1
|
Averbuch D, Tridello G, Wendel L, Itälä-Remes M, Oren I, Karas M, Blijlevens N, Beguin Y, Broers A, Calore E, Cattaneo C, Isaksson C, Robin C, Gadisseur A, Maertens J, De Becker A, Lueck C, Metafuni E, Pichler H, Popova M, Ram R, Yeshurun M, Mikulska M, Camara RDL, Styczynski J. Listeria monocytogenes Infections in Hematopoietic Cell Transplantation Recipients: Clinical Manifestations and Risk Factors. A Multinational Retrospective Case-Control Study from the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:712.e1-712.e12. [PMID: 38621480 DOI: 10.1016/j.jtct.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
Listeriosis is rare after hematopoietic stem cell transplantation (HCT). Little is known about listeriosis in this population. In this retrospective international case-control study, we evaluated 41 listeriosis episodes occurring between 2000 and 2021 in HCT recipients (111 transplant centers in 30 countries) and assessed risk factors for listeriosis by comparisons with matched controls. The 41 listeriosis episodes (all due to Listeria monocytogenes [LM]) occurred in 30 allogeneic (allo)-HCT recipients and 11 autologous (auto)-HCT recipients at a median of 6.2 months (interquartile range [IQR], 1.6 to 19.3 months) post-HCT. The estimated incidence was 49.8/100,000 allo-HCT recipients and 13.7/100,000 auto-HCT recipients. The most common manifestations in our cohort were fever (n = 39; 95%), headache (n = 9; 22%), diarrhea, and impaired consciousness (n = 8 each; 20%). Four patients (10%) presented with septic shock, and 19 of 38 (50%) were severely lymphocytopenic. Thirty-seven patients (90%) had LM bacteremia. Eleven patients (27%) had neurolisteriosis, of whom 4 presented with nonspecific signs and 5 had normal brain imaging findings. Cerebrospinal fluid analysis revealed high protein and pleocytosis (mainly neutrophilic). Three-month mortality was 17% overall (n = 7), including 27% (n = 3 of 11) in patients with neurolisteriosis and 13% (n = 4 of 30) in those without neurolisteriosis. In the multivariate analysis comparing cases with 74 controls, non-first HCT (odds ratio [OR], 5.84; 95% confidence interval [CI], 1.10 to 30.82; P = .038); and lymphocytopenia <500 cells/mm3 (OR, 7.54; 95% CI, 1.50 to 37.83; P = .014) were significantly associated with listeriosis. There were no statistically significant differences in background characteristics, immunosuppression, and cotrimoxazole prophylaxis between cases and controls. HCT recipients are at increased risk for listeriosis compared to the general population. Listeriosis cause severe disease with septic shock and mortality. Neurolisteriosis can present with nonspecific signs and normal imaging. Lymphocytopenia and non-first HCT are associated with an increased risk of listeriosis, and cotrimoxazole was not protective.
Collapse
Affiliation(s)
- Dina Averbuch
- Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
| | - Gloria Tridello
- European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
| | - Lotus Wendel
- European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
| | - Maija Itälä-Remes
- Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland
| | - Ilana Oren
- Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland; Infectious Diseases Unit, Rambam Medical Center, Haifa, Israel
| | - Michal Karas
- Allogeneic Stem Cell Transplant Unit, Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yves Beguin
- Department of Hematology, CHU of Liège and University of Liège, Liège, Belgium
| | - Annoek Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabetta Calore
- Pediatric Hematology-Oncology and Stem Cell Transplant Division, University Hospital of Padova, Italy
| | | | | | - Christine Robin
- Department of Hematology, APHP Henri Mondor Teaching Hospital, Créteil, France
| | - Alain Gadisseur
- Department of Hematology, Stem Cell Transplantation & Coagulation Disorders, Antwerp University Hospital, Edegem, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ann De Becker
- Department of Hematology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Catherina Lueck
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Elisabetta Metafuni
- Department of Diagnostic Imaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Rome, Italy
| | - Herbert Pichler
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marina Popova
- Bone Marrow Transplantation, RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Ron Ram
- Bone Marrow Transplantation Unit, Hematology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | | | - Jan Styczynski
- Department of Paediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| |
Collapse
|
2
|
