicz-Jarosz H. An unusual presentation of Listeria monocytogenes rhombencephalitis. Neurol Neurochir Pol 2017; 51:180-183. [PMID: 28110853 DOI: 10.1016/j.pjnns.2016.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/16/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
We describe a case of 52-year-old woman with a medical history of Crohn's disease presented abrupt fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem. The patient was initially diagnosed with ischaemic stroke, because of acute clinical course and results of neuroimaging. Cerebrospinal fluid analysis revealed mild infection with negative Gram staining and culture. Final diagnosis of Listeria monocytogenes brainstem infection (rhombencephalitis) was set up on the basis of further clinical course and positive blood cultures. Listerial rhombencephalitis should be kept in mind in immunocompromised adult patients who develop fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem even without typical neuroimaging, cerebrospinal fluid findings and negative cultures. Early diagnosis and adequate antibiotic treatment is of crucial importance.
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Affiliation(s)
- Albert Acewicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Grzegorz Witkowski
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Rafal Rola
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Danuta Ryglewicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Yao M, Zhou J, Zhu Y, Zhang Y, Lv X, Sun R, Shen A, Ren H, Cui L, Guan H, Wu H. Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by Next-Generation Sequencing. J Clin Neurol 2016; 12:446-451. [PMID: 27486935 PMCID: PMC5063871 DOI: 10.3988/jcn.2016.12.4.446] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Encephalitis caused by Listeria monocytogenes (L. monocytogenes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal fluid (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens. Methods This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis. Results Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocytogenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and sequenced reads corresponding to L. monocytogenes in all three cases. Conclusions This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.
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Affiliation(s)
- Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiali Zhou
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yinxin Zhang
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Xia Lv
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ruixue Sun
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Ao Shen
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Honglong Wu
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China.,Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Infección del sistema nervioso central por Listeria monocytogenes en pacientes con lupus eritematoso sistémico: análisis de 26 casos, incluyendo el reporte de un caso nuevo. ACTA ACUST UNITED AC 2013; 9:340-7. [DOI: 10.1016/j.reuma.2013.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 12/29/2022]
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Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia. Neurol Ther 2013; 2:63-70. [PMID: 26000217 PMCID: PMC4389028 DOI: 10.1007/s40120-013-0009-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Listeria monocytogenes is an important opportunistic pathogen affecting patients with immunosuppression and shows a high tropism for the central nervous system. The clinical manifestations of central nervous system listerial infections are variable and represent a diagnostic challenge. CASE REPORT The authors report the case of a 59-year-old woman who was admitted for confusion, agitation, and right-lower extremity weakness. The patient was treated for 3 months with fludarabine and 2 months with corticosteroids for chronic lymphocytic leukemia and hemolytic anemia, respectively. At the time of admission, the neurological examination revealed grade 4 right-lower extremity weakness with reflex asymmetry and right-sided Babinski sign; no signs of meningeal irritation were detectable. Physical examination was notable for grade 1 obesity and subfebrility. The cerebral computed tomography scan demonstrated a hypodense lesion in the left frontal lobe. Cerebral magnetic resonance imaging revealed a hyperintense lesion in the left frontal lobe with extension toward the basal ganglia (T2 and Fluid-Attenuated Inversion Recovery [FLAIR] sequences), and small nodular enhancing lesions after gadolinium infusion in the affected territory. Blood analyses revealed pancytopenia and elevated liver enzymes. During the second day after admission, the patient developed fever and neurological examination revealed signs of meningeal irritation. The cerebrospinal fluid (CSF) analyses revealed: red blood cells 24 cells/mm(3); white blood cells 829 cells/mm(3) (76% lymphocytes, 22% neutrophils, 2% monocytes); protein level 111.2 mg/dL; glucose level 10.2 mg/dL. Empiric anti-infection treatment was started with intravenous ceftriaxone, ciprofloxacine, aciclovir, and fluconasole. Both blood cultures and CSF cultures were positive for L. monocytogenes. The antimicrobial regimen was changed to ampicillin. The clinical and imaging outcome was excellent. CONCLUSION The supratentorial focal lesions secondary to Listeria meningoencephalitis are rare. The cases with focal neurological signs without fever at onset can resemble stroke.
