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Akiki M, Azar MH, Hallit S, Maalouly R, Fahed E, Younes P, Slim J, Hallit R. Concomitant Listeria monocytogenes and Streptococcus equinus brain abscess in an immunocompetent individual: a case report. J Med Case Rep 2024; 18:390. [PMID: 39175052 PMCID: PMC11342486 DOI: 10.1186/s13256-024-04690-1] [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: 02/04/2024] [Accepted: 07/02/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Listeria monocytogenes brain abscess is a rare phenomenon that is common in immunocompromised patients. Streptococcus equinus brain abscess has never been reported in the literature to our knowledge. In this case report, we describe a case of brain abscess secondary to Listeria monocytogenes and Streptococcus equinus in an immunocompetent patient with transient low CD4 count. CASE PRESENTATION A 27-year-old white, male patient, previously healthy, nonalcoholic, and occasional smoker, presented to the emergency department for confusion and headache. The patient was found to have a left parietal abscess, which was drained and the fluid was sent for culture. Culture grew Listeria monocytogenes and Streptococcus equinus. The patient was treated with intravenous ampicillin followed by oral amoxicillin for a total of 6 weeks. The CD4 count was low initially. However, after the resolution of the infection, the CD4 count came back within normal range. Another brain magnetic resonance imaging was done that showed a significantly decreased hyperintensity within the left parietal subcortical white matter at the site of surgery with significantly decreased enhancement and almost total resolution of the previous abscess. CONCLUSION Transient low CD4 count is a rare phenomenon that exposes patients to unusual and atypical infections. Since low CD4 count is transient, patients treated promptly recover from their illness. Our patient developed a Listeria monocytogenes and Streptococcus equinus brain abscess, which is considered rare and has not been previously described in the literature to our knowledge.
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Affiliation(s)
- Maria Akiki
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, NJ, 07102, USA
- New York Medical College, New York, USA
| | | | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, 11931, Jordan.
| | - Rina Maalouly
- Faculty of Medicine, University of Balamand, Koura, Lebanon
- Department of Radiology, Bellevue Medical Center, P.O. Box 295, Mansourieh, Lebanon
| | - Elie Fahed
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Department of Neurosurgery, Bellevue Medical Center, P.O. Box 295, Mansourieh, Lebanon
| | - Philippe Younes
- Department of Neurosurgery, Bellevue Medical Center, P.O. Box 295, Mansourieh, Lebanon
- Faculty of Medicine, Lebanese University, Hadat, Lebanon
| | - Jihad Slim
- New York Medical College, New York, USA
- Department of Infectious Disease, Saint Michael's Medical Center, Newark, NJ, 07102, USA
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Department of Infectious Disease, Notre-Dame des Secours University Hospital, Byblos, 3, Lebanon.
- Department of Infectious Disease, Bellevue Medical Center, P.O. Box 295, Mansourieh, Lebanon.
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Zawadzki R, Rogalska W, Pałdyna M, Głuszczuk D, Zajkowska J, Kubas B. Imaging modalities in neurolisteriosis: a literature review. Pol J Radiol 2024; 89:e345-e357. [PMID: 39139260 PMCID: PMC11321029 DOI: 10.5114/pjr/189214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/23/2024] [Indexed: 08/15/2024] Open
Abstract
Listeriosis caused by Listeria monocytogenes due to its ability to withstand harsh conditions and form biofilms on post-processed food poses a serious public health issue. It typically manifests itself with fever and gastrointestinal symptoms, but it can escalate with life-threatening conditions, especially in immunocompromised patients, the elderly, oncologically sick, and even pregnant women. The diagnosis is based on blood and cerebrospinal fluid culture growth, but it presents significant challenges due to deceptive findings and low positivity rates, the golden standard includes molecular diagnostic tests such as real-time PCR and metagenomic next-generation sequencing, which offer higher sensitivity and rapid detection. Radiological imaging, particularly magnetic resonance imaging, can play a crucial role in diagnosis of central nervous system (CNS) invasion by L. monocytogenes, enabling the detection of characteristic CNS lesions. The aim of the paper was to sum up the imaging features of L. monocytogenes CNS invasions in conventional imaging techniques, which can potentially speed up the diagnostic workflow for patients presenting with neurological symptoms associated with L. monocytogenes infection, particularly when conventional tests yield inconclusive results.