Xu W, Peng MJ, Lu LS, Guo ZJ, Li AM, Li J, Cheng Y, Li JY, Li YJ, Lian JQ, Li Y, Sun Y, Zhang WL, Zhang Y. Clinical Characteristics and Fatality Risk Factors for Patients with Listeria monocytogenes Infection: A 12-Year Hospital-Based Study in Xi'an, China. Infect Dis Ther 2024; 13:1359-1378. [PMID: 38733495 PMCID: PMC11128421 DOI: 10.1007/s40121-024-00986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Listeriosis is a severe food-borne disease caused by Listeria monocytogenes infection. The data of listeriosis in Xi'an population are limited. The aim of this study is to evaluate the clinical features and fatality risk factors for listeriosis in three tertiary-care hospitals in Xi'an, China METHODS: The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, cranial imaging examination, antibiotics therapeutic schemes, and clinical outcomes were collected between 2011 and 2023. Logistic regression analysis was performed. RESULTS Seventy-one etiologically confirmed listeriosis patients were enrolled, including 12 neonatal and 59 non-neonatal cases. The majority of neonatal listeriosis presented as preterm (50%) and fetal distress (75%). The main clinical manifestations of non-neonatal listeriosis included fever (88%), headache (32%), disorder of consciousness (25%), vomiting (17%), abdominal pain (12%), and convulsions (8%). The fatality rate in neonatal cases was higher than in non-neonatal listeriosis (42 vs. 17%). Although no deaths were reported in maternal listeriosis, only two of 23 patients had an uneventful obstetrical outcome. Five maternal listeriosis delivered culture-positive neonates, three of whom decreased within 1 week post-gestation due to severe complications. Twenty-eight cases were neurolisteriosis and 43 cases were bacteremia. Neurolisteriosis had a higher fatality rate compared with bacteremia listeriosis (36 vs. 12%). The main neuroradiological images were cerebral edema/hydrocephalus, intracranial infection, and cerebral hernia. Listeria monocytogenes showed extremely low resistance to ampicillin (two isolates) and penicillin (one isolate). The fatality risk factors were the involvement of the central nervous system, hyperbilirubinemia, and hyponatremia for all enrolled subjects. Hyperuricemia contributed to the elevation of fatality risk in non-neonatal listeriosis. CONCLUSIONS When the patients suffered with symptoms of fever and central nervous system infection, they should be alert to the possibility of listeriosis. Early administration of ampicillin- or penicillin-based therapy might be beneficial for recovery of listeriosis.
Collapse
Affiliation(s)
- Wen Xu
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
- Department of Disease Prevention and Control, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, China
| | - Mei-Juan Peng
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Lin-Shan Lu
- Department of Obstetrics and Gynecology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, China
| | - Zhen-Jun Guo
- Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - A-Min Li
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Jing Li
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Yan Cheng
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Jia-Yu Li
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Yi-Jun Li
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, 17 Changle West Rd, Xi'an, 710032, Shaanxi, China
| | - Jian-Qi Lian
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Yu Li
- Department of Infectious Diseases, Shaanxi Provincial People's Hospital, 256 West Youyi Rd, Xi'an, 710068, Shaanxi, China.
| | - Yang Sun
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Xi'an Medical University, 167 Fangdong St, Xi'an, 710038, Shaanxi, China.
| | - Wei-Lu Zhang
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, 17 Changle West Rd, Xi'an, 710032, Shaanxi, China.
| | - Ye Zhang
- Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China.
| |
Collapse
|
3
|
Keeratiratwattana A, Saraya AW, Prakkamakul S. Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis. Neuroradiology 2024; 66:717-727. [PMID: 38436702 DOI: 10.1007/s00234-024-03313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To describe the imaging findings and determine the incidence of a characteristic worm-like pattern along the white matter tracts in neurolisteriosis on CT/MRI. METHODS An IRB-approved retrospective study in 21 consecutive neurolisteriosis cases during January 2002-July 2020. At least one of the following is required: (1) Positive Listeria monocytogenes (LM) in blood with clinical signs of meningeal irritation and/or abnormal CSF profile, (2) positive LM in blood with signs of encephalitis, (3) positive LM in CSF, (4) positive LM from brain biopsy/aspiration. Six cases were excluded due to the lack of contrast-enhanced images, leaving a total of 15 cases for analysis (mean age 53.5 years ± 18.8 SD). The imaging studies were independently reviewed by two blinded readers. Demographic data, imaging findings, and incidence of the worm-like pattern were reported. The Cohen's kappa was used to calculate interrater reproducibility. RESULTS Of the 12 patients with relevant imaging findings, nine cases (75%) had parenchymal lesions (eight cases in supratentorial compartment and one case in infratentorial compartment), four cases (33.3%) had leptomeningeal enhancement and two cases (16.7%) had hydrocephalus. Brain abscesses were found in eight cases and nodules evocative of abscess in one case. Restricted diffusion in the central area and hemosiderin deposition were observed in all cases. The involvement of white matter tract in a worm-like pattern was demonstrated in eight of nine patients with parenchymal lesions (88.9%). CONCLUSION Abnormal findings in brain CT/MRI images are common in neurolisteriosis. The incidence of worm-like spread along the white matter tracts is high and may help diagnose suspicious patients.