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Abstract
PURPOSE OF REVIEW Encephalitis and postinfectious encephalitis represent two important conditions for the neurologist, both in terms of their presentations as neurologic emergencies and their potential to cause death or serious neurologic impairment. This article reviews the major infectious and noninfectious causes of encephalitis and discusses postinfectious encephalitis as an indirect effect of systemic illness. RECENT FINDINGS Encephalitis caused by herpes simplex virus type 1 and West Nile virus are of major importance. In addition, within the past few years we have gained improved understanding of the neurologic syndromes caused by varicella-zoster virus, the recognition of enterovirus 71 as a significant human pathogen, and the realization that encephalitis may also occur by autoimmune mechanisms requiring immunosuppressive therapy. We have also learned that postinfectious encephalitis may be recurrent rather than monophasic, and that children and adults initially diagnosed with postinfectious encephalitis may later develop classic multiple sclerosis. SUMMARY Encephalitis and postinfectious encephalitis present as neurologic emergencies requiring prompt diagnosis and initiation of treatment. Important concerns are to identify infectious conditions requiring antibiotic or antiviral therapy and postinfectious or other autoimmune encephalitides requiring immunosuppression.
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Affiliation(s)
- John E Greenlee
- University of Utah, Clinical Neuroscience Center, 175 North Medical Dr E, Salt Lake City, UT 84132, USA.
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Valderrama WB, Cutter CN. An Ecological Perspective ofListeria monocytogenesBiofilms in Food Processing Facilities. Crit Rev Food Sci Nutr 2013; 53:801-17. [DOI: 10.1080/10408398.2011.561378] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Systemic lupus erythematosus (SLE) cerebritis versus Listeria monocytogenes meningoencephalitis in a patient with systemic lupus erythematosus on chronic corticosteroid therapy: the diagnostic importance of cerebrospinal fluid (CSF) of lactic acid levels. Heart Lung 2011; 41:394-7. [PMID: 22177759 DOI: 10.1016/j.hrtlng.2011.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Listeria monocytogenes is a motile, aerobic, Gram-positive intracellular bacillus that causes enteritis, meningitis, meningoencephalitis, or subacute bacterial endocarditis. Patients with impaired T-lymphocyte function/cell-mediated immunity are predisposed to intracellular pathogens, e.g., L. monocytogenes. In adults, infection by L. monocytogenes of the central nervous system (CNS) clinically manifests as either acute bacterial meningitis or meningoencephalitis. In patients with systemic lupus erythematosus (SLE) presenting with headache and fever, SLE cerebritis must be differentiated from acute bacterial meningitis by lumbar puncture and cerebrospinal fluid (CSF) analysis. Neuropathogenic viruses are the most common causes of meningoencephalitis. The most rapid and accurate way to differentiate bacterial meningoencephalitis from nonbacterial meningoencephalitis is CSF lactic acid levels. METHODS We present a patient receiving chronic corticosteroid therapy and manifesting SLE and severe L. monocytogenes meningoencephalitis. An early diagnosis of L. meningoencephalitis was achieved by demonstrating a very highly elevated level of lactic acid in his CSF, days before CSF and blood cultures tested positive for L. monocytogenes. RESULTS AND CONCLUSION In this patient, the highly elevated levels of lactic acid in his CSF ruled out both viral meningoencephalitis and SLE cerebritis. The case was complicated by communicating hydrocephalus, and the patient later underwent placement of a shunt. He completed 6 weeks of meningeal dosed ampicillin.
