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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:S2666-6367(24)00346-4. [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] [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.
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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
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2
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Bongiovanni M, Cavallo C, Barda B, Strulak L, Bernasconi E, Cardia A. Clinical Findings of Listeria monocytogenes Infections with a Special Focus on Bone Localizations. Microorganisms 2024; 12:178. [PMID: 38258004 PMCID: PMC10821090 DOI: 10.3390/microorganisms12010178] [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: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the microorganism can occur after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described in the past. L. monocytogenes can cause a number of different clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. L. monocytogenes systemic infections can develop following tissue penetration across the gastrointestinal tract or to hematogenous spread to sterile sites, possibly evolving towards bacteremia. L. monocytogenes only rarely causes bone or joint infections, usually in the context of prosthetic material that can provide a site for bacterial seeding. We describe here the clinical findings of invasive listeriosis, mainly focusing on the diagnosis, clinical management, and treatment of bone and vertebral infections occurring in the context of invasive listeriosis.
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Affiliation(s)
- Marco Bongiovanni
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Claudio Cavallo
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
| | - Beatrice Barda
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Lukasz Strulak
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (B.B.); (E.B.)
| | - Andrea Cardia
- Division of Neurosurgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (C.C.); (L.S.)
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3
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:4-12. [PMID: 37076331 DOI: 10.1016/j.eimce.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
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Affiliation(s)
| | | | | | | | | | | | - Rocio Otero López
- Neurosurgery Department, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Infectious Disease Unit, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Pilar Alonso García
- Clinical Microbiology Department, Universitary Hospital Lucus Augusti, Lugo, Spain
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4
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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
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5
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Tago M, Hirata R, Hirakawa Y, Makio S, Oishi T, Nakamura M, Yamashita S, Tokushima Y, Tokushima M, Katsuki NE, Aihara H, Fujiwara M. Listeria meningitis diagnosed by blood culture with fever, neurological symptoms, and no meningeal irritation signs. Clin Case Rep 2023; 11:e8020. [PMID: 37830068 PMCID: PMC10565091 DOI: 10.1002/ccr3.8020] [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: 06/04/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
Key Clinical Message Listeria can cause neurological symptoms in immunocompromised and older patients. Additionally, it is impossible to rule out meningitis by the absence of typical meningeal irritation signs. Therefore, patients with fever and neurological impairments should be rapidly examined for blood and cerebrospinal fluid cultures to rule out Listeria meningitis. Abstract A woman in her 90s developed fever, dysarthria, and transient disturbance of consciousness. Physical examination revealed no meningeal irritation signs. Listeria monocytogenes were detected in her blood culture the following day. Because of an increased number of cells in cerebrospinal fluid, she was diagnosed with Listeria meningitis.
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Affiliation(s)
- Masaki Tago
- Department of General MedicineSaga University HospitalSagaJapan
| | - Risa Hirata
- Department of General MedicineSaga University HospitalSagaJapan
| | - Yuka Hirakawa
- Department of General MedicineSaga University HospitalSagaJapan
| | - Seijiro Makio
- Department of General MedicineSaga University HospitalSagaJapan
| | - Toru Oishi
- Department of General MedicineSaga University HospitalSagaJapan
| | | | - Shun Yamashita
- Department of General MedicineSaga University HospitalSagaJapan
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6
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Tran SY, Barry S, Waller JL, Bollag WB, Young L, Padala S, Baer SL. Risk factors and mortality in patients with listeriosis and end-stage renal disease. Am J Med Sci 2023; 366:263-269. [PMID: 37331513 DOI: 10.1016/j.amjms.2023.06.012] [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: 11/03/2022] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) is a known immunocompromising status that predisposes patients to developing infections. Disease from Listeria monocytogenes may affect any host but tends to be more severe in the immunocompromised. METHODS We used a large population of patients with ESRD to identify risk factors for listeriosis and mortality. Patients with a diagnosis of Listeria and other risk factors for listeriosis were identified using claims data from the United States Renal Data System database from 2004-2015. Demographic parameters and risk factors associated with Listeria were modeled using logistic regression while association with mortality was assessed with Cox Proportional Hazards modeling. RESULTS A diagnosis of Listeria was identified in 291 (0.01%) of a total 1,071,712 patients with ESRD. Cardiovascular disease, connective tissue disease, upper gastrointestinal ulcerative disease, liver disease, diabetes, cancer, and human immunodeficiency virus were all associated with an increased risk of Listeria. Patients with Listeria had an increased risk of death relative to patients without Listeria (adjusted hazard ratio=1.79; 95% confidence interval 1.52-2.10). CONCLUSIONS Incidence of listeriosis in our study population was over 7 times higher than what has been reported for the general population. The independent association of a Listeria diagnosis with increased mortality is also consistent with the disease's high mortality in the general population. Due to limitations with diagnosis, providers should maintain high clinical suspicion for listeriosis when patients with ESRD present with a compatible clinical syndrome. Further prospective study may help precisely quantify the increased risk of listeriosis in patients with ESRD.