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Affiliation(s)
- Radosław Zawadzki
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Weronika Rogalska
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Marianna Pałdyna
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Dominika Głuszczuk
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
| | - Bożena Kubas
- Department of Radiology, Medical University of Białystok, Białystok, Poland
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Xia X, Zhang L, Zheng H, Peng X, Jiang L, Hu Y. Clinical characteristics and prognosis of pediatric Listeria monocytogenes meningitis based on 10-year data from a large children's hospital in China. Microbiol Spectr 2024; 12:e0324423. [PMID: 38275295 PMCID: PMC10913449 DOI: 10.1128/spectrum.03244-23] [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: 08/31/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
This study aims to summarize the clinical characteristics and prognosis of Listeria monocytogenes (LM) meningitis in children in Chongqing, China. A retrospective analysis of the clinical data and follow-up results of 20 LM meningitis patients admitted to the Children's Hospital of Chongqing Medical University (CHCMU) from January 2012 to December 2022 was performed. The LM meningitis incidence rate was between 0 and 14.3 per 100,000 persons. The median age at onset was 8.98 months. There were five neonate cases, which all had perinatal abnormalities. Seven non-neonatal cases (7/15, 46.7%) had a documented history of contaminated food intake. One case had primary immunodeficiency. The most common symptoms were fever (20/20), altered consciousness (19/20), and vomiting (15/20). Seven cases had seizures, eight cases had cranial nerve involvement, eight cases had positive Babinski sign, and 10 cases had positive meningeal signs. The most common complications were hyponatremia (6/20), hypokalemia (6/20), respiratory failure (5/20), subdural effusion (3/20), and hydrocephalus (2/20). Treatment primarily involved monotherapy or combination therapy with meropenem (15/20) and ampicillin (10/20). Fifteen cases were treated with monotherapy or combination therapy using vancomycin. Twelve cases were successfully followed up from 10 months to 9 years and 6 months, and all had favorable long-term outcomes. LM meningitis incidence in children is low and with nonspecific clinical manifestations. Strengthening food hygiene and safety education, and avoiding infections during pregnancy are important to prevent LM infection in neonates and high-risk individuals. Meropenem and ampicillin are the preferred treatments. Early diagnosis and treatment can improve prognosis.IMPORTANCEThe incidence of LM meningitis is extremely low, and there is currently no standardized treatment. We conducted a retrospective analysis of ten years of data from CHCMU regarding diagnosed LM meningitis cases, aiming to provide clinical evidence for the diagnosis and treatment.
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Affiliation(s)
- Xueqian Xia
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Lingyu Zhang
- Department of Neonatology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hao Zheng
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Peng
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuha, China
| | - Li Jiang
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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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.
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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
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Steinbrecher M, Wolfert C, Maurer C, Messmann H, Shiban E, Sommer B, Fuchs A. Cerebral abscess due to Listeria monocytogenes infection in silent diabetes mellitus: Case presentation, treatment and patient outcome. IDCases 2023; 33:e01864. [PMID: 37577046 PMCID: PMC10415914 DOI: 10.1016/j.idcr.2023.e01864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Invasive listeriosis most often presents as bacteremia or neurolisteriosis. Cerebral infection mostly manifests as meningitis or meningoencephalitis, but cerebral abscesses are a rare manifestation. Case presentation We present the rare case of a 51-year old patient with progressive right sided hemiparesis caused by a cerebral abscess due to Listeria monocytogenes infection. The initially suspected cerebral ischemia or bleeding was ruled out. Magnetic resonance imaging led to the suspected diagnosis of an angiocentric lymphoma. An open cerebral biopsy revealed an intracranial abscess formation. After abscess evacuation and identification of Listeria monocytogenes, anti-infective treatment with ampicillin and gentamicin was started. After repeated cerebral imaging with signs of ongoing tissue inflammation after 6 weeks we chose to prolong the therapy with oral amoxicillin until resolution of signs of intracerebral inflammation after 12 weeks, documented by repeated cerebral magnetic resonance imaging. During hospitalization, the patient was diagnosed with diabetes mellitus type II and treatment was initiated. The patient was discharged without any persistent neurologic deficits. Discussion For the treatment of bacterial brain abscesses, 4-6 weeks of intravenous antimicrobial treatment after surgical drainage are recommended. However, first line therapy of invasive cerebral listeriosis is not well established. We decided to use a combined treatment using ampicillin and gentamicin, followed by prolonged oral treatment due to ongoing tissue inflammation. Conclusion No evidence-based treatment recommendations are available for brain abscess caused by Listeria monocytogenes. We report a case with favorable outcome after anti-infective ampicillin- and gentamicin-based therapy. Systematic assessment of treatment would be desirable.
