1
|
Bongiovanni M, Cavallo C, Barda B, Strulak L, Bernasconi E, Cardia A. Clinical Findings of Listeria monocytogenes Infections with a Special Focus on Bone Localizations. Microorganisms 2024; 12:178. [PMID: 38258004 PMCID: PMC10821090 DOI: 10.3390/microorganisms12010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the microorganism can occur after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described in the past. L. monocytogenes can cause a number of different clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. L. monocytogenes systemic infections can develop following tissue penetration across the gastrointestinal tract or to hematogenous spread to sterile sites, possibly evolving towards bacteremia. L. monocytogenes only rarely causes bone or joint infections, usually in the context of prosthetic material that can provide a site for bacterial seeding. We describe here the clinical findings of invasive listeriosis, mainly focusing on the diagnosis, clinical management, and treatment of bone and vertebral infections occurring in the context of invasive listeriosis.
Collapse
Affiliation(s)
- Marco Bongiovanni
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Claudio Cavallo
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
| | - Beatrice Barda
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Lukasz Strulak
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Andrea Cardia
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
| |
Collapse
|
2
|
Abstract
Listeria monocytogenes is a Gram-positive facultative intracellular pathogen that can cause severe invasive infections upon ingestion with contaminated food. Clinically, listerial disease, or listeriosis, most often presents as bacteremia, meningitis or meningoencephalitis, and pregnancy-associated infections manifesting as miscarriage or neonatal sepsis. Invasive listeriosis is life-threatening and a main cause of foodborne illness leading to hospital admissions in Western countries. Sources of contamination can be identified through international surveillance systems for foodborne bacteria and strains' genetic data sharing. Large-scale whole genome studies have increased our knowledge on the diversity and evolution of L. monocytogenes, while recent pathophysiological investigations have improved our mechanistic understanding of listeriosis. In this article, we present an overview of human listeriosis with particular focus on relevant features of the causative bacterium, epidemiology, risk groups, pathogenesis, clinical manifestations, and treatment and prevention.
Collapse
Affiliation(s)
- Merel M Koopmans
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - José A Vázquez-Boland
- Infection Medicine, Edinburgh Medical School (Biomedical Sciences), University of Edinburgh, Edinburgh, United Kingdom
| | - Diederik van de Beek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Yu L, Zhang Y, Qi X, Bai K, Zhang Z, Bu H. Next-generation sequencing for the diagnosis of Listeria monocytogenes meningoencephalitis: a case series of five consecutive patients. J Med Microbiol 2023; 72. [PMID: 36748504 DOI: 10.1099/jmm.0.001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction. The prompt and specific diagnosis of Listeria monocytogenes meningoencephalitis (LMM) is challenging. Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) is an emerging technique for diagnosing infrequent causative pathogens.Hypothesis/Gap statement. We hypothesized that NGS of CSF is an effective approach for diagnosing LMM.Aim. To evaluate the effectiveness of NGS, we present five cases of LMM diagnosed using NGS of the CSF.Methodology. Between August 2017 and 30 September 2020, we used NGS of the CSF to detect pathogens in patients with clinically suspected central nervous system infections. The clinical characteristics, laboratory tests, imaging findings and NGS results are reviewed.Results. Five patients were diagnosed with LMM using NGS of the CSF within 2 to 4 days, although the clinical manifestations, medical history and imaging findings varied strikingly. NGS of CSF showed sequence reads corresponding to L. monocytogenes species ranging from 118 to 1997 bp, genomic coverage of 0.29-5.96 %, relative abundance of 14.83-32.16 % and sequencing depth of 1.12 to 1.35. The prompt diagnosis resulted in targeted and effective treatment with the appropriate antibiotics, although two patients with the most severe cerebral parenchymal lesions showed little improvement.Conclusion. Our results demonstrate the power of NGS of CSF for the prompt diagnosis of LMM. NGS of CSF is an important complementary tool for identifying L. monocytogenes.
Collapse
Affiliation(s)
- Lili Yu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Yu Zhang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Xuejiao Qi
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Kaixuan Bai
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Zhenyuan Zhang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Hui Bu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| |
Collapse
|
4
|
Athanasiou V, Leonidou L, Lekkou A, Antzoulas P, Solou K, Diamantakis G, Gliatis J. Treatment of Prosthetic Joint Infection due to Listeria Monocytogenes. A Comprehensive Literature Review and a Case of Total Hip Arthroplasty Infection. Arthroplast Today 2022; 13:48-54. [PMID: 34977306 PMCID: PMC8683650 DOI: 10.1016/j.artd.2021.10.016] [Citation(s) in RCA: 1] [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: 08/16/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
As reported in contemporary literature, prosthetic joint infection (PJI) caused by Listeria monocytogenes (LM) is a rare infection affecting mainly immunocompromised patients. It is considered a late complication occurring months or years after the arthroplasty that is treated with, or without, implant retention, in one-stage or two-stage surgical procedures, and long-term administration of antibiotics. We reviewed the published studies in the English language and present a case of a patient who underwent total hip arthroplasty (THA) and had been affected by this infection. Our patient was successfully treated with 3 months of antibiotics (ampicillin and TMP/SMX) and a two-stage surgical procedure. The success rates of conservative treatment and one-stage or two-stage procedures are dependent on appropriate patient selection and chronicity of the infection. Ιmmmunocompromised patients are susceptible to PJI caused by LM and should be advised that consumption of unpasteurized dairy products increases the risk of this atypical infection.