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Affiliation(s)
- Sarah Y Tran
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
| | - Sauveur Barry
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
| | - Jennifer L Waller
- Department of Population Health Science, Medical College of Georgia at Augusta University, Augusta, GA, USA.
| | - Wendy B Bollag
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA.
| | - Lufei Young
- College of Nursing at Augusta University, Augusta, GA, USA.
| | - Sandeep Padala
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
| | - Stephanie L Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA.
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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.
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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
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8
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Huang C, Lu TL, Yang Y. Mortality risk factors related to listeriosis - A meta-analysis. J Infect Public Health 2023; 16:771-783. [PMID: 36958172 DOI: 10.1016/j.jiph.2023.03.013] [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: 12/12/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Relatively few studies have focused on mortality risk factors for listeriosis in the literature. Information on the mortality of populations with listeriosis is needed. We aimed to explore the mortality risk factors related to listeriosis in this meta-analysis. METHODS The studies were considered eligible for inclusion only if they directly compared the mortality risk factors for listeriosis between dead patients and surviving patients. The mortality risk factors included clinical predisposing factors and predisposing comorbidities. RESULTS Thirteen studies were included in this study. There were 12,265 listeriosis patients, including 2863 (23.3%) dead patients. The meta-analysis provided evidence that the mortality risk factors related to listeriosis were as follows: 1. Clinical predisposing factors included age ≥ 60 years, primary bacteremia and central nervous system involvement; 2. Predisposing comorbidities included non-hematological malignancies, alcoholism, chronic kidney disease, cardiovascular disease, and pulmonary disease. In addition, autoimmune disease comorbidity had a protective effect against listeriosis. CONCLUSION The presence of older patients, primary bacteremia, central nervous system involvement, non-hematological malignancies, alcoholism, chronic kidney disease, cardiovascular disease, and pulmonary disease should alert physicians to the higher risk of mortality.
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Affiliation(s)
- Chienhsiu Huang
- Department of Internal medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
| | - Tsung-Lung Lu
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Yalun Yang
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
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Shimizu H, Imoto H, Hara S, Nishioka H. Listeria rhombencephalitis mimicking stroke in a patient with giant cell arteritis. J Infect Chemother 2023; 29:703-706. [PMID: 36996936 DOI: 10.1016/j.jiac.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
Listeria monocytogenes sometimes causes central nervous system infections. However, rhombencephalitis is a rare form of L. monocytogenes infection. Its clinical symptoms and magnetic resonance imaging (MRI) findings are often similar to those of vertebrobasilar stroke. We present the case of a 79-year-old woman with Listeria rhombencephalitis presenting with rhinorrhea and productive cough. She had giant cell arteritis (GCA) treated with prednisolone and methotrexate. She was admitted for loss of appetite, rhinorrhea, and productive cough. These symptoms were alleviated without specific treatment; however, she suddenly developed multiple cranial nerve palsies, and MRI showed hyperintense signals on diffusion-weighted imaging and hypointense signals on apparent diffusion coefficient in the brainstem. Ischemic stroke due to exacerbation of GCA was suspected, and treatment with intravenous methylprednisolone was initiated; however, seizures occurred, and a lumbar puncture was performed. Cerebrospinal fluid and blood cultures revealed L. monocytogenes, and she was diagnosed with Listeria rhombencephalitis. Although antibiotic treatment was continued, the patient died. Thus, when patients with rhinorrhea or productive cough develop sudden cranial nerve palsy, Listeria rhombencephalitis should be considered as a differential diagnosis, and lumbar puncture should be performed.