Collapse
Affiliation(s)
- Aimpavee Keeratiratwattana
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand
| | - Abhinbhen W Saraya
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases and Health Science Centre (TRC-EID-HS), King Chulalongkorn Memorial Hospital - The Thai Red Cross Society, Bangkok, Thailand
| | - Supada Prakkamakul
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand.
| |
Collapse
|
4
|
Ryabinkina YV, Shapovalenko TV, Polishchuk RV, Luneva IE, Koneva EE, Sidyakina IV, Yatsko KA. [Listeria meningoencephalitis resulting in complete bilateral ophtalmoplegia and locked-in syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:140-147. [PMID: 38465823 DOI: 10.17116/jnevro2024124021140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This is a description of the case of quite severe neurolisteriosis in an adult man resulting in the rare combination of neurological symptoms such as complete bilateral ophtalmoplegia and locked-in syndrome. The case illustrates clinical features that are special for this disorder and also highlights management of such patients.
Collapse
Affiliation(s)
| | | | | | - I E Luneva
- Research Center of Neurology, Moscow, Russia
| | - E E Koneva
- Clinical Hospital MEDSI in Otradnoye, Moscow, Russia
| | - I V Sidyakina
- Clinical Hospital MEDSI in Otradnoye, Moscow, Russia
| | - K A Yatsko
- Research Center of Neurology, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
| |
Collapse
|
5
|
Garrì F, Puthenparampil M, Simonato D, Rinaldi F, Gallo P. A rare case of Listeria rhombencephalitis with a sudden onset and unusual brain MRI features. Neurol Sci 2024; 45:353-355. [PMID: 37735306 DOI: 10.1007/s10072-023-07080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Federica Garrì
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy.
| | - Marco Puthenparampil
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
| | - Davide Simonato
- Neuroradiology Unit (DS), University Hospital of Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
| | - Paolo Gallo
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
| |
Collapse
|
6
|
Fotopoulou ET, Jenkins C, Barker CR, Painset A, Didelot X, Simbo A, Douglas A, Godbole G, Jorgensen F, Gharbia S, McLauchlin† J. Genomic epidemiology of the clinically dominant clonal complex 1 in the Listeria monocytogenes population in the UK. Microb Genom 2024; 10:001155. [PMID: 38165396 PMCID: PMC10868620 DOI: 10.1099/mgen.0.001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Listeria monocytogenes is a food-borne pathogen, typically affecting the elderly, immunocompromised patients and pregnant women. The aim of this study was to determine the population structure of L. monocytogenes clonal complex 1 (CC1) in the UK and describe the genomic epidemiology of this clinically significant CC. We interrogated a working dataset of 4073 sequences of L. monocytogenes isolated between January 2015 and December 2020 from human clinical specimens, food and/or food-production environments. A minimum spanning tree was reconstructed to determine the population structure of L. monocytogenes in the UK. Subsequent analysis focused on L. monocytogenes CC1, as the cause of the highest proportion of invasive listeriosis in humans. Sequencing data was integrated with metadata on food and environmental isolates, and information from patient questionnaires, including age, sex and clinical outcomes. All isolates either belonged to lineage I (n=1299/4073, 32%) or lineage II (n=2774/4073, 68%), with clinical isolates from human cases more likely to belong to lineage I (n=546/928, 59%) and food isolates more likely to belong to lineage II (n=2352/3067, 77%). Of the four largest CCs, CC1 (n=237) had the highest proportion of isolates from human cases of disease (CC1 n=160/237, 67.5 %; CC121 n=13/843, 2 %; CC9 n=53/360, 15 %; CC2 n=69/339, 20%). Within CC1, most cases were female (n=95/160, 59%, P=0.01771) and the highest proportion of cases were in people >60 years old (39/95, 41%, P=1.314×10-6) with a high number of them aged 20-39 years old (n=35/95, 37%) most linked to pregnancy-related listeriosis (n=29/35, 83%). Most of the male cases were in men aged over 60 years old (40/65, 62%), and most of the fatal cases in both males and females were identified in this age group (42/55, 76%). Phylogenetic analysis revealed 23 5 SNP single linkage clusters comprising 80/237 (34 %) isolates with cluster sizes ranging from 2 to 19. Five 5 SNP clusters comprised isolates from human cases and an implicated food item. Expanding the analysis to 25 SNP single linkage clusters resolved an additional two clusters linking human cases to a potential food vehicle. Analysis of demographic and clinical outcome data identified CC1 as a clinically significant cause of invasive listeriosis in the elderly population and in women of child-bearing age. Phylogenetic analysis revealed the population structure of CC1 in the UK comprised small, sparsely populated genomic clusters. Only clusters containing isolates from an implicated food vehicle, or food processing or farming environments, were resolved, emphasizing the need for clinical, food and animal-health agencies to share sequencing data in real time, and the importance of a One Health approach to public-health surveillance of listeriosis.