Collapse
Affiliation(s)
- Vasileios Athanasiou
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Patras University Hospital, Patra, Greece
| | - Leonidia Leonidou
- Consultant in Internal Medicine, Department of Internal Medicine, Patras University Hospital, Patra, Greece
| | - Alexandra Lekkou
- Consultant in Internal Medicine, Department of Internal Medicine, Patras University Hospital, Patra, Greece
| | - Panagiotis Antzoulas
- Resident in Orthopaedic Surgery, Orthopaedic Department, Patras University Hospital, Patra, Greece
| | - Konstantina Solou
- Resident in Orthopaedic Surgery, Orthopaedic Department, Patras University Hospital, Patra, Greece
| | - Georgios Diamantakis
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Patras University Hospital, Patra, Greece
| | - John Gliatis
- Associate Professor in Orthopaedics, Orthopaedic Department, Patras University Hospital, Patra, Greece
| |
Collapse
|
5
|
Zhang N, Sun W, Zhou L, Chen M, Dong X, Wei W. Multiple brain abscesses due to Listeria monocytogenes infection in a patient with systemic lupus erythematosus: A case report and literature review. Int J Rheum Dis 2021; 24:1427-1439. [PMID: 34633142 DOI: 10.1111/1756-185x.14226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022]
Abstract
AIM To review the clinical features of systemic lupus erythematosus (SLE) complicated by central nervous system (CNS) infection due to Listeria monocytogenes. METHOD A patient with SLE receiving high-dose glucocorticoids combined with cyclophosphamide who developed multiple brain abscesses due to Listeria infection is described. The case is compared with known cases in a literature review. RESULTS A review of the literature showed that CNS infections are rare bacterial complications of SLE, but they can be a significant cause of mortality, especially those due to L. monocytogenes. The most significant risk factor for listerial meningitis is a prior history of receiving immunosuppressive therapy. At-risk patients should avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products. The case we report is the fifth SLE patient with multiple brain abscesses due to L. monocytogenes, and the first to be discharged with no sequelae. Timely and accurate identification and treatment of CNS infections and neuropsychiatric lupus are very important for favorable disease prognosis. CONCLUSION Repeated blood culture is helpful for early diagnosis, and empirical anti-infective treatment that covers L. monocytogenes is recommended for SLE patients with risk factors when CNS infection occurs. A comprehensive assessment might be helpful to distinguish CNS infections from neuropsychiatric SLE. For severe infection, the dosage of steroids does not need to be reduced immediately but can be gradually adjusted based on the results of a comprehensive evaluation of the disease.
Collapse
Affiliation(s)
- Na Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Wenwen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Lei Zhou
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Ming Chen
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Xiaoying Dong
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| |
Collapse
|
6
|
Listeria Rhomboencephalitis in an Immunocompetent Host. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Lan ZW, Xiao MJ, Guan YL, Zhan YJ, Tang XQ. Detection of Listeria monocytogenes in a patient with meningoencephalitis using next-generation sequencing: a case report. BMC Infect Dis 2020; 20:721. [PMID: 33004020 PMCID: PMC7528245 DOI: 10.1186/s12879-020-05447-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections. Case presentation We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole. Conclusion To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.
Collapse
Affiliation(s)
- Zi-Wei Lan
- The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Min-Jia Xiao
- The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Yuan-Lin Guan
- Hugobiotech Co., Ltd, No 1 Disheng East Road, Daxing District, Beijing, 100000, China
| | - Ya-Jing Zhan
- The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| | - Xiang-Qi Tang
- The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| |
Collapse
|
8
|
Aspectos actuales de la listeriosis. Med Clin (Barc) 2020; 154:453-458. [DOI: 10.1016/j.medcli.2020.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022]
|
9
|
Schlech WF. Epidemiology and Clinical Manifestations of Listeria monocytogenes Infection. Microbiol Spectr 2019; 7:10.1128/microbiolspec.gpp3-0014-2018. [PMID: 31837132 PMCID: PMC11026082 DOI: 10.1128/microbiolspec.gpp3-0014-2018] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 12/21/2022] Open
Abstract
Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the organism can develop after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described. Listeria monocytogenes can cause a number of clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. The latter syndrome mimics the veterinary infection in ruminants called "circling disease". Neonatal infection can occur as a result of maternal chorioamnionitis ("early onset" sepsis) or through passage through a birth canal colonized with Listeria from the gastrointestinal tract. ("late onset" meningitis). Treatment of listeriosis is usually with a combination of ampicillin and an aminoglycoside but other regimens have been used. The mortality rate is high, reflecting the combination of an immunocompromised host and an often delayed diagnosis.