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10
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Barichello T, Rocha Catalão CH, Rohlwink UK, van der Kuip M, Zaharie D, Solomons RS, van Toorn R, Tutu van Furth M, Hasbun R, Iovino F, Namale VS. Bacterial meningitis in Africa. Front Neurol 2023; 14:822575. [PMID: 36864913 PMCID: PMC9972001 DOI: 10.3389/fneur.2023.822575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Bacterial meningitis differs globally, and the incidence and case fatality rates vary by region, country, pathogen, and age group; being a life-threatening disease with a high case fatality rate and long-term complications in low-income countries. Africa has the most significant prevalence of bacterial meningitis illness, and the outbreaks typically vary with the season and the geographic location, with a high incidence in the meningitis belt of the sub-Saharan area from Senegal to Ethiopia. Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are the main etiological agents of bacterial meningitis in adults and children above the age of one. Streptococcus agalactiae (group B Streptococcus), Escherichia coli, and Staphylococcus aureus are neonatal meningitis's most common causal agents. Despite efforts to vaccinate against the most common causes of bacterial neuro-infections, bacterial meningitis remains a significant cause of mortality and morbidity in Africa, with children below 5 years bearing the heaviest disease burden. The factors attributed to this continued high disease burden include poor infrastructure, continued war, instability, and difficulty in diagnosis of bacterial neuro-infections leading to delay in treatment and hence high morbidity. Despite having the highest disease burden, there is a paucity of African data on bacterial meningitis. In this article, we discuss the common etiologies of bacterial neuroinfectious diseases, diagnosis and the interplay between microorganisms and the immune system, and the value of neuroimmune changes in diagnostics and therapeutics.
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Affiliation(s)
- Tatiana Barichello
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Carlos Henrique Rocha Catalão
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Neuroscience and Behavioral Science, Ribeirao Preto Medical School, University of São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Ursula K. Rohlwink
- Pediatric Neurosurgery Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Martijn van der Kuip
- Department of Pediatric Infectious Diseases and Immunology, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Dan Zaharie
- Department of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Regan S. Solomons
- Department of Pediatric and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ronald van Toorn
- Department of Pediatric and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marceline Tutu van Furth
- Department of Pediatric Infectious Diseases and Immunology, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Internal Medicine, UT Health, McGovern Medical School, Houston, TX, United States
| | - Federico Iovino
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Vivian Ssonko Namale
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, United States
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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11
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Yu L, Zhang Y, Qi X, Bai K, Zhang Z, Bu H. Next-generation sequencing for the diagnosis of Listeria monocytogenes meningoencephalitis: a case series of five consecutive patients. J Med Microbiol 2023; 72. [PMID: 36748504 DOI: 10.1099/jmm.0.001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction. The prompt and specific diagnosis of Listeria monocytogenes meningoencephalitis (LMM) is challenging. Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) is an emerging technique for diagnosing infrequent causative pathogens.Hypothesis/Gap statement. We hypothesized that NGS of CSF is an effective approach for diagnosing LMM.Aim. To evaluate the effectiveness of NGS, we present five cases of LMM diagnosed using NGS of the CSF.Methodology. Between August 2017 and 30 September 2020, we used NGS of the CSF to detect pathogens in patients with clinically suspected central nervous system infections. The clinical characteristics, laboratory tests, imaging findings and NGS results are reviewed.Results. Five patients were diagnosed with LMM using NGS of the CSF within 2 to 4 days, although the clinical manifestations, medical history and imaging findings varied strikingly. NGS of CSF showed sequence reads corresponding to L. monocytogenes species ranging from 118 to 1997 bp, genomic coverage of 0.29-5.96 %, relative abundance of 14.83-32.16 % and sequencing depth of 1.12 to 1.35. The prompt diagnosis resulted in targeted and effective treatment with the appropriate antibiotics, although two patients with the most severe cerebral parenchymal lesions showed little improvement.Conclusion. Our results demonstrate the power of NGS of CSF for the prompt diagnosis of LMM. NGS of CSF is an important complementary tool for identifying L. monocytogenes.
