Listeria monocytogenes meningitis in an immunocompetent 18-year-old patient as a possible diagnostic and therapeutical problem
Abstract
Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patiens with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.
References
Hussein AS, Shafran SD. Acute bacterial meningitis in adults: a 12-year review. Medicine (Baltimore) 2000; 79(6): 360−8.
Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep 2008; 10(4): 300–6.
Bortolussi R, Kennedy W. Aerobic Gram-Positive Bacilli. In: Armstrong D, Cohen J, editors. Infectious Diseases. London: Mosby; 1999. p. 13−8.
Sigurdardottir B, Bjornsson OM, Jonsdottir KE, Erlendsdottir H, Gudmundsson S. Acute bacterial meningitis in adults: a 20-year overview. Arch Inter Med. 1997; 157(4): 426−30.
McMillan DA, Lin CY, Aronin SI, Quagliarello VJ. Community-acquired bacterial meningitis in adults: categorization of causes and timing of death. Clin Infect Dis 2001; 33(7): 969−75.
van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351(18): 1849–59.
Zuniga M, Aquado JM, Vada J. Listeria monocytogenes menigi-tis in previously haelthy adults: ling-term follow-up. Q J Med 1992; 85(307−308): 911−5.
Jamal WY, Al-Shomari S, Boland F, Rotimi VO. Listeria monocytogenes in an immunocompetent adult patient. Med Princ Pract 2005; 14(1): 55−7.
Aronin SI, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical out-come and effect of antibiotic timing. Ann Intern Med 1998; 129(11): 862−9.
Gilbert DN, Moellering RC Jr, Eliopoulos GM, Chambers HF, Saag MS. The Sanford Guide to Antimicrobial Therapy 2011. 41th ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2010.
Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis. Clin Microbiol Rev 2010; 23(3): 467–92.
Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis 2006; 43(10): 1233–8.
Ross KL, Tunkel AR, Scheld WM. Aute bacterial meningitis. In: Scheld WM, Whitley RJ, Marra CM, editors. Infections of the central nervous system. 3rd ed. Philadelphia: Lippincott Wil-liams & Wilkins; 2004. p. 347−422.
Mylonakis E, Hohmann EL, Calderwood SB. Central nervous sys-tem infection with Listeria monocytogenes: 33 years of experience at a general hospital and review of 776 episodes from the lite-rature. Medicine (Baltimore) 1998; 77(5): 313–36.
Pinner RW, Schuchat A, Swaminathan B, Hayes PS, Deaver KA, Weaver RE, et al. Role of foods in sporadic listeriosis. II: Mi-crobiologic and epidemiologic investigation. JAMA. 1992; 267(15): 2046−50.
Ramaswamy V, Cresence VM, Rejitha JS, Lekshmi MU, Dharsana KS, S. Prasad SP, et al. Listeria – review of epidemioloy and pathogenesis. J Microbiol Immunol Infect. 2007; 40(1): 4–13.
Lorber B. Listeriosis. Clin Infect Dis 1997; 24(1): 1−9, quiz 10−1.
Hohmann EL, Portnoy DA. Infections caused by Listeria mono-cytogenes. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, editors. Harrison's principles of internal medicine. 17 th ed. USA, New York: The McGraw-Hill; 2008. p. 895−7.
Quagliarello VJ, Scheld WM. Treatment of Bacterial Meningitis. N Engl J Med 1997; 336(10): 708−16.
Stepanovic S, Lazarevic G, Jesic M, Kos R. Meropenem therapy failure in Listeria monocytogens infection. Eur J Clin Micro-biol Infect Dis 2004; 23(6): 484−6.
Amaya-Villar R, García-Cabrera E, Sulleiro-Igual E, Fernández-Viladrich P, Fontanals-Aymerich D, Catalán-Alonso P, et al. Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults. BMC Infect Dis 2010; 10: 324.