Collapse
Affiliation(s)
- Walter F Schlech
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
10
|
Buonomo AR, Zappulo E, Viceconte G, Scotto R, Borgia G, Gentile I. Risk of opportunistic infections in patients treated with alemtuzumab for multiple sclerosis. Expert Opin Drug Saf 2018; 17:709-717. [PMID: 29848085 DOI: 10.1080/14740338.2018.1483330] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Alemtuzumab is a monoclonal anti CD-52 antibody recently approved for use in relapsing-remitting multiple sclerosis(MS). Given that the targeted antigen is primarily expressed on B and T lymphocytes, the administration of this biological drug is associated with rapid but protracted peripheral lymphopenia. AREAS COVERED The impact on infective risk of this immune impairment is still to be fully understood. In this review, we attempt to summarize all the available literature concerning opportunistic infections occurring in patients with MS receiving alemtuzumab. Infective adverse events were observed in more than 70% of patients in phase 2/3 RCTs, mainly of mild-to-moderate severity. Nevertheless, several post-marketing reports documented cases of serious, rare, and unexpected infections. EXPERT OPINION Predictive risk factors and prognostic features of opportunistic infections in this setting still need to be exactly assessed. At present, the only recommended preventive measures consist in anti-herpetic prophylaxis, Listeria-free diet, Tuberculosis prophylaxis and annual Papillomavirus screening. Given the non-negligible risk of unpredicted infective events, we advise physicians to take into account patients' history of infectious diseases and vaccine status and to consider supplementary prophylactic strategies, including screening for Toxoplasma gondii and viral hepatitis serostatus as well as pre-emptive approaches to avert CMV reactivation and Pneumocystosis.
Collapse
Affiliation(s)
- Antonio Riccardo Buonomo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Emanuela Zappulo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Giulio Viceconte
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Riccardo Scotto
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Guglielmo Borgia
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Ivan Gentile
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| |
Collapse
|
11
|
Listeria monocytogenes Infection in Hairy Cell Leukemia: A Case Report and Literature Review. Case Rep Hematol 2018; 2018:5616898. [PMID: 29651349 PMCID: PMC5831943 DOI: 10.1155/2018/5616898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022] Open
Abstract
Listeria monocytogenes infections have been described in patients with diverse types of malignancy, especially leukemia. We report the case of a 65-year-old man with previously untreated hairy cell leukemia characterized by CD5 positivity and trisomy 12 (3% of blood lymphocytes) who developed bacteremia due to L. monocytogenes serotype 1/2b. We summarize clinical features and treatment of this patient and five previously reported patients with hairy cell leukemia who also had L. monocytogenes infections. All six patients were men. Their mean age at infection diagnosis was 70 y. Three men had undergone splenectomy 4–11 y before they developed L. monocytogenes infection. The central nervous system was the primary site of infection in four men. Bacteremia alone occurred in two other men. At diagnosis of infection, one man was receiving antileukemia chemotherapy and another man was receiving treatment for Kaposi's sarcoma. Two other patients had other comorbid conditions. All six men recovered from their infections.
Collapse
|
12
|
Two cases of listeria rhombencephalitis. IDCases 2017; 11:22-25. [PMID: 29255676 PMCID: PMC5726744 DOI: 10.1016/j.idcr.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022] Open
Abstract
Listeria rhombencephalitis (LRE) is a rare encephalitis of the hindbrain that can present with a variety of neurological symptoms. It is a diagnostic challenge, but prompt antimicrobial therapy is important to prevent high rates of mortality and morbidity. We report two cases of LRE, with several contrasting clinical features and different disease courses. Despite being rare, it is important to consider listeria in patients with possible meningoencephalitis, even if cultures are negative. Empirical treatment of meningoencephalitis should provide coverage for listeria, especially if the patient is at risk of listeriosis or there is a potential history of listeria exposure.