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Affiliation(s)
- Lili Yu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Yu Zhang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Xuejiao Qi
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Kaixuan Bai
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Zhenyuan Zhang
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
| | - Hui Bu
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.,Key Laboratory of Neurology of Hebei Province, Shijiazhuang 050000, Hebei, PR China
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Listeria monocytogenes-How This Pathogen Uses Its Virulence Mechanisms to Infect the Hosts. Pathogens 2022; 11:pathogens11121491. [PMID: 36558825 PMCID: PMC9783847 DOI: 10.3390/pathogens11121491] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Listeriosis is a serious food-borne illness, especially in susceptible populations, including children, pregnant women, and elderlies. The disease can occur in two forms: non-invasive febrile gastroenteritis and severe invasive listeriosis with septicemia, meningoencephalitis, perinatal infections, and abortion. Expression of each symptom depends on various bacterial virulence factors, immunological status of the infected person, and the number of ingested bacteria. Internalins, mainly InlA and InlB, invasins (invasin A, LAP), and other surface adhesion proteins (InlP1, InlP4) are responsible for epithelial cell binding, whereas internalin C (InlC) and actin assembly-inducing protein (ActA) are involved in cell-to-cell bacterial spread. L. monocytogenes is able to disseminate through the blood and invade diverse host organs. In persons with impaired immunity, the elderly, and pregnant women, the pathogen can also cross the blood-brain and placental barriers, which results in the invasion of the central nervous system and fetus infection, respectively. The aim of this comprehensive review is to summarize the current knowledge on the epidemiology of listeriosis and L. monocytogenes virulence mechanisms that are involved in host infection, with a special focus on their molecular and cellular aspects. We believe that all this information is crucial for a better understanding of the pathogenesis of L. monocytogenes infection.
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13
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Wu GX, Zhou JY, Hong WJ, Huang J, Yan SQ. Treatment failure in a patient infected with Listeria sepsis combined with latent meningitis: A case report. World J Clin Cases 2022; 10:10565-10574. [PMID: 36312510 PMCID: PMC9602244 DOI: 10.12998/wjcc.v10.i29.10565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/20/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Listeria is a food-borne disease, which is rarely prevalent in the normal population; it mostly occurs in pregnant women, newborns, immunodeficiency patients, and the elderly. The main manifestations of this disease in patients include sepsis, meningitis, etc, and the mortality rate remains high, although the onset of meningitis is relatively insidious.
CASE SUMMARY A 75-year-old man presented with a fever for 1 wk and was admitted to the hospital for diagnosis and management of a lung infection. His condition improved after receiving anti-infective treatment for 2 wk. However, soon after he was discharged from the hospital, he developed fever again, and gradually developed various neurological symptoms, impaired consciousness, and stiff neck. Thereafter, through the cerebrospinal fluid metagenomic testing and blood culture, the patient was diagnosed with Listeria monocytogenes meningitis and sepsis. The patient died after being given active treatment, which included penicillin application and invasive respiratory support.
CONCLUSION This case highlights the ultimate importance of early identification and timely application of the various sensitive antibiotics, such as penicillin, vancomycin, meropenem, etc. Therefore, for high-risk populations with unknown causes of fever, multiple blood cultures, timely cerebrospinal fluid examination, and metagenomic detection technology can assist in confirming the diagnosis quickly, thereby guiding the proper application of antibiotics and improving the prognosis.
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Affiliation(s)
- Gui-Xian Wu
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Zhejiang University, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318050, Zhejiang Province, China
| | - Jian-Ya Zhou
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Wei-Jun Hong
- Neurology Department, Taizhou Hospital of Zhejiang Province, Zhejiang University, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318050, Zhejiang Province, China
| | - Jing Huang
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Zhejiang University, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318050, Zhejiang Province, China
| | - Shuang-Quan Yan
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Zhejiang University, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318050, Zhejiang Province, China
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14
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Rhombencephalitis in Pregnancy-A Challenging Case of Probable Listeria Infection. Life (Basel) 2022; 12:life12101600. [PMID: 36295036 PMCID: PMC9604870 DOI: 10.3390/life12101600] [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: 08/15/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Rhombencephalitis refers to inflammation of the brainstem and cerebellum, and can be caused by infections, autoimmune disorders or paraneoplastic syndromes. The most common infective cause is the bacterium Listeria monocytogenes. Listeria monocytogenes is the predominant species to cause human listeriosis, and is commonly due to the ingestion of contaminated foods. Symptoms include a mild gastroenteritis, fever (often with extreme temperature variations), headache, and myalgia. In more severe cases, invasive disease may lead to bacteraemia and neurolisteriosis. Pregnant women are more susceptible to listeriosis, which is believed to be due to pregnancy-related immune modulation. Maternal-neonatal infection with adverse pregnancy outcomes include neonatal listeriosis, spontaneous miscarriage and intrauterine fetal demise. Diagnosis may be challenging due to initial nonspecific symptoms and low sensitivity and specificity of confirmatory diagnostic laboratory tests. Here, we describe a case of rhombencephalitis in pregnancy, attributed to Listeria, and review the clinical features, diagnosis and multidisciplinary management. Lastly, we describe the immunological response to Listeria monocytogenes and show in vitro pro-inflammatory effects of Listeria monocytogenes on peripheral blood mononuclear cells and placental explants.