Collapse
Affiliation(s)
- Emily T. Fotopoulou
- Water and Environmental Microbiology Services, UK Health Security Agency Food, 61 Colindale Avenue, London NW9 5EQ, UK
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Claire Jenkins
- Water and Environmental Microbiology Services, UK Health Security Agency Food, 61 Colindale Avenue, London NW9 5EQ, UK
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Clare R. Barker
- Water and Environmental Microbiology Services, UK Health Security Agency Food, 61 Colindale Avenue, London NW9 5EQ, UK
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health and Care Research, University of Liverpool, Liverpool L69 7BE, UK
| | - Anais Painset
- Water and Environmental Microbiology Services, UK Health Security Agency Food, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Xavier Didelot
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health and Care Research, University of Liverpool, Liverpool L69 7BE, UK
- Health Protection Research Unit in Genomics and Enabling Data, National Institute for Health and Care Research, University of Warwick, Coventry CV4 7AL, UK
| | - Ameze Simbo
- School of Life Sciences and Department of Statistics, University of Warwick, Coventry CV4 7AL, UK
| | - Amy Douglas
- School of Life Sciences and Department of Statistics, University of Warwick, Coventry CV4 7AL, UK
| | - Gauri Godbole
- School of Life Sciences and Department of Statistics, University of Warwick, Coventry CV4 7AL, UK
| | - Frieda Jorgensen
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Saheer Gharbia
- Water and Environmental Microbiology Services, UK Health Security Agency Food, 61 Colindale Avenue, London NW9 5EQ, UK
- Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health and Care Research, University of Liverpool, Liverpool L69 7BE, UK
| | - Jim McLauchlin†
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| |
Collapse
|
7
|
Choudhury P, Mohanty S, Reddy Y, Reddy N. A Rare Case of Listeria Meningitis With Spinal Involvement. Pediatr Infect Dis J 2023; 42:e498-e499. [PMID: 37851965 DOI: 10.1097/inf.0000000000004100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Prerna Choudhury
- Paediatric Neurology, Rainbow Children's Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Shashwat Mohanty
- Paediatric Intensive Care Unit, Rainbow Children's Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Yeshwanth Reddy
- Paediatric Intensive Care Unit, Rainbow Children's Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Nihaal Reddy
- Paediatric Neuroradiology, Rainbow Children's Hospital, Hyderabad, Telengana, India
| |
Collapse
|
8
|
Iyigundogdu I, Gedik E, Derle E, Kibaroglu S. Listeria Rhombencephalitis and Infratentorial Brain Abcesses ın a Young Adult with Stroke Like Presentation. Neurol India 2023; 71:1263-1265. [PMID: 38174473 DOI: 10.4103/0028-3886.391395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
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.
Collapse
Affiliation(s)
- Ilkin Iyigundogdu
- Department of Neurology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ender Gedik
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Eda Derle
- Department of Neurology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Seda Kibaroglu
- Department of Neurology, Faculty of Medicine, Baskent University, Ankara, Turkey
| |
Collapse
|
9
|
Schattner A, Leibovitz E, Glick Y. Severe CNS relapse of partially treated Listeria: hydrocephalus, brain oedema and coma. QJM 2023; 116:864-865. [PMID: 37364029 DOI: 10.1093/qjmed/hcad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- A Schattner
- From the Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel
- Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
- Ariel University, Ariel, Israel
| | - E Leibovitz
- From the Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel
- Ariel University, Ariel, Israel
| | - Y Glick
- Ariel University, Ariel, Israel
- Department of Imaging, Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| |
Collapse
|
10
|
Xu X, Shan Y, Cen Y, Zhao J, Yang X, Liu R, Tan Q, Ma Y, He M, Zhang J, Yang F, Yu S. Clinical Characteristics and Treatment of Listeria monocytogenes Infections in the Central Nervous System. Infect Drug Resist 2023; 16:5899-5909. [PMID: 37700798 PMCID: PMC10493144 DOI: 10.2147/idr.s424012] [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: 06/02/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose Listeria monocytogenes infections are rare in the central nervous system (CNS) and frequently difficult-to-diagnose. Our goal is to assess CNS listeriosis patients' clinical characteristics, diagnosis, treatment, and prognosis. Patients and Methods Patients with CNS listeriosis admitted to the Department of neurology, the first medical center of the Chinese PLA general hospital, were enrolled in this study from March 2018 to August 2022. Results This study analyzed eight adults, including five males and three females. The average age of onset was (50.25 ± 11.52) years. The clinical manifestations included fever, headache, altered mental status, vomiting, seizures, neck rigidity, hemiplegia and cranial nerve palsies. Cerebrospinal fluid (CSF) tests revealed intracranial hypertension, elevated cell count and protein concentration, and decreased glucose levels. The positive rates of blood and CSF culture were 40% and 28.57%, respectively. All patients underwent CSF metagenomic next-generation sequencing (mNGS), with a 100% positive rate and the specific read number 12-20394. Magnetic resonance imaging (MRI) exhibited leptomeningitis, meningoencephalitis, and brain abscess, and no specific changes were discovered in two patients. All patients received antibiotic treatment, seven were cured, and one died. Conclusion Monitoring the proportion of monocytes in blood and mNGS results of CSF can play a crucial role in diagnosing pathogens. Early and sufficient application of two to three sensitive antibiotics with a BBB permeability of 20-30% for at least 2-3 months can significantly improve CNS listeriosis prognosis.
