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Halfman C, Slate L, Yamamoto J, Jones S. Immunocompromised Child on Infliximab: A Case Report of Listeria monocytogenes Meningitis. Clin Pract Cases Emerg Med 2020; 4:530-532. [PMID: 33217264 PMCID: PMC7676764 DOI: 10.5811/cpcem.2020.7.48053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Patients with naturally occurring, impaired cell-mediated immunity secondary to age and pregnancy are known to be at risk of developing severe and invasive Listeria monocytogenes infections. Immunosuppressant medications, particularly infliximab, are also known to increase this risk. CASE REPORT We present the case of a seven-year-old female on infliximab who was diagnosed with culture positive L. monocytogenes meningitis after a negative cerebral spinal fluid polymerase chain reaction (PCR). CONCLUSION Patients receiving infliximab who display signs of central nervous system infection should be suspected to have L. monocytogenes as an infecting agent, and empiric addition of ampicillin to their antibiotic regimen should be considered, with substitution of trimethoprim-sulfamethoxazole in cases of penicillin allergy, regardless of initial PCR results.
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Affiliation(s)
- Camille Halfman
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
| | - Luke Slate
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
| | - Julienne Yamamoto
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
| | - Samantha Jones
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
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2
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Brisca G, La Valle A, Campanello C, Pacetti M, Severino M, Losurdo G, Palmieri A, Buffoni I, Renna S. Listeria meningitis complicated by hydrocephalus in an immunocompetent child: case report and review of the literature. Ital J Pediatr 2020; 46:111. [PMID: 32741364 PMCID: PMC7397632 DOI: 10.1186/s13052-020-00873-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Listeria monocytogenes is a Gram-positive bacteria transmitted to human by animal stools, contaminated water and food. In children, Listeria monocytogenes typically affects newborns and immunocompromised patients often leading to invasive syndromes including sepsis, brain abscesses, meningitis, meningoencephalitis and rhombencephalitis. In healthy and immunocompetent children, Listeria meningitis is rare, but can progress rapidly and may be associated with severe complications (hydrocephalus, ventriculitis, cranial nerves palsy and cerebrospinal abscesses) and high mortality rate. Case presentation We describe a very uncommon case of meningoencephalitis due to Listeria monocytogenes in a 11-month-old immunocompetent girl. Cerebrospinal fluid (CSF) culture was positive on the second day. Antibiotic therapy was promptly started but the disease was complicated by neurological deterioration and decompensated hydrocephalus. The child required a very demanding pediatric and neurosurgical management and was discharged after 40 days without major sequelae. Conclusion Listeria is difficult to isolate and it is not susceptible to first-line treatment for bacterial meningitis with extended-spectrum cephalosporins. Early recognition is therefore crucial for a positive outcome. Pediatricians have to perform close clinical monitoring of these children and be aware of possible complications. A review of all cases of Listeria meningitis complicated by hydrocephalus in healthy children has been performed, to provide an overview on clinical features, treatment options and outcome.
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Affiliation(s)
- Giacomo Brisca
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Alberto La Valle
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Claudia Campanello
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Mattia Pacetti
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Giuseppe Losurdo
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Antonella Palmieri
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Isabella Buffoni
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Salvatore Renna
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
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Abstract
Listeria monocytogenes is a gram-positive, facultative anaerobic, motile bacillus widely spread in the environment. However, clinical infection in humans is uncommon. The route of infection is often through ingestion of raw vegetables, meat and unpasteurised dairy products. Listeria is an uncommon cause of meningitis in immunocompetent individuals, but it should be considered strongly in neonates and the elderly, and it should also be considered in those with impaired cell-mediated immunity. 1 , 2 Only a few case reports of invasive listeriosis in humans have been reported from India. 3 - 8 In our case, a 13-year-old previously healthy boy was thus diagnosed.
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Affiliation(s)
- Krishna Mohan Gulla
- 1 Fellow, Pediatric ICU, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- 2 Consultant, Pediatric ICU, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Sachdev
- 3 Director, Pediatric ICU, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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Liang JJ, He XY, Ye H. Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage: A case report and review of the literature. World J Clin Cases 2019; 7:538-547. [PMID: 30842967 PMCID: PMC6397815 DOI: 10.12998/wjcc.v7.i4.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/25/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Listeria monocytogenes (L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L. monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage, which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.
CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance. His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus. Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage. Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.
CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.