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15
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Alammora A, Elamin A. Intracranial Hemorrhage Associated With Listeria monocytogenes Bacteremia in an Elderly Patient on Mycophenolate Mofetil. Cureus 2022; 14:e27562. [PMID: 36059338 PMCID: PMC9428365 DOI: 10.7759/cureus.27562] [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: 07/31/2022] [Indexed: 11/24/2022] Open
Abstract
Listeria monocytogenes is an important foodborne bacterial pathogen in immunosuppressed patients, pregnant women, and individuals at the extremes of age, including neonates and older adults. Invasion of the central nervous system (CNS) and bacteremia are the principal clinical manifestations of infection in these hosts. In contrast, normal hosts who ingest high numbers of Listeria may develop self-limited febrile gastroenteritis. Hydrocephalus and intracranial hemorrhage (ICH) are very rare and severe complications of L. monocytogenes infection. ICH associated with L. monocytogenes has been reported even less frequently than hydrocephalus, with most cases occurring in the pediatric population. In this paper, we present a case of L. monocytogenes bacteremia in a 71-year-old male, complicated by intracranial hemorrhage. He presented at first with nonspecific symptoms of generalized weakness and fatigability and later developed drowsiness, disorientation, and fever, which prompted further investigations that revealed the presence of ICH and L. monocytogenes bacteremia.
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16
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Moscatt V, Marino A, Ceccarelli M, Cosentino F, Zagami A, Celesia B, Nunnari G, Cacopardo B. Possible role of low dose dexamethasone administration in listeria monocytogenes meningoencephalitis: A case series. Biomed Rep 2022; 17:73. [PMID: 35950097 PMCID: PMC9353624 DOI: 10.3892/br.2022.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vittoria Moscatt
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95122 Catania, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Aldo Zagami
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Benedetto Celesia
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Sobana M, Halim D, Ardisasmita MN, Imron A, Gamayani U, Achmad TH. Periventricular hypodensity is associated with the incidence of pre-shunt seizure in hydrocephalic children. Childs Nerv Syst 2022; 38:1321-1329. [PMID: 35467126 DOI: 10.1007/s00381-022-05526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The seizure incidence in hydrocephalic children has been acknowledged in a lot of studies previously; nonetheless, seizure pathogenesis in these children remains unclear. Its high proportion of hydrocephalic children who underwent shunt surgery suggests that the seizure might be associated with the protocol of shunt placement and/or the shunt existence intracranially; however, this hypothesis could not explain the pre-shunt seizure incidence in hydrocephalic children. OBJECTIVE This study aims to evaluate the patients' characteristics and CT findings in pre-shunt hydrocephalic children to identify the possible seizure etiology in these patients. METHODS Three hundred and thirty-four children with hydrocephalus were included in this study, including 147 hydrocephalic children with the pre-shunt seizure history and 187 hydrocephalic children presented without the pre-shunt seizure history. The following information was retrieved from the patients' medical records: gender, age, pediatric Glasgow Coma Scale (pGCS) upon admission, and hydrocephalus diagnoses. CT findings were re-evaluated to assess the compression association of sulci and gyri, Sylvian fissures, cisterns, FH/ID ratio, Evan's ratio, and periventricular hypodensity with pre-shunt seizure. RESULTS The results show that the pre-shunt seizure incidence is significantly higher in hydrocephalic children aged 1 to 5 years old (63/113 (55%), p = 0.0001), diagnosed with communicating hydrocephalus (97/163 (59%), p = 0.0001) or infectious hydrocephalus (80/109 (73%), p = 0.0001). The presence of periventricular hypodensity is significantly associated with the pre-shunt seizure incidence (132/205 (64.3%), p = 0.0001). Results from univariate analyses suggest significant association between periventricular hypodensity in every location and pre-shunt seizure (p < 0.0001). Multivariate analyses identify that temporal horn in the right lateral ventricle as the location of periventricular hypodensity has the strongest association with the pre-shunt seizure. CONCLUSION The presence of periventricular hypodensity in head CT scan is significantly associated with the pre-shunt seizure incidence. Further investigation to confirm this finding and evaluate the possible roles of inflammation in the pre-shunt seizure in hydrocephalic children is important to seek its possible implication on the treatment of pre-shunt seizure in these children.