Collapse
Affiliation(s)
- Xiaojiao Xu
- School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Yuheng Shan
- Department of Neurology, Characteristic Medical Centre of People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
| | - Yuying Cen
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
| | - Jiahua Zhao
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
| | - Xiaosa Yang
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
| | - Rui Liu
- School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Qingche Tan
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Yubao Ma
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Mianwang He
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Jiatang Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
| | - Fei Yang
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Shengyuan Yu
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| |
Collapse
|
11
|
Klein M, Abdel-Hadi C, Bühler R, Grabein B, Linn J, Nau R, Salzberger B, Schlüter D, Schwager K, Tumani H, Weber J, Pfister HW. German guidelines on community-acquired acute bacterial meningitis in adults. Neurol Res Pract 2023; 5:44. [PMID: 37649122 PMCID: PMC10470134 DOI: 10.1186/s42466-023-00264-6] [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: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION The incidence of community-acquired acute bacterial meningitis has decreased during the last decades. However, outcome remains poor with a significant proportion of patients not surviving and up to 50% of survivors suffering from long-term sequelae. These guidelines were developed by the Deutsche Gesellschaft für Neurologie (DGN) under guidance of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) to guide physicians through diagnostics and treatment of adult patients with acute bacterial meningitis. RECOMMENDATIONS The most important recommendations are: (i) In patients with suspected acute bacterial meningitis, we recommend that lumbar cerebrospinal fluid (with simultaneous collection of serum to determine the cerebrospinal fluid-serum glucose index and blood cultures) is obtained immediately after the clinical examination (in the absence of severely impaired consciousness, focal neurological deficits, and/or new epileptic seizures). (ii) Next, we recommend application of dexamethasone and empiric antibiotics intravenously. (iii) The recommended initial empiric antibiotic regimen consists of ampicillin and a group 3a cephalosporin (e.g., ceftriaxone). (iv) In patients with severely impaired consciousness, new onset focal neurological deficits (e.g. hemiparesis) and/or patients with newly occurring epileptic seizures, we recommend that dexamethasone and antibiotics are started immediately after the collection of blood; we further recommend that -if the imaging findings do not indicate otherwise -a lumbar CSF sample is taken directly after imaging. (v) Due to the frequent occurrence of intracranial and systemic complications, we suggest that patients with acute bacterial meningitis are treated at an intensive care unit in the initial phase of the disease. In the case of impaired consciousness, we suggest that this is done at an intensive care unit with experience in the treatment of patients with severe CNS diseases. CONCLUSIONS The German S2k-guidelines give up to date recommendations for workup, diagnostics and treatment in adult patients with acute bacterial meningitis.
Collapse
Affiliation(s)
- Matthias Klein
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
- Emergency Department, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | | | - Robert Bühler
- Department of Neurology, Bürgerspital, Solothurn, Switzerland
| | - Beatrice Grabein
- Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Jennifer Linn
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Roland Nau
- Department of Neuropathology, Evangelisches Krankenhaus Göttingen-Weende, Georg-August-University, Göttingen, Göttingen, Germany
| | - Bernd Salzberger
- Klinik und Poliklinik für Innere Medizin, University of Regensburg, Regensburg, Germany
| | - Dirk Schlüter
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Hannover, Germany
| | - Konrad Schwager
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- Hals- und plastische Gesichtschirurgie, Kommunikationsstörungen, Fulda, Germany
| | - Hayrettin Tumani
- Labor für Liquordiagnostik, Neurologische Universitätsklinik Ulm, University of Ulm, Ulm, Germany
| | - Jörg Weber
- Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Hans-Walter Pfister
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
12
|
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
|
13
|
Ghosh R, León-Ruiz M, Sardar SS, Lalsing D P, Benito-León J. Downbeat Nystagmus as a Presenting Manifestation of Neurolisteriosis in a Pregnant Woman. Neuroophthalmology 2023; 47:218-224. [PMID: 37434673 PMCID: PMC10332207 DOI: 10.1080/01658107.2023.2186431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Listeria monocytogenes has tropism towards two immunologically "privileged" sites, the fetoplacental unit in pregnant women and the central nervous system (neurolisteriosis) in immunocompromised individuals. We report a case of neurolisteriosis in a previously asymptomatic pregnant woman from rural West Bengal, India, who presented with a subacute onset febrile illness with features of rhombencephalitis and a predominantly midline-cerebellopathy (slow and dysmetric saccades, florid downbeat nystagmus, horizontal nystagmus, and ataxia). With timely detection and the institution of prolonged intravenous antibiotic therapy, both the mother and the fetus were saved uneventfully.