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Affiliation(s)
- Jing-Jing Liang
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan 430060, Hubei Province, China
| | - Xiao-Yan He
- Department of Neurology, Shijiazhuang Second Hospital, Shijiazhuang 050200, Hebei Province, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Castellazzi ML, Marchisio P, Bosis S. Listeria monocytogenes meningitis in immunocompetent and healthy children: a case report and a review of the literature. Ital J Pediatr 2018; 44:152. [PMID: 30594251 PMCID: PMC6311039 DOI: 10.1186/s13052-018-0595-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background Listeria monocytogenes is a gram-positive bacteria generally transmitted to humans through ingestion of contaminated food. It typically infects high risk subjects, such as pregnant women, neonates, the elderly and immunocompromised patients. Listeria meningitis is rarely reported in previously healthy children with no immunological disorders. However, it can be aggressive in such subjects and is associated with a high mortality rate. Prompt diagnosis is essential so that adequate antibiotic treatment can be started and the best outcome achieved. Case presentation We report the case of a previously healthy 16-month-old child with Listeria meningitis who was successfully treated with intravenous ampicillin and gentamicin without any sequelae. Conclusions Although Listeria meningitis is rare in previously healthy immunocompetent children, it must be considered, especially in children who do not improve with first-line antibiotic treatment. A review of the literature published since 1996 has been performed, to provide a general overview on this topic.
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Affiliation(s)
- Massimo Luca Castellazzi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Nachmias B, Orenbuch-Harroch E, Makranz C, Nechusthan H, Eliahou R, Ben-Yehuda D, Lossos A. Early hydrocephalus in Listeria meningitis: Case report and review of the literature. IDCases 2018; 14:e00455. [PMID: 30237977 PMCID: PMC6141257 DOI: 10.1016/j.idcr.2018.e00455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 01/28/2023] Open
Abstract
Listeria monocytogenes is a gram-positive bacterium with a predilection to infect the central nervous system, often affecting immunocompromised or elderly patients. The most common manifestations are meningitis and rhomboencephalitis. We report two cases of Listeria meningitis complicated by acute hydrocephalus several days after presentation and we further review the literature of similar cases. We conclude that acute hydrocephalus is a significant, not often recognized, complication of Listeria meningitis, usually occurring several days from onset when coverage did not include anti-Listeria antimicrobials. In high risk patients, meningitis combined with acute hydrocephalus is suggestive of LM infection.
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Affiliation(s)
- B Nachmias
- Hadassah-Hebrew University Medical Center, Department of Hematology, Jerusalem, Israel
| | - E Orenbuch-Harroch
- Hadassah-Hebrew University Medical Center, Department of Infectious disease, Jerusalem, Israel
| | - C Makranz
- Leslie and Michael Gaffin Center for Neuro-Oncology, Departments of Oncology and Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - H Nechusthan
- Hadassah-Hebrew University Medical Center, Department of Oncology, Jerusalem Israel
| | - R Eliahou
- Hadassah-Hebrew University Medical Center, Department of Neuro-imaging, Jerusalem, Israel
| | - D Ben-Yehuda
- Hadassah-Hebrew University Medical Center, Department of Hematology, Jerusalem, Israel
| | - A Lossos
- Leslie and Michael Gaffin Center for Neuro-Oncology, Departments of Oncology and Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Villa G, Diana MC, Solari N, Bandettini R, Sorrentino S, Loy A, Losurdo G, Renna S. Listeria Meningitis in an Immunocompetent Child. Pediatr Emerg Care 2017; 33:579-581. [PMID: 27055168 DOI: 10.1097/pec.0000000000000687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Listeria monocytogenes is a facultative anerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria infection is usually found in the older adults, immunocompromised patients, pregnant women, and newborns, whereas it is rare in healthy infants and children. Listeria monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscess in children. The course of meningoencephalitis by Listeria is often severe and even fatal. Complications such as acute hydrocephalus, brain abscess, and spine abscess can develop, and the mortality associated with listeriosis is significantly high. We present a case of a previously healthy 7-year-old boy who developed Listeria monocytogenes meningitis.