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Affiliation(s)
- Mirna Sobana
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Danny Halim
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.,Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Mulya Nurmansyah Ardisasmita
- Division of Epidemiology and Biostatistics, Department of Public Health, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Akhmad Imron
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran/Dr, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Uni Gamayani
- Division of Pediatric Neurology, Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Tri Hanggono Achmad
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia. .,Department of Basic Medical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.
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19
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Zhao CW, Dai S, Wu Q. Pearls & Oy-sters: Diagnosis and Subtyping of Listeria Ventriculitis in an Immunocompetent Host. Neurology 2022; 99:123-126. [PMID: 35508397 DOI: 10.1212/wnl.0000000000200732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/29/2022] [Indexed: 11/15/2022] Open
Abstract
Listeria monocytogenes is a gram-positive food-borne pathogen that causes gastrointestinal symptoms and central nervous system (CNS) infection in susceptible hosts.. Two lineages of Listeria cause the majority of neurolisteriosis in humans. In this report, we discuss a case of a 23-year-old previously healthy female who presented with acute-onset rapidly progressive altered mental status after eating undercooked meats at a local restaurant. Given her age and lack of comorbidities, bacterial meningitis was suspected, and she was treated with ceftriaxone, vancomycin, and steroids. Magnetic resonance imaging of the brain was consistent with meningitis and ventriculitis; Cerebrospinal fluid (CSF) analysis also suggested bacterial meningitis. Despite mechanical ventilation, pressors, and ventricular drain placement, she quickly decompensated and died 12 hours after arrival. CSF culture later returned positive for Listeria monocytogenes We used whole genome sequencing and near-source comparison to identify the Listeria subtype that led to her unexpected presentation. The results suggest that her CSF isolate was consistent with a lineage II Listeria serotype, which is known to exhibit greater genetic variation than the more commonly isolated lineage I serotypes. We conclude the discussion with diagnostic and treatment approaches to neurolisteriosis. In susceptible hosts, namely immunocompromised, pregnant, neonatal or elderly patients, Listeria infection may result in CNS invasion, causing meningoencephalitis and, rarely, ventriculitis and rhombencephalitis. Although neurolisteriosis most commonly affects individuals with known risk factors, CNS infection is nevertheless possible in otherwise healthy young patients. Suspicion should be raised in patients with an exposure history and do not improve with empiric antibiotics.
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Affiliation(s)
- Charlie Weige Zhao
- Yale School of Medicine, New Haven, CT .,Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT
| | - Shujuan Dai
- Department of Neurology, Kunming Medical University, Yunnan, China
| | - Qian Wu
- Department of Neurology, Kunming Medical University, Yunnan, China
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20
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Brodiazhenko T, Turnbull KJ, Wu KJY, Takada H, Tresco BIC, Tenson T, Myers AG, Hauryliuk V. Synthetic oxepanoprolinamide iboxamycin is active against Listeria monocytogenes despite the intrinsic resistance mediated by VgaL/Lmo0919 ABCF ATPase. JAC Antimicrob Resist 2022; 4:dlac061. [PMID: 35733912 PMCID: PMC9204466 DOI: 10.1093/jacamr/dlac061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 01/15/2023] Open
Abstract
Background Listeriosis is a food-borne disease caused by the Gram-positive Bacillota (Firmicute) bacterium Listeria monocytogenes. Clinical L. monocytogenes isolates are often resistant to clinically used lincosamide clindamycin, thus excluding clindamycin as a viable treatment option. Objectives We have established newly developed lincosamide iboxamycin as a potential novel antilisterial agent. Methods We determined MICs of the lincosamides lincomycin, clindamycin and iboxamycin for L. monocytogenes, Enterococcus faecalis and Bacillus subtilis strains expressing synergetic antibiotic resistance determinants: ABCF ATPases that directly displace antibiotics from the ribosome and Cfr, a 23S rRNA methyltransferase that compromises antibiotic binding. For L. monocytogenes strains, either expressing VgaL/Lmo0919 or lacking the resistance factor, we performed time-kill kinetics and post-antibiotic effect assays. Results We show that the synthetic lincosamide iboxamycin is highly active against L. monocytogenes and can overcome the intrinsic lincosamide resistance mediated by VgaL/Lmo0919 ABCF ATPase. While iboxamycin is not bactericidal against L. monocytogenes, it displays a pronounced post-antibiotic effect, which is a valuable pharmacokinetic feature. We demonstrate that VmlR ABCF of B. subtilis grants significant (33-fold increase in MIC) protection from iboxamycin, while LsaA ABCF of E. faecalis grants an 8-fold protective effect. Furthermore, the VmlR-mediated iboxamycin resistance is cooperative with that mediated by the Cfr, resulting in up to a 512-fold increase in MIC. Conclusions While iboxamycin is a promising new antilisterial agent, our findings suggest that emergence and spread of ABCF ARE variants capable of defeating next-generation lincosamides in the clinic is possible and should be closely monitored.