Collapse
|
13
|
Korsak D, Krawczyk-Balska A. Identification of the Molecular Mechanism of Trimethoprim Resistance inListeria monocytogenes. Foodborne Pathog Dis 2017; 14:696-700. [PMID: 28910155 DOI: 10.1089/fpd.2017.2323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dorota Korsak
- Department of Applied Microbiology, Faculty of Biology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| | - Agata Krawczyk-Balska
- Department of Applied Microbiology, Faculty of Biology, Institute of Microbiology, University of Warsaw, Warsaw, Poland
| |
Collapse
|
14
|
Management of adult infectious encephalitis in metropolitan France. Med Mal Infect 2017; 47:206-220. [PMID: 28336304 DOI: 10.1016/j.medmal.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Infectious encephalitis is a severe disease leading to a high mortality and morbidity. The most frequent causes include Herpes simplex virus, Varicella Zoster virus, Listeria monocytogenes, and Mycobacterium tuberculosis. Urgent treatment is required (anti-infective therapy and nonspecific supportive care). The aim of this study was to define treatment strategy, empirical and after microbiological documentation at 48hours, through a systematic literature review.
Collapse
|
15
|
Abstract
Background In patients, rapid identification of bacterial species may help to guide treatment at early stages. New protocols for the identification directly from positive blood culture flasks significantly helped in the presented case report. Case presentation Two patients (a father and son) presented with diarrhea, malaise, and fever of 3 to 4 days duration. Blood cultures from both patients cultured short Gram-positive rods. MALDI-TOF based rapid identification protocol direct from positive blood culture identified Listeria monocytogenes as the cause of sepsis and could be confirmed with conventional methods. Listeria monocytogenes was identified 24 h later by conventional biochemical identification methods (VITEK 2). Antibiotic treatment was adjusted early in response to the MALDI-TOF based identification of bacteremia. Pulsed field gel electrophoresis confirmed the suspected relatedness of the father’s and son’s isolates. Conclusions MALDI-TOF based may provide a rapid identification of bacterial species directly from positive blood culture.
Collapse
|
16
|
Seo Y, Noh YS, Wie SH, Chang UI. Prosthetic knee joint infection due to Listeria monocytogenes bacteremia in a diabetic female. Korean J Intern Med 2016; 31:616-9. [PMID: 26813571 PMCID: PMC4855094 DOI: 10.3904/kjim.2014.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | - U-Im Chang
- Correspondence to U-Im Chang, M.D. Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-8313 Fax: +82-31-253-8898 E-mail:
| |
Collapse
|
17
|
Hobbs M. Colovesical fistula presenting as Listeria monocytogenes bacteraemia. BMJ Case Rep 2015; 2015:bcr-2014-209178. [PMID: 25827919 DOI: 10.1136/bcr-2014-209178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of colovesical fistula presenting with a clinical syndrome of urosepsis subsequently demonstrated to be due to Listeria monocytogenes bacteraemia. The patient had a history of previous rectal cancer with a low anterior resection and a covering ileostomy that had been reversed 6 months prior to this presentation. L. monocytogenes was also isolated among mixed enteric organisms on urine culture. There were no symptoms or signs of acute gastrointestinal listeriosis or meningoencephalitis. This unusual scenario prompted concern regarding the possibility of communication between bowel and bladder, which was subsequently confirmed with CT and a contrast enema. The patient recovered well with intravenous amoxicillin and to date has declined surgical management of his colovesical fistula. This case illustrates the importance of considering bowel pathology when enteric organisms such as Listeria are isolated from unusual sites.
Collapse
Affiliation(s)
- Mark Hobbs
- General Medicine, Middlemore Hospital, Auckland, New Zealand
| |
Collapse
|
18
|
The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study. Eur J Clin Microbiol Infect Dis 2015; 34:1213-21. [DOI: 10.1007/s10096-015-2346-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
|
19
|
Abstract
Listeria monocytogenes is a ubiquitous Gram-positive bacillus widespread in nature. It is responsible for febrile abortion and encephalitis in cattle. It survives and multiplies at 4°C and does not alter the taste of food. Listeria monocytogenes is able to cross 3 host barriers: the intestinal, blood-brain and placental barriers. Maternal infection is rare but still severe in France, with 30 to 50 annual cases. Maternal infection is frequently asymptomatic, or manifests as isolated fever, whereas fetal and neonatal infection is severe and have a poor prognosis, with up to 25-35 % fetal/neonatal mortality. Amoxicillin is the reference antibiotic for listeriosis treatment and should be administered to every pregnant patient with unexplained fever, particularly in case of consumption of at risk food. Prevention in pregnant women relies on adherence to strict diet recommendations such as reheating of leftovers until steaming and avoidance of unpasteurized dairy products, cold delicatessen, meat spreads and pâtés. Listeriosis is a notifiable disease in France.