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Affiliation(s)
- Giovanna Villa
- From the *Emergency Department of Paediatrics, Departments of †Clinical Pathology and Microbiology and ‡Hematology and Oncology, and §Infectious Diseases Unit, G. Gaslini Children's Hospital, Genoa, Italy
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An unusual presentation of paediatric Listeria meningitis with selective spinal grey matter involvement and acute demyelinating polyneuropathy. Eur J Paediatr Neurol 2016; 20:196-9. [PMID: 26371981 DOI: 10.1016/j.ejpn.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/27/2015] [Accepted: 08/17/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Paediatric Listeria meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications. METHODS We report an unusual case of Listeria meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident. RESULTS Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery. CONCLUSION Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria-related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
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Listeria meningitis and ventriculitis in an immunocompetent child: case report and literature review. Infection 2011; 40:207-11. [PMID: 21877182 DOI: 10.1007/s15010-011-0177-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 08/09/2011] [Indexed: 01/02/2023]
Abstract
Listeria monocytogenes meningitis is very rare in immunocompetent children. We present a case of a previously healthy 6-year-old girl who developed L. monocytogenes meningitis and ventriculitis. We also review the medical literature on non-neonatal L. monocytogenes meningitis in immunocompetent children.
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10
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Lee JE, Cho WK, Nam CH, Jung MH, Kang JH, Suh BK. A case of meningoencephalitis caused by Listeria monocytogenes in a healthy child. KOREAN JOURNAL OF PEDIATRICS 2010; 53:653-6. [PMID: 21189933 PMCID: PMC2994123 DOI: 10.3345/kjp.2010.53.5.653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 10/05/2009] [Accepted: 10/20/2009] [Indexed: 02/08/2023]
Abstract
Listeria monocytogenes is a facultative anaerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria occurs predominantly in the elderly, immunocompromised patients, pregnant women and newborns. Infections by this microorganism are rare in healthy infants and children. L. monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in children. The course of meningoencephalitis by listeria is often severe and even fatal. Acute hydrocephalus can develop as a complication and the mortality associated with listeriosis is significantly high. We present a case of meningoencephalitis caused by L. monocytogenes in a previously healthy 7-year-old girl.
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Affiliation(s)
- Ji Eun Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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[Acute encephalopathy, hydrocephalus and central diabetes insipidus as the first signs of Listeria monocytogenes meningitis]. An Pediatr (Barc) 2010; 72:288-9. [PMID: 20189898 DOI: 10.1016/j.anpedi.2009.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 11/22/2009] [Accepted: 12/21/2009] [Indexed: 11/20/2022] Open
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Dilber E, Aksoy A, Cakir M, Bahat E, Kamaşak T, Dilber B. Listeria monocytogenes meningitis in two immunocompetent children. ACTA ACUST UNITED AC 2009; 29:225-9. [PMID: 19689866 DOI: 10.1179/027249309x12467994694058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Listeria monocytogenes is an uncommon cause of bacterial meningitis beyond the neonatal period. Patients with immunosuppression or neoplastic disease are at increased risk of developing serious invasive disease, particularly meningitis. L. monocytogenes meningitis in two previously healthy, immunocompetent children aged 7 years and 18 months is described. One of them was successfully treated with ampicillin and amikacin. In the other there was resistance to ampicillin, and meropenem, vancomycin and amikacin were given. One patient developed unilateral abducens paralysis and inappropriate antidiuretic hormone secretion. L. monocytogenes should be suspected in children with bacterial meningitis who fail to respond to empirical antibiotic therapy.
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Affiliation(s)
- E Dilber
- Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Cocuk Bölümü, Trabzon, Turkey.
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Platnaris A, Hatzimichael A, Ktenidou-Kartali S, Kontoyiannides K, Kollios K, Anagnostopoulos J, Roilides E. A case of Listeria meningoencephalitis complicated by hydrocephalus in an immunocompetent infant. Eur J Pediatr 2009; 168:343-6. [PMID: 18463893 DOI: 10.1007/s00431-008-0739-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Revised: 04/02/2008] [Accepted: 04/05/2008] [Indexed: 12/14/2022]
Abstract
We report a very unusual case of meningoencephalitis due to Listeria monocytogenes in a 7-month-old immunocompetent boy. Cerebrospinal fluid (CSF) culture was initially negative, but was positive on the seventh day. The disease was complicated by seizures and hydrocephalus managed with temporary ventriculostomy. The infant was discharged without obvious neurological sequelae after 30 days and developed without neurological or developmental sequelae at two years of age. Listeria is difficult to isolate and is not susceptible to third-generation cephalosporins commonly used for the empirical treatment of bacterial meningitis.
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Affiliation(s)
- Antonios Platnaris
- 3rd Pediatric Department, Aristotle University, Hippokration Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
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