Collapse
Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Moisés León-Ruiz
- Section of Clinical Neurophysiology, Department of Neurology, University Hospital “La Paz”, Madrid, Spain
| | - Sona Singh Sardar
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Padavi Lalsing D
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| |
Collapse
|
14
|
Kammoun H, Kim M, Hafner L, Gaillard J, Disson O, Lecuit M. Listeriosis, a model infection to study host-pathogen interactions in vivo. Curr Opin Microbiol 2021; 66:11-20. [PMID: 34923331 DOI: 10.1016/j.mib.2021.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 12/19/2022]
Abstract
Listeria monocytogenes (Lm) is a foodborne pathogen and the etiological agent of listeriosis. This facultative intracellular Gram-positive bacterium has the ability to colonize the intestinal lumen, cross the intestinal, blood-brain and placental barriers, leading to bacteremia, neurolisteriosis and maternal-fetal listeriosis. Lm is a model microorganism for the study of the interplay between a pathogenic microbe, host tissues and microbiota in vivo. Here we review how animal models permissive to Lm-host interactions allow deciphering some of the key steps of the infectious process, from the intestinal lumen to the crossing of host barriers and dissemination within the host. We also highlight recent investigations using tagged Lm and clinically relevant strains that have shed light on within-host dynamics and the purifying selection of Lm virulence factors. Studying Lm infection in vivo is a way forward to explore host biology and unveil the mechanisms that have selected its capacity to closely associate with its vertebrate hosts.
Collapse
Affiliation(s)
- Hana Kammoun
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Minhee Kim
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Lukas Hafner
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Julien Gaillard
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Olivier Disson
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Marc Lecuit
- Institut Pasteur, Université de Paris, Inserm U1117, Biology of Infection Unit, 75015 Paris, France; Institut Pasteur, National Reference Centre and WHO Collaborating Centre Listeria, 75015 Paris, France; Necker-Enfants Malades University Hospital, Division of Infectious Diseases and Tropical Medicine, APHP, Institut Imagine, 75006 Paris, France.
| |
Collapse
|
15
|
Soni A, Tucker LM. Neurolisteriosis presenting with multiple intracerebral haemorrhages. Pract Neurol 2021; 22:73-74. [PMID: 34417347 DOI: 10.1136/practneurol-2021-003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Aayesha Soni
- Department of Neurology, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
16
|
Simonsen AL, Shekhrajka N, Hertz FB, Helweg-Larsen J, Bengård Andersen Å, Lebech AM. Listeria Monocytogenes Brain Abscesses in a Patient with Disseminated Non-Small Cellular Lung Cancer: MRI Findings. Diagnostics (Basel) 2021; 11:diagnostics11061115. [PMID: 34207242 PMCID: PMC8235038 DOI: 10.3390/diagnostics11061115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 01/04/2023] Open
Abstract
Brain abscesses caused by Listeria monocytogenes (LM) are very rare and carry a high mortality risk. We present a patient with disseminated non-small cellular lung cancer (NSCLC) and multiple unusual LM brain abscesses. These abscesses have multiple elongated peripherally enhancing lesions in a characteristic formation that is "worm or tramtrack-like" following the white matter fiber tracts.
Collapse
Affiliation(s)
- Anders Lykkemark Simonsen
- Heart Centre, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark; (J.H.-L.); (Å.B.A.); (A.-M.L.)