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Affiliation(s)
- Markus Steinbrecher
- Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Christina Wolfert
- Department of Neurosurgery, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Christoph Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Helmut Messmann
- Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Björn Sommer
- Department of Neurosurgery, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Andre Fuchs
- Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
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Bokhari SFH, Sattar H, Abid S, Jaffer SR, Sajid S. Listerial Meningitis and Brain Abscess With Coexisting COVID-19 Infection in a Young, Immunocompetent Male: A Case Report. Cureus 2022; 14:e29455. [PMID: 36299945 PMCID: PMC9587750 DOI: 10.7759/cureus.29455] [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] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
Listeria monocytogenes (LM) is a gram-positive intracellular pathogen that can cause central nervous system infections such as meningitis, meningoencephalitis, rhombencephalitis, or cerebritis. It rarely causes a brain abscess. Listerial meningitis and brain abscess most commonly occur in immunocompromised individuals, neonates, pregnant females, alcoholics, and the elderly. We present a unique case of a young immunocompetent male who presented with listerial meningitis and brain abscess. Coexisting coronavirus disease 2019 (COVID-19) infection was also present. Since LM was not included in the differentials, the standard antibiotic regimen started for the meningitis therapy was ineffective. Remdesivir was administered to treat the coexisting COVID-19 infection. When the lumbar tap polymerase chain reaction pointed out that the causative agent was Listeria, we shifted to ampicillin and gentamicin therapy, to which the patient responded very effectively.LM is an atypical cause of meningitis and brain abscesses. A high index of suspicion is therefore required for early detection and effective treatment of listerial meningitis and brain abscess.
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Magiar O, Vulpie S, Musuroi C, Marincu I, Murariu A, Turaiche M, Musuroi SI, Muntean D, Licker M. Listeria Monocytogenes Meningitis in an Immunocompetent Patient. Infect Drug Resist 2022; 15:989-994. [PMID: 35299851 PMCID: PMC8921837 DOI: 10.2147/idr.s351132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Oana Magiar
- Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
| | - Silvana Vulpie
- Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
- Correspondence: Silvana Vulpie, Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Liviu Rebreanu, No. 156, Timișoara, Timis, 300723, Romania, Tel +40 727248701, Email
| | - Corina Musuroi
- Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
- Microbiology Department, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
| | - Iosif Marincu
- ”Victor Babeș” Clinical Hospital of Infectious Diseases, Methodological and Infectious Diseases Research Centre Timisoara, Timis, Romania
- Infectious Diseases Department, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
| | - Alina Murariu
- Neurology II Department, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
| | - Mirela Turaiche
- ”Victor Babeș” Clinical Hospital of Infectious Diseases, Methodological and Infectious Diseases Research Centre Timisoara, Timis, Romania
- Infectious Diseases Department, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
| | - Silvia Ioana Musuroi
- Internal Medicine Department, Clinical Emergency Municipal Hospital, Timisoara, Romania
| | - Delia Muntean
- Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
- Microbiology Department, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
- Multidisciplinary Research Centre for Antibiotic Resistance, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
| | - Monica Licker
- Clinical Laboratory, “Pius Brînzeu” County Clinical Emergency Hospital Timisoara, Timis, Romania
- Microbiology Department, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
- Multidisciplinary Research Centre for Antibiotic Resistance, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timis, Romania
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Ogunleye OO, Karimi V, Gujadhur N. Listeria Bacteremia Presenting With Cerebral Abscess and Endocarditis in an Elderly Patient With Chronic Immune Thrombocytopenia. Cureus 2021; 13:e16601. [PMID: 34466310 PMCID: PMC8396421 DOI: 10.7759/cureus.16601] [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] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Central nervous system involvement by Listeria monocytogenes usually presents as meningitis, meningoencephalitis or, less frequently, rhombencephalitis. Listerial brain abscesses are rare. Moreover, only 5-8% of listerial bacteremia is complicated by infective endocarditis (IE). A 70-year-old man with chronic immune thrombocytopenia (ITP) presented to our emergency department with acute onset of altered mental status and right-sided weakness. He was