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Sundén B, Larsson M, Falkeborn T, Paues J, Forsum U, Lindh M, Ydrenius L, Akerlind B, Serrander L. Real-time PCR detection of human herpesvirus 1-5 in patients lacking clinical signs of a viral CNS infection. BMC Infect Dis 2011; 11:220. [PMID: 21849074 PMCID: PMC3176207 DOI: 10.1186/1471-2334-11-220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 08/17/2011] [Indexed: 11/13/2022] Open
Abstract
Background Infections of the central nervous system (CNS) with herpes- or enterovirus can be self-limiting and benign, but occasionally result in severe and fatal disease. The polymerase chain reaction (PCR) has revolutionized the diagnostics of viral pathogens, and by multiple displacement amplification (MDA) prior to real-time PCR the sensitivity might be further enhanced. The aim of this study was to investigate if herpes- or enterovirus can be detected in cerebrospinal fluid (CSF) from patients without symptoms. Methods Cerebrospinal fluid (CSF) samples from 373 patients lacking typical symptoms of viral CNS infection were analysed by real-time PCR targeting herpesviruses or enteroviruses with or without prior MDA. Results In total, virus was detected in 17 patients (4%). Epstein-Barr virus (EBV) was most commonly detected, in general from patients with other conditions (e.g. infections, cerebral hemorrhage). MDA satisfactorily amplified viral DNA in the absence of human nucleic acids, but showed poor amplification capacity for viral DNA in CSF samples, and did not increase the sensitivity for herpes virus-detection with our methodology. Conclusions Viral pathogens are rarely detected in CSF from patients without signs of CNS infection, supporting the view that real-time PCR is a highly specific method to detect symptomatic CNS-infection caused by these viruses. However, EBV may be subclinically reactivated due to other pathological conditions in the CNS.
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Affiliation(s)
- Birgitta Sundén
- Div Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Sweden
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de Almeida SM, Boritza K, Cogo LL, Pessa L, França J, Rota I, Muro M, Ribeiro C, Raboni SM, Vidal LR, Nogueira MB, Ellis R. Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis. Clin Chem Lab Med 2011; 49:891-6. [PMID: 21345043 DOI: 10.1515/cclm.2011.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV. METHODS CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n=17); 2) HIV positive with normal CSF (n=20); 3) enterovirus meningitis (n=33); 4) Herpesviridae meningoencephalitis (n=30); 5) fungal meningitis (n=25); 6) tuberculosis (TB) meningitis (n=17); 7) toxoplasmosis (n=18); 8) neurosyphilis (n=6); 9) control group (n=57). RESULTS CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9-7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7-5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4-1.9 mmol/L) and other groups (p ≤ 0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity. CONCLUSIONS CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
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Metelmann C, Schulz K, Geldschläger-Canda R, Plötz S, Handrick W. [Listeriosis in adults - case reports and review of the literature]. Wien Klin Wochenschr 2010; 122:354-9. [PMID: 20559880 DOI: 10.1007/s00508-010-1385-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/05/2010] [Indexed: 12/19/2022]
Abstract
Listeriosis is a rare disease with increasing incidence occurring mainly in elderly people and patients suffering from underlying diseases and immunosuppressive therapy. On the basis of three case reports and a review of the literature the most important aspects of epidemiology, pathogenesis, clinical manifestations, diagnostics and therapy of listeriosis are discussed.
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Affiliation(s)
- Claudia Metelmann
- Institut für Medizinische Diagnostik Greifswald, Greifswald, Deutschland
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Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep 2010; 10:300-6. [PMID: 18765103 DOI: 10.1007/s11908-008-0049-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The foodborne pathogen Listeria monocytogenes has a particular tropism for the central nervous system and can produce infection in the meninges and brain substance. Well-recognized clinical syndromes include meningitis, brain abscess, rhombencephalitis, and spinal cord abscess; simultaneous infection of the meninges and brain is common. Although it is an uncommon cause of infection in the population at large, L. monocytogenes is an important cause of central nervous system infection in those with impaired cell-mediated immunity, whether due to underlying disease or treatment with immunosuppressive therapeutic agents; it is the etiology in 20% of bacterial meningitis cases in neonates and in 20% of cases in those older than 50 years. Ampicillin is considered the treatment of choice, and trimethoprim-sulfamethoxazole is recommended for those allergic to penicillin. At-risk patients should be advised to avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products.
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Affiliation(s)
- Heather E Clauss
- Section of Infectious Diseases, Temple University Hospital, Broad and Ontario Streets, Philadelphia, PA 19140, USA
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de Almeida SM, Faria FL, de Goes Fontes K, Buczenko GM, Berto DB, Raboni SM, Vidal LR, Nogueira MB. Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases. Clin Chem Lab Med 2009; 47:755-61. [PMID: 19527140 DOI: 10.1515/cclm.2009.160] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis. METHODS CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF. RESULTS CSF LA was higher in bacterial meningitis 8.7 + 5.4 mmol/L compared with viral meningitis (1.9 + 0.6) and the other groups (p < 0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. CONCLUSIONS CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity, specificity and predictive values. CSF LA can help in the cases with diagnostic uncertainty.
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
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