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Affiliation(s)
| | | | - Kelvin J Y Wu
- Department of Chemistry and Chemical Biology, Harvard University , Cambridge, MA , USA
| | - Hiraku Takada
- Department of Experimental Medicine, University of Lund , 221 84 Lund , Sweden
- Faculty of Life Sciences, Kyoto Sangyo University , Kamigamo, Motoyama, Kita-ku, Kyoto 603-8555 , Japan
| | - Ben I C Tresco
- Department of Chemistry and Chemical Biology, Harvard University , Cambridge, MA , USA
| | - Tanel Tenson
- University of Tartu, Institute of Technology , 50411 Tartu , Estonia
| | - Andrew G Myers
- Department of Chemistry and Chemical Biology, Harvard University , Cambridge, MA , USA
| | - Vasili Hauryliuk
- University of Tartu, Institute of Technology , 50411 Tartu , Estonia
- Department of Experimental Medicine, University of Lund , 221 84 Lund , Sweden
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21
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Roy M, Vuppuluri N, Roy AK. Listeria Meningitis in a Patient With Plaque Psoriasis on Ustekinumab Therapy. Cureus 2022; 14:e23336. [PMID: 35464555 PMCID: PMC9017281 DOI: 10.7759/cureus.23336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/15/2023] Open
Abstract
Listeria monocytogenes is a foodborne infection and is a leading cause of meningitis. The at-risk population includes patients over age 65, neonates, pregnant females, and patients with impaired cell immunity. Ustekinumab is a human monoclonal antibody that binds to and interferes with the proinflammatory cytokines, interleukin-12 (IL-12) and interleukin-23(IL-23). The drug is used for the treatment of Crohn’s disease, ulcerative colitis, psoriatic arthritis, and plaque psoriasis. We present a case of listeria meningitis in a patient on ustekinumab therapy for plaque psoriasis.
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22
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Affiliation(s)
- Yohann Le Govic
- Infectious Agents, Resistance and Chemotherapy (AGIR), University of Picardy Jules Verne, Amiens, France
- Parasitology-Mycology Department, Center for Human Biology, University Hospital of Amiens-Picardie, Amiens, France
| | - Baptiste Demey
- Infectious Agents, Resistance and Chemotherapy (AGIR), University of Picardy Jules Verne, Amiens, France
- Virology Department, Center for Human Biology, University Hospital of Amiens-Picardie, Amiens, France
| | - Julien Cassereau
- Department of Neurology, Angers University Hospital, Angers, France
- Univ Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - Yong-Sun Bahn
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
- * E-mail: (Y-SB); (NP)
| | - Nicolas Papon
- Univ Angers, Univ Brest, IRF, SFR ICAT, Angers, France
- * E-mail: (Y-SB); (NP)
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23
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Thiankhaw K, Wantaneeyawong C, Madla C. Conglomerate ring and tract-like enhancement lesions: Neuroimaging in Listeria monocytogenes brain abscess. Radiol Case Rep 2022; 17:676-679. [PMID: 35003459 PMCID: PMC8718813 DOI: 10.1016/j.radcr.2021.12.008] [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: 10/23/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
This report aims to describe a characteristic neuroimaging of Listeria monocytogenes brain abscess in predisposed patients. A 56-year-old man presented with fever and headache for 3 weeks. Cerebrospinal fluid (CSF) revealed pleocytosis with lymphocytosis, high protein, and low glucose. Both hemoculture and CSF culture yielded L monocytogenes. Another case is a 23-year-old woman with systemic lupus erythematosus, who presented with fever, headache and left hemiparesis. CSF showed pleocytosis with polymorphonuclear cells predominance and low glucose. Hemoculture positive for L monocytogenes. Their MRI brain revealed conglomerate ring and tract-like enhancement lesions at the right parietotemporal lobe. The patients were diagnosed with L monocytogenes brain abscess. They received a high dose of ceftriaxone and ampicillin for 6 weeks. The clinical and MRI at the end of treatment was a substantial improvement. Our information can help the physician concern about this pathogen in patients who presented with brain abscess and had these MRI findings.