Collapse
|
20
|
|
21
|
Listeria monocytogenes meningitis in adults: the Czech Republic experience. BIOMED RESEARCH INTERNATIONAL 2013; 2013:846186. [PMID: 24106719 PMCID: PMC3784069 DOI: 10.1155/2013/846186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/13/2013] [Indexed: 11/22/2022]
Abstract
Background. Listeria monocytogenes (LM) is currently the third most frequent pathogen of bacterial meningitis in adults. Methods. A prospective study of patients with LM meningitis in a Czech tertiary care hospital, carried out from 1997 to 2012. Results. Thirty-one patients were diagnosed with LM meningitis, which was 7% of a total of 440 adult patients with acute bacterial meningitis (ABM) over a 16-year period. Their median age was 63 years, range 26–80 years. Nineteen patients (61%) had underlying immunocompromising comorbidity; 15 patients (48%) were older than 65 years. Fourteen patients (45%) had arterial hypertension. The typical triad of fever, neck stiffness, and altered mental status was present in 21 patients (68%). The median count of cerebrospinal fluid (CSF) leukocytes was 680/μL, protein level 2.6 g/L, and glucose ratio 0.28. Four patients (13%) died, and nine (29%) survived with moderate to severe sequelae.
Conclusion. LM meningitis is known to affect immunosuppressed and elderly patients. Arterial hypertension seems to be another important predisposing factor. Clinical symptoms, CSF findings, and disease outcomes, did not significantly differ from other community-acquired ABM in our study, although the CSF leukocyte count was lower. Ampicillin showed good clinical and bacteriological efficacy in the majority of patients.
Collapse
|
22
|
Hu R, Li J, Yao K, Miao M, Zhu K, Liu Z. Listeria septicemia accompanied by central nervous system involvement in a patient with multiple myeloma and secondary diabetes. Am J Case Rep 2013; 14:226-9. [PMID: 23847709 PMCID: PMC3702689 DOI: 10.12659/ajcr.889168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 05/14/2013] [Indexed: 11/26/2022] Open
Abstract
Patient: Female, 58 Final Diagnosis: Listeria septicemia Symptoms: Nausea • vomitting • high fever • apathetic intelligence • repeated convulsion Medication: Levofloxacin Clinical Procedure: — Specialty: Hematology Objective: Rare disease
Collapse
Affiliation(s)
- Rong Hu
- Department of Hematology, Shengjing Hospital, China Medical University, Shenyang,China
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.
Collapse
Affiliation(s)
- Diederik van de Beek
- Department of Neurology, Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | | | | | | |
Collapse
|
24
|
Abstract
Among bacteria that reach the central nervous system (CNS), Listeria monocytogenes (Lm) is one of deadliest, in human and ruminant. This facultative intracellular bacterium has the particularity to induce meningitis, meningoencephalitis and rhombencephalitis. Mechanisms by which Lm accesses the CNS remain poorly understood, but two major routes of infection have been proposed, based on clinical, in vitro and in vivo observations. A retrograde neural route is likely to occur in ruminants upon crossing of the oral epithelium, and this probably accounts for the observation that Lm induces almost exclusively rhombencephalitis in these animals. In contrast, the hematogenous route is likely the most frequent in human, in whom bacteria circulating in the blood, either free or associated with leukocytes are thought to breach the blood-brain barrier. New animal models that faithfully reproduce the hallmarks of human neurolisterisosis will allow addressing the molecular mechanisms underlying Lm ability to induce CNS disease, and improve our understanding of the pathophysiology of this deadly infection.
Collapse
Affiliation(s)
- Olivier Disson
- Microbes and Host Barriers Group, French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France
| | | |
Collapse
|
25
|
Goldberg E, Bishara J. Contemporary unconventional clinical use of co-trimoxazole. Clin Microbiol Infect 2012; 18:8-17. [DOI: 10.1111/j.1469-0691.2011.03613.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Muñoz P, Rojas L, Bunsow E, Saez E, Sánchez-Cambronero L, Alcalá L, Rodríguez-Creixems M, Bouza E. Listeriosis: An emerging public health problem especially among the elderly. J Infect 2012; 64:19-33. [DOI: 10.1016/j.jinf.2011.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/16/2011] [Accepted: 10/17/2011] [Indexed: 12/27/2022]
|
27
|
Kosmidis CI, Chandrasekar PH. Management of gram-positive bacterial infections in patients with cancer. Leuk Lymphoma 2011; 53:8-18. [PMID: 21740298 DOI: 10.3109/10428194.2011.602770] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bacterial infections, particularly those due to gram-positive bacteria, continue to predominate in patients with cancer. Coagulase-negative and coagulase-positive staphylococci and enterococci remain as common pathogenic microorganisms. Clostridium difficile has emerged as a significant pathogen. Major clinical syndromes include vascular catheter-related infection, febrile neutropenia, diarrhea and colitis. Rising antimicrobial resistance among gram-positive bacteria is of serious concern. The clinical utility of penicillin against streptococci and vancomycin against coagulase-negative and coagulase-positive staphylococci and enterococci may be rapidly diminishing. Liberal empiric use of vancomycin during neutropenic fever needs careful reconsideration. Newer promising anti-gram-positive bacterial drugs with activity against methicillin-resistant staphylococci include daptomycin, linezolid, tigecycline and telavancin. However, toxicity concerns, limited data in immunocompromised populations and high cost prevent the widespread use of these drugs among patients with cancer.
