Rhombencephalitis due to Listeria monocytogenes

Listeria monocytogenes brain abscesses presenting as contiguous, tubular rim-enhancing lesions on Magnetic Resonance Imaging: Case series and literature review

Listeriosis has more than a 50% mortality when the central nervous system is involved, necessitating rapid diagnosis and treatment. We present four patients with brain abscesses in the setting of diagnosed neurolisteriosis, all of which demonstrated an odd presentation of multiple small, contiguous tubular lesions with rim enhancement on magnetic resonance imaging. Our review of published cases of neurolisteriosis suggests that this may be a useful pattern to identify neurolisteriosis abscesses, allowing earlier detection and therapy.

Analysis of a case report of meningitis caused by Listeria monocytogenes

Background

Listeria monocytogenes is a Gram-positive bacterium transmitted to humans through contaminated food, water, and animal faeces, posing a public health risk. Listeria monocytogenes is difficult to isolate and is not sensitive to first-line treatment with broad-spectrum cephalosporins for bacterial meningitis. Listeria meningitis is rare but can progress rapidly and may be accompanied by serious complications (hydrocephalus, ventricular inflammation, cerebral palsy, and brain abscess) and a high mortality rate.

Case presentation

It is a retrospective analysis of the clinical characteristics and treatment of a rare case of Listeria monocytogenes infection. Using laboratory indicators such as white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT), three detection methods (cerebrospinal fluid/blood culture), Targeted gene sequencing technology (tNGS), and Metagenomic next-generation sequencing technology (mNGS) combined with clinical manifestations of patients, analyze the use plan and prognosis of antibiotics in patients. The patient in this case initially had neurological symptoms such as fever, headache, unclear consciousness, and vomiting; laboratory indicators include elevated WBC, CRP, and PCT. Listeria monocytogenes was cultured in both the patient's cerebrospinal fluid and blood samples. After treatment with penicillin and meropenem, the patient recovered and was discharged without any sequelae.

Conclusion

Due to the rarity of Listeria monocytogenes, there may be deficiencies and difficulties in clinical differential diagnosis, making it difficult to achieve targeted antibiotic treatment. Therefore, accurate identification of Listeria monocytogenes and relevant laboratory inflammation indicator testing, combined with traditional culture methods and NGS testing, through empirical coverage of Listeria monocytogenes, targeted antibiotic treatment ultimately impacts clinical outcomes significantly.

Imaging modalities in neurolisteriosis: a literature review

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.