- Correspondence: or
| | - Nitesh Shekhrajka
- Department of Neuroradiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark;
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark;
| | - Jannik Helweg-Larsen
- Heart Centre, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark; (J.H.-L.); (Å.B.A.); (A.-M.L.)
| | - Åse Bengård Andersen
- Heart Centre, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark; (J.H.-L.); (Å.B.A.); (A.-M.L.)
| | - Anne-Mette Lebech
- Heart Centre, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark; (J.H.-L.); (Å.B.A.); (A.-M.L.)
| |
Collapse
|
17
|
Dessy A, Berger S, Kumar A, Grossman SN, Cardiel M, Galetta SL. Clinical Reasoning: A 29-Year-Old Man With Fevers and Rapidly Progressive Cranial Neuropathies. Neurology 2021; 97:95-98. [PMID: 33893206 DOI: 10.1212/wnl.0000000000012085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexa Dessy
- From the Department of Neurology, NYU Langone Medical Center, New York, NY.
| | - Stephen Berger
- From the Department of Neurology, NYU Langone Medical Center, New York, NY
| | - Arooshi Kumar
- From the Department of Neurology, NYU Langone Medical Center, New York, NY
| | - Scott N Grossman
- From the Department of Neurology, NYU Langone Medical Center, New York, NY
| | - Myrna Cardiel
- From the Department of Neurology, NYU Langone Medical Center, New York, NY
| | - Steven L Galetta
- From the Department of Neurology, NYU Langone Medical Center, New York, NY
| |
Collapse
|
18
|
Impens F, Dussurget O. Three decades of listeriology through the prism of technological advances. Cell Microbiol 2021; 22:e13183. [PMID: 32185895 DOI: 10.1111/cmi.13183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
Decades of breakthroughs resulting from cross feeding of microbiological research and technological innovation have promoted Listeria monocytogenes to the rank of model microorganism to study host-pathogen interactions. The extraordinary capacity of this bacterium to interfere with a vast array of host cellular processes uncovered new concepts in microbiology, cell biology and infection biology. Here, we review technological advances that revealed how bacteria and host interact in space and time at the molecular, cellular, tissue and whole body scales, ultimately revolutionising our understanding of Listeria pathogenesis. With the current bloom of multidisciplinary integrative approaches, Listeria entered a new microbiology era.
Collapse
Affiliation(s)
- Francis Impens
- Center for Medical Biotechnology, VIB, Ghent, Belgium.,Department for Biomedical Medicine, Ghent University, Ghent, Belgium.,VIB Proteomics Core, VIB, Ghent, Belgium
| | - Olivier Dussurget
- Institut Pasteur, Unité de Recherche Yersinia, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
19
|
Precht C, Vermathen P, Henke D, Staudacher A, Lauper J, Seuberlich T, Oevermann A, Schweizer-Gorgas D. Correlative Magnetic Resonance Imaging and Histopathology in Small Ruminant Listeria Rhombencephalitis. Front Neurol 2020; 11:518697. [PMID: 33391140 PMCID: PMC7773005 DOI: 10.3389/fneur.2020.518697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 11/12/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Listeria rhombencephalitis, infection of the brainstem with Listeria monocytogenes, occurs mainly in humans and farmed ruminants and is associated with high fatality rates. Small ruminants (goats and sheep) are a large animal model due to neuropathological similarities. The purpose of this study was to define magnetic resonance imaging (MRI) features of listeria rhombencephalitis in naturally infected small ruminants and correlate them with histopathology. Secondly, the purpose of this study was to compare the results with MRI findings reported in humans. Methods: Twenty small ruminants (13 sheep and 7 goats) with listeria rhombencephalitis were prospectively enrolled and underwent in vivo MRI of the brain, including T2-weighted, fluid attenuation inversion recovery, and T1-weighted sequences pre- and post-contrast administration and postmortem histopathology. In MRI, lesions were characterized by location, extent, border definition, signal intensity, and contrast enhancement. In histopathology, the location, cell type, severity, and chronicity of inflammatory infiltrates and signs of vascular damage were recorded. In addition, histopathologic slides were matched to MRIs, and histopathologic and MRI features were compared. Results: Asymmetric T2-hyperintense lesions in the brainstem were observed in all animals and corresponded to the location and pattern of inflammatory infiltrates in histopathology. Contrast enhancement in the brainstem was observed in 10 animals and was associated with vessel wall damage and perivascular fibrin accumulation in 8 of 10 animals. MRI underestimated the extension into rostral brain parts and the involvement of trigeminal ganglia and meninges. Conclusion: Asymmetric T2-hyperintense lesions in the brainstem with or without contrast enhancement can be established as criteria for the diagnosis of listeria rhombencephalitis in small ruminants. Brainstem lesions were similar to human listeria rhombencephalitis in terms of signal intensity and location. Different from humans, contrast enhancement was a rare finding, and abscessation was not observed.