Collapse
|
28
|
Fernández Guerrero ML, Torres R, Mancebo B, González-López JJ, Górgolas M, Jusdado JJ, Roblas RF. Antimicrobial treatment of invasive non-perinatal human listeriosis and the impact of the underlying disease on prognosis. Clin Microbiol Infect 2011; 18:690-5. [PMID: 21851486 DOI: 10.1111/j.1469-0691.2011.03616.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Listeriosis is a resurgent foodborne disease in European countries. Benefits of combined β-lactam-aminoglycoside treatment remain controversial and the impact of the underlying disease on prognosis has not been fully assessed. We conducted a retrospective review of cases of sporadic listeriosis in adults from 1995 to 2008 at two university-affiliated hospitals serving a population of 600,000 people in Madrid, Spain. The primary end-point was the associated in-hospital mortality. Sixty-four patients were studied. Estimated incidence of listeriosis was 0.76/100.000 persons/year. Seventy-four per cent had chronic underlying diseases; cirrhosis of the liver and haematological and solid neoplasias were the most common comorbidities. Primary bacteraemia (58%) and meningitis (42%) were the most frequent manifestations. Focal infections were seen in ten cases. In-hospital mortality was 31%. Patients treated with ampicillin or with an ampicillin-gentamicin combination did not differ in age, severity of underlying disease or type of presentation. Differences in mortality were not seen between patients treated with monotherapy and those given combined treatment (28% vs 35%; p 0.634). Ten patients were treated with trimethoprim-sulfamethozaxole alone and only one died. All patients without comorbidities survived infection but mortality of patients with cirrhosis of the liver was 21% and that of patients with haematological or solid neoplasias was 66%. Only haematological neoplasia (OR 6.67; 95% CI 1.71-26.04; p 0.006) was significantly associated with an increased risk of mortality (R(2) (Cox-Snell) = 0.262). Mortality of listeriosis mainly depended on the severity of the underlying disease. Combined ampicillin-gentamicin therapy did not improved survival. Trimethoprim-sulfamethozaxole may be an effective alternative therapy for listerial infections.
Collapse
Affiliation(s)
- M L Fernández Guerrero
- Division of Infectious Diseases, Department of Medicine, Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz and Service of Internal Medicine, Hospital Severo Ochoa, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
29
|
Potential nosocomial acquisition of epidemic Listeria monocytogenes presenting as multiple brain abscesses resembling nocardiosis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 21:57-60. [PMID: 21358887 DOI: 10.1155/2010/812648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Listerial brain abscesses are rare, and are found mostly in patients with underlying hematological malignancies or solid-organ transplants. A case of a patient with Crohn's disease and multiple brain abscesses involving the left cerebellum and right sylvian fissure is described. The Gram stain and histopathology of the cerebellar abscess revealed Gram-positive, beaded rods suggestive of Nocardia. However, on culture, Listeria monocytogenes was identified. Listeria may appear Gram-variable and has been misidentified as streptococci, enterococci and diphtheroids. The present case is the first reported case of L monocytogenes resembling Nocardia on both microbiological and histopathological assessment. Reported cases of listerial brain abscesses are sporadic, while the current case was part of a nationwide listerial outbreak linked to consumption of contaminated deli meats. Broad antimicrobial therapy (including antilisterial coverage) in immunosuppressed patients presenting with brain abscess is crucial, until cultures confirm the identification of the organism.
Collapse
|
30
|
Talbot BEM, Webster D, Fisher M, Alexander E. High-dose amoxicillin should be included in the empirical treatment of suspected meningitis in patients at risk of HIV infection. BMJ Case Rep 2011; 2011:bcr.04.2011.4057. [PMID: 22696737 DOI: 10.1136/bcr.04.2011.4057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report on a case of Listeria rhomboencepahlitis in a previously undiagnosed HIV positive man. This case is of interest as the incidence of Listeria has increased dramatically in recent years and so may increase in the HIV-infected population. The organism is inherently resistant to cephalosporin antibiotics, empirically employed in the treatment of central nervous system infections and thus highlights the need to include amoxicillin in meningitis treatment regimes in patients at risk of HIV infection as well as the older and those known to be immuno-compromised.