afebrile, with no heart murmurs or peripheral IE stigmata. Neurologic examination showed disorientation, expressive aphasia, and right-sided hemiparesis. Laboratory findings were unremarkable except for leukocytosis and hyponatremia. Brain MRI showed an irregular rim-enhancing lesion in the left frontal lobe, suspicious for a high-grade glial neoplasm. The lesion was excised, and he was started empirically on vancomycin, ceftriaxone, and metronidazole. After blood cultures grew Listeria monocytogenes, antibiotics were de-escalated to ampicillin and gentamicin. Echocardiography showed mitral valve vegetation. By Day 6, his mental status had improved. On Day 9, he was discharged to our inpatient rehabilitation center to complete six weeks on IV ampicillin and IV gentamicin. Pathology of the brain mass was subsequently reported as a listerial brain abscess. Chronic treatment with high-dose oral glucocorticoids and pre-existing ITP have been independently implicated as predisposing factors in listerial brain abscess. There is a propensity to misdiagnose listerial brain abscess as an intracranial neoplasm due to similar clinical/imaging findings. In addition, Listeria monocytogenes is an atypical cause of IE. Therefore, a high index of suspicion is necessary for early recognition and successful treatment of listerial brain abscess and listerial endocarditis in high-risk patients.
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Affiliation(s)
- Olushola O Ogunleye
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Vanessa Karimi
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Nili Gujadhur
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
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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.
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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.)
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Yuan L, Zhu Y, Huang S, Lin L, Jiang X, Chen S. NF-κB/ROS and ERK pathways regulate NLRP3 inflammasome activation in Listeria monocytogenes infected BV2 microglia cells. J Microbiol 2021; 59:771-781. [PMID: 34061343 DOI: 10.1007/s12275-021-0692-9] [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: 12/28/2020] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023]
Abstract
Listeria monocytogenes is a food-borne pathogen responsible for neurolisteriosis, which is potentially lethal in immunocompromised individuals. Microglia are the main target cells for L. monocytogenes in central nervous system (CNS). However, the precise mechanisms by which they trigger neuroinflammatory processes remain unknown. The BV2 microglial cell line and a murine model of L. monocytogenes infection were used for experiments in this study. Listeria monocytogenes induced pyroptosis and nucleotide binding and oligomerization, leucine-rich repeat, pyrin domain-containing 3 (NLRP3) inflammasome activation in BV2. Pharmacological inhibition of the NLRP3 inflammasome attenuated L. monocytogenes-induced pyroptosis. Moreover, inhibition of nuclear factor kappa-B (NF-κB) and extracellular regulated protein kinases (ERK) pathways induced a decrease in caspase1 activation and mature IL-1β-17 secretion. Our collective findings support critical involvement of the NLRP3 inflammasome in L. monocytogenes-induced neuroinflammation and, to an extent, ROS production. In addition, ERK and NF-κB signaling play an important role in activation of the NLRP3 inflammasome, both in vitro and in vivo.
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Affiliation(s)
- Lin Yuan
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China.,Department of Clinical Laboratory, Northern Jiangsu People's Hospital, Yangzhou, 225001, P. R. China
| | - Yurong Zhu
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China.,Department of Microbiology Laboratory, Linfen Central Hospital, Linfen, 041000, P. R. China
| | - Shuang Huang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China
| | - Lin Lin
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China
| | - Xugan Jiang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China
| | - Shengxia Chen
- School of Medicine, Jiangsu University, Zhenjiang, 212013, P. R. China.
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Meyerowitz EA, Sanchez S, Mansour MK, Triant VA, Goldberg MB. Isolated Cerebral Mucormycosis in Immunocompetent Adults who Inject Drugs: Case Reports and Systematic Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa552. [PMID: 33409328 PMCID: PMC7765436 DOI: 10.1093/ofid/ofaa552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 01/16/2023] Open
Abstract
Background Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review. Methods Using the criteria (1) isolated cerebral disease, (2) mucormycosis (by polymerase chain reaction, culture, or pathology), and (3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020. Results Of these 55 cases, ~60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status. Conclusions No patient survived without amphotericin, and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.