Collapse
Affiliation(s)
- Christina Precht
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Magnetic Resonance Spectroscopy and Methodology, Department of Biomedical Research, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Diana Henke
- Division of Neurology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Anne Staudacher
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Josiane Lauper
- Clinic for Ruminants, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Torsten Seuberlich
- Neurocenter, Department of Clinical Research and Veterinary Public Health, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Anna Oevermann
- Neurocenter, Department of Clinical Research and Veterinary Public Health, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer-Gorgas
- Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| |
Collapse
|
20
|
Stephens RJ, Liang SY. Central Nervous System Infections in the Immunocompromised Adult Presenting to the Emergency Department. Emerg Med Clin North Am 2020; 39:101-121. [PMID: 33218652 DOI: 10.1016/j.emc.2020.09.006] [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] [Indexed: 11/30/2022]
Abstract
Over the past 2 decades, the population of immunocompromised patients has increased dramatically in the United States. These patients are at elevated risk for both community-acquired and opportunistic central nervous system infections. We review the most common and serious central nervous system pathogens affecting these patients and outline a diagnostic and therapeutic approach to their management in the emergency department. We recommend a broad diagnostic evaluation, including neuroimaging and cerebrospinal fluid studies where appropriate, empiric antimicrobial therapy, and early involvement of subspecialists to provide comprehensive care for these complex patients.
Collapse
Affiliation(s)
- Robert J Stephens
- Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Stephen Y Liang
- Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA; Department of Internal Medicine, Division of Infectious Disease, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| |
Collapse
|
21
|
Brainstem Encephalitis Caused by Listeria monocytogenes. Pathogens 2020; 9:pathogens9090715. [PMID: 32872638 PMCID: PMC7558588 DOI: 10.3390/pathogens9090715] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022] Open
Abstract
International outbreaks of listerial infections have become more frequent in recent years. Listeria monocytogenes, which usually contaminates food, can cause potentially fatal infections. Listerial cerebritis is a rare disease that is encountered mostly in immunocompromised or elderly patients. However, listerial brainstem encephalitis (mesenrhombencephalitis or rhombencephalitis) is found in persons who were formerly in good health, and recognizing this disease, particularly at its early stages, is challenging. Listerial brainstem encephalitis has high mortality, and serious sequelae are frequently reported in survivors. Early recognition and correct diagnosis, as well as the timely use of appropriate antibiotics, can reduce the severity of listerial infections. The trigeminal nerve is proposed as a pathway through which L. monocytogenes reaches the brainstem after entering damaged oropharyngeal mucosa or periodontal tissues. This review introduces the clinical manifestations, pathology, magnetic resonance imaging (MRI) findings, diagnosis, and treatment of listerial brainstem encephalitis. Moreover, it proposes that L. monocytogenes may also invade the brainstem along the vagus nerve after it infects enteric neurons in the walls of the gastrointestinal tract.
Collapse
|
22
|
Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e28-e34. [DOI: 10.15586/jptcp.v27i3.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
|
23
|
Listeria Cerebritis with Tumor Necrosis Factor Inhibition. Case Rep Infect Dis 2020; 2020:4901562. [PMID: 32373374 PMCID: PMC7196993 DOI: 10.1155/2020/4901562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 11/18/2022] Open
Abstract
Background Listeria monocytogenes is historically a central nervous system pathogen of consideration in the very young, very old, and immune suppressed. Diagnosis of Listeria is based on positive bodily fluid culture or PCR testing. Cerebral edema is nonspecific and can be a manifestation of vasculitis, trauma, anoxia, ischemia, infarction, malignancy, or an infectious process. A main mechanism of immune protection against Listeria is tumor necrosis factor (TNF). Lenalidomide, an immunosuppressant, inhibits TNF. Case Presentation. A 61-year-old female with diabetes mellitus 2 and multiple myeloma treated with stem cell transplant and immunosuppressant (lenalidomide) was found to have cerebral edema after presenting with headache for 3 weeks and new focal neurologic deficits. Vitals signs were stable, with no meningeal exam findings and unremarkable initial serum testing. Blood cultures on days 0 and 2 of hospitalization as well as cerebral spinal fluid cultures were negative for infectious organisms. PCR testing of CSF was also negative for microorganisms. Brain biopsy was scheduled but postponed due to outstanding prion testing. The patient's focal neurologic deficits worsened prompting administration of dexamethasone after extensive negative infectious disease workup. By day 6, gross neurologic function deteriorated prompting transfer to higher level of care where the patient spiked a fever and one set of blood cultures revealed Gram-positive bacillus. Aggressive antimicrobial therapy was initiated, excluding ampicillin; however, this was later added. Blood culture further identified Listeria monocytogenes. By day 17, the patient suffered demise. Autopsy revealed brain microabscess lesions consistent with Listeria. Conclusion Clinicians should employ prophylactic antimicrobial treatment for Listeria when caring for those patients presenting with cerebral edema who are immune suppressed with TNF inhibition no matter the initial exam findings, serum testing, and/or radiologic interpretation. If initial workup is negative and brain biopsy is needed to determine the next course of action in the patient with cerebral edema, transfer the patient to a higher level of care if unable to complete biopsy at your facility in an expedient fashion.
Collapse
|