Collapse
|
31
|
Lee MC, Wu YK, Chen CH, Wu TW, Lee CH. Listeria monocytogenes meningitis in a young woman with systemic lupus erythematosus. Rheumatol Int 2010; 31:555-7. [DOI: 10.1007/s00296-010-1590-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 07/14/2010] [Indexed: 11/28/2022]
|
32
|
Moragas M, Martínez-Yélamos S, Murillo Ó, Fernández-Viladrich P. Absceso cerebral del adulto por Listeria monocytogenes: presentación de 6 casos y revisión de la literatura médica. Enferm Infecc Microbiol Clin 2010; 28:87-94. [DOI: 10.1016/j.eimc.2009.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/02/2009] [Accepted: 01/08/2009] [Indexed: 10/20/2022]
|
33
|
Deghmane AE, Alonso JM, Taha MK. Emerging drugs for acute bacterial meningitis. Expert Opin Emerg Drugs 2009; 14:381-93. [DOI: 10.1517/14728210903120887] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
34
|
Therapie der Listeriose. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-1946-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
35
|
[Treatment of opportunistic infections in adolescent and adult patients infected with the human immunodeficiency virus during the era of highly active antiretroviral therapy. AIDS Study Group (GESIDA) and National AIDS Plan Expert Committee]. Enferm Infecc Microbiol Clin 2008; 26:356-79. [PMID: 18588819 DOI: 10.1157/13123842] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the huge advance that highly active antiretroviral therapy has represented for the prognosis of infection by human immunodeficiency virus (HIV), opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. This is often the case because of severe immunodepression, poor adherence to antiretroviral therapy, failure of therapy, or the fact that patients are unaware of their HIV-positive status and debut with an opportunistic infection. This article updates the guidelines on treatment of acute episodes of various opportunistic infections in HIV-infected patients, including infections due to parasites, fungi, viruses, mycobacteria, and bacteria. This edition has a new chapter on imported parasite infections as well as additional information on endemic mycoses in the chapter on fungal infections, taking into account the growing number of immigrants in our setting. Lastly, the chapter on the immune reconstitution syndrome has also been updated, providing relevant data on a phenomenon that has clinical and diagnostic repercussions in patients who start antiretroviral therapy while they are severely immunodepressed (English version available at http://www.gesida.seimc.org).
Collapse
|
36
|
Tsai SH, Chu SJ, Wu CP, Wang NC. Listerial meningitis in a patient with undiagnosed acquired immunodeficiency syndrome: ampicillin should be added to the empirical antibiotic coverage. Emerg Med J 2007; 23:e50. [PMID: 16921071 PMCID: PMC2564238 DOI: 10.1136/emj.2006.036152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Meningitis is an important differential diagnosis in patients with fever, headache, and/or altered consciousness in the emergency department (ED). With human immunodeficiency virus (HIV) infection becoming increasingly common, patients with acquired immunodeficiency syndrome (AIDS) need to be recognised promptly to facilitate the choice of appropriate antibiotic therapy for potential opportunistic infections. Physicians should be able to recognise a patient with undiagnosed AIDS who presents to the ED and perform further confirmational tests without violating the rights of the patient. Additional tests focusing on discovering potential opportunistic pathogens should be performed. Ampicillin should be added to the empirical regimen for the coverage of Listeria meningocerebritis, which should be considered in all potentially immunocompromised hosts with suggestive clinical presentations. Failure to recognise patients with AIDS and provide antibiotics active against L monocytogenes in such hosts may lead to a catastrophic outcome.
Collapse
Affiliation(s)
- S-H Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | | |
Collapse
|
37
|
Leza MA, Fernández JAC, Simón MRP, Laso JG, Fernández AA, Millán LA. Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura. Rev Clin Esp 2002. [DOI: 10.1016/s0014-2565(02)71170-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Schlech WF. Reply. Clin Infect Dis 2001. [DOI: 10.1086/320176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
39
|
|
40
|
Abstract
The authors discuss the latest findings regarding the use of one or more antimicrobial drugs for a variety of infections. They offer suggestions for treatment based on a host of considerations, including the synergy and antagonism of specific drugs, type of infection, potential toxicities, and cost.
Collapse
Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, University of Madrid, Madrid, Spain.
| | | |
Collapse
|
41
|
Abstract
Listeria monocytogenes emerged as an important foodborne pathogen in the latter part of the 20th century. Clinical syndromes caused by this microorganism include sepsis in the immunocompromised patient, meningoencephalitis in infants and adults, and febrile gastroenteritis. Focal infections at other sites are less frequent. Listeria species are commonly found in raw and unprocessed food products. Major outbreaks of listeriosis, with high morbidity and mortality, have been caused by a variety of foods, including soft cheeses, delicatessen meats, and vegetable products. Improved detection methods, dietary recommendations, and, in some cases, preemptive antibiotic treatment or prophylaxis have reduced the incidence of sporadic listeriosis infections in the United States. Microbial virulence factors distinguishing environmental strains of L. monocytogenes from invasive strains causing foodborne illness and host factors promoting human infection remain incompletely understood.