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Affiliation(s)
- Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110, Inthawaroros Road, Sriphum, Chiang Mai, 50200, Thailand
- Corresponding author.Kitti Thiankhaw.
| | - Chayasak Wantaneeyawong
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110, Inthawaroros Road, Sriphum, Chiang Mai, 50200, Thailand
| | - Chakri Madla
- Division of Neuro Imaging and Interventional Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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24
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Liao Y, Liu L, Zhou H, Fang F, Liu X. Case Report: Refractory Listeria innocua Meningoencephalitis in a Three-Year-Old Boy. Front Pediatr 2022; 10:857900. [PMID: 35664865 PMCID: PMC9160653 DOI: 10.3389/fped.2022.857900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Listeria innocua is widely distributed in the environment and food and is considered a non-pathogenic bacterium for both humans and animals. To our knowledge, only a few cases of L. innocua infection in humans and ruminants have been reported. Moreover, there has been no report on human L. innocua meningoencephalitis. Here, we report a case of severe refractory meningoencephalitis in a three-year-old boy after infection with L. innocua. The child's first symptoms were a runny nose, high fever, and rashes, which quickly progressed to unconsciousness and convulsions. The initial analysis of cerebral spinal fluid revealed remarkably elevated protein levels and increased white blood cells count. The blood culture of the patient in the early stage was positive for L. innocua. In addition, his brain imaging tests were observed dynamically, and the result showed a speedy progression from multiple intracranial abnormal signals to hydrocephalus and interstitial cerebral edema. After receiving antibiotics and symptomatic treatment for nearly 3 months, the patient's condition improved markedly. However, he still had residual complications such as hydrocephalus. Although L. innocua is considered harmless, it can still cause disease in humans, even severe meningoencephalitis, with rapid progression and poor prognosis. Early discovery, diagnosis, and treatment are necessary to elevate the survival rate and life quality of those patients. Antibiotics should be used with sufficient duration and dosage. Cephalosporins are not suitable for the treatment of L. innocua meningoencephalitis and penicillin antibiotics are preferred for children. The presentation of this case will help to expand our knowledge of Listeria infections and provide a potential candidate for pathogens causing severe childhood central nervous system infection.
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Affiliation(s)
- Yi Liao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingling Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Fang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinglou Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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25
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Bagatella S, Tavares-Gomes L, Oevermann A. Listeria monocytogenes at the interface between ruminants and humans: A comparative pathology and pathogenesis review. Vet Pathol 2021; 59:186-210. [PMID: 34856818 DOI: 10.1177/03009858211052659] [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] [Indexed: 12/17/2022]
Abstract
The bacterium Listeria monocytogenes (Lm) is widely distributed in the environment as a saprophyte, but may turn into a lethal intracellular pathogen upon ingestion. Invasive infections occur in numerous species worldwide, but most commonly in humans and farmed ruminants, and manifest as distinct forms. Of those, neuroinfection is remarkably threatening due to its high mortality. Lm is widely studied not only as a pathogen but also as an essential model for intracellular infections and host-pathogen interactions. Many aspects of its ecology and pathogenesis, however, remain unclear and are rarely addressed in its natural hosts. This review highlights the heterogeneity and adaptability of Lm by summarizing its association with the environment, farm animals, and disease. It also provides current knowledge on key features of the pathology and (molecular) pathogenesis of various listeriosis forms in naturally susceptible species with a special focus on ruminants and on the neuroinvasive form of the disease. Moreover, knowledge gaps on pathomechanisms of listerial infections and relevant unexplored topics in Lm pathogenesis research are highlighted.
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Affiliation(s)
- Stefano Bagatella
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Leticia Tavares-Gomes
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Anna Oevermann
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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26
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Quereda JJ, Morón-García A, Palacios-Gorba C, Dessaux C, García-del Portillo F, Pucciarelli MG, Ortega AD. Pathogenicity and virulence of Listeria monocytogenes: A trip from environmental to medical microbiology. Virulence