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Affiliation(s)
- Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarimer Sanchez
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Virginia A Triant
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcia B Goldberg
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
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Vettas C, Dimosiari A, Kydona C, Pyrpasopoulou A, Avdelidou E, Roilidis E, Garyfallos A, Dimitroulas T. Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis. Mediterr J Rheumatol 2020; 31:220-223. [PMID: 32676561 PMCID: PMC7362124 DOI: 10.31138/mjr.31.2.220] [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: 07/21/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Listeria monocytogenes is an opportunistic pathogen that causes severe infections of the Central Nervous System, such as meningitis or meningoencephalitis, and brain abscesses. Abscesses account for approximately 1-10% of CNS listerial infections and are observed in 1% of all listerial infections. METHODS We describe a case of 70-year-old male patient who had several admissions in different hospitals over the last 8 weeks. RESULTS He suffered from intermittent fever for over a month, recurrent episodes of headaches, disorientation and other neurological symptoms. His condition was misdiagnosed as giant cell arteritis and initially the patient was started on corticosteroids. MRI of the brain revealed the presence of multiple brain abscesses and the cerebrospinal fluid study confirmed the presence of Listeria Monocytogenes. The patient was started on ampicillin and he completed a 6 weeks' course of treatment. CONCLUSIONS This case emphasizes the need to include rare pathogens in the differential diagnosis when possible CNS infections are involved, as well as to show that in many cases some auto-immune diseases are overdiagnosed.
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Affiliation(s)
- Christos Vettas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Dimosiari
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Kydona
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Pyrpasopoulou
- Second Propedeutic Clinic of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Infectious Diseases, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Avdelidou
- Department of Neurology, Hippokration University Hospital, Thessaloniki, Greece
| | - Emmanouil Roilidis
- Third Department of Paediatrics, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Infectious Diseases, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Nagibina MV, Vengerov YY, Tishkevich OA, Smirnova TY, Baikova LB, Svistunova TS, Ryzhov GE, Matosova SV, Tsvetkova NA, Sadykova VD. [Listeriosis of the Central nervous system]. TERAPEVT ARKH 2019; 91:38-44. [PMID: 32598608 DOI: 10.26442/00403660.2019.11.000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECT To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. MATERIALS AND METHODS The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. RESULTS LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. CONCLUSION Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.
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Affiliation(s)
- M V Nagibina
- Evdokimov State Medical Stomatological University department of infectious diseases and epidemiology
| | - Y Y Vengerov
- Evdokimov State Medical Stomatological University department of infectious diseases and epidemiology
| | | | | | | | | | - G E Ryzhov
- Evdokimov State Medical Stomatological University department of infectious diseases and epidemiology
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Tecellioglu M, Kamisli O, Kamisli S, Erdogmus UA, Özcan C. Listeria monocytogenes rhombencephalitis in a patient with multiple sclerosis during fingolimod therapy. Mult Scler Relat Disord 2018; 27:409-411. [PMID: 30530070 DOI: 10.1016/j.msard.2018.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe a case of Listeria monocytogenes rhombencephalitis in a patient receiving fingolimod. METHODS This is a case study. RESULTS Our patient developed acute rhombencephalitis with hydrocephalus induced with Listeria monocytogenes while on fingolimod. Shunt surgery was performed for the hydrocephalus and patient recovered partially after medical and surgical therapy. CONCLUSION We describe the first probable case of fingolimod-associated Listeria monocytogenes rhombencephalitis in a patient with multiple sclerosis. Clinicians should be aware of listeriosis and implement measures for its prevention.
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Affiliation(s)
- Mehmet Tecellioglu
- Inonu University, School of Medicine, Department of Neurology, Malatya, Turkey
| | - Ozden Kamisli
- Inonu University, School of Medicine, Department of Neurology, Malatya, Turkey.
| | - Suat Kamisli
- Inonu University, School of Medicine, Department of Neurology, Malatya, Turkey
| | - Umut Adem Erdogmus
- Inonu University, School of Medicine, Department of Neurology, Malatya, Turkey
| | - Cemal Özcan
- Inonu University, School of Medicine, Department of Neurology, Malatya, Turkey
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