Collapse
Affiliation(s)
- W F Schlech
- Division of Infectious Diseases, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
| |
Collapse
|
42
|
Nau R, Sörgel F, Prange HW. Pharmacokinetic optimisation of the treatment of bacterial central nervous system infections. Clin Pharmacokinet 1998; 35:223-46. [PMID: 9784935 DOI: 10.2165/00003088-199835030-00005] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Central nervous system (CNS) infections caused by bacteria with reduced sensitivity to antibacterials are an increasing worldwide challenge. In successfully treating these infections the following conditions should be considered: (i) Antibacterials do not distribute homogeneously in the central nervous compartments [cerebrospinal fluid (CSF), extracellular space of the nervous tissue, intracellular space of the neurons, glial cells and leucocytes]. Even within the CSF, after intravenous administration, a ventriculo-lumbar concentration gradient is often observed. (ii) Valid parameters of drug entry into the CSF are the CSF: serum concentration ratio in steady state and the CSF: serum ratio of the area under the concentration-time curves (AUCCSF/AUCS). Frequently, the elimination half-life (t1/2 beta) in CSF is longer than t1/2 beta in serum. (iii) For most antibacterials, lipophilicity, molecular weight and serum protein binding determine the drug entry into the CSF and brain tissue. With an intact blood-CSF and blood-brain barrier, the entry of hydrophilic antibacterials (beta-lactam antibacterials, glycopeptides) into the CNS compartments is poor and increases during meningeal inflammation. More lipophilic compounds [metronidazole, quinolones, rifampicin (rifampin) and chloramphenicol] are less dependent on the function of the blood-CSF and blood-brain barrier. (iv) Determination of the minimal inhibitory concentrations (MIC) of the causative organism is necessary for optimisation of treatment. (v) For rapid sterilisation of CSF, drug concentrations of at least 10 times MIC are required. The minimum CSF concentration: MIC ratio ensuring successful therapy is unknown. Strategies to achieve optimum antibacterial concentrations in the presence of minor disturbances of the blood-CSF and blood-brain barrier include, the increased use of low toxicity antibacterials (e.g., beta-lactam antibiotics), the use of moderately lipophilic compounds, and the combination of intravenous and intraventricular administration. Antibacterials which do not interfere with bacterial cell wall synthesis delay and/or decrease the liberation of proinflammatory bacterial products, delay or inhibit tumour necrosis factor release, and may reduce brain oedema in experimental meningitis. Conclusive evidence of the reduction of neuronal damage by this approach, however, is lacking.
Collapse
Affiliation(s)
- R Nau
- Department of Neurology, University of Göttingen, Germany.
| | | | | |
Collapse
|
43
|
Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77:313-36. [PMID: 9772921 DOI: 10.1097/00005792-199809000-00002] [Citation(s) in RCA: 270] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We reviewed 776 previously reported and 44 new cases of CNS listeriosis outside of pregnancy and the neonatal period, and evaluated the epidemiologic, diagnostic, and therapeutic characteristics of this infection. Among patients with Listeria meningitis/meningoencephalitis, hematologic malignancy and kidney transplantation were the leading predisposing factors, but 36% of patients had no underlying diseases recognized. The infection occurred throughout life, with a higher incidence before the age of 3 and after the age of 45-50 years. Fever, altered sensorium, and headache were the most common symptoms, but 42% of patients had no meningeal signs on admission. Compared with patients with acute meningitis due to other bacterial pathogens, patients with Listeria infection had a significantly lower incidence of meningeal signs, and the CSF profile was significantly less likely to have a high WBC count or a high protein concentration. Gram stain of CSF was negative in two-thirds of cases of CNS listeriosis. One-third of patients had focal neurologic findings, and approximately one-fourth developed seizures over their course. Mortality was 26% overall, and was higher among patients with seizures and those older than 65 years of age. Relapse occurred in 7% of episodes. Ampicillin for a minimum of 15-21 days (with an aminoglycoside for at least the first 7-10 days) remains the treatment of choice. Cerebritis/abscess due to L. monocytogenes, without meningeal involvement, is less common but may be diagnosed by blood cultures and CNS imaging, or by stereotactic biopsy. Longer antibiotic therapy (at least 5-6 weeks) is needed in the presence of localized CNS involvement.
Collapse
Affiliation(s)
- E Mylonakis
- Infectious Disease Division, Massachusetts General Hospital, Boston 02114, USA
| | | | | |
Collapse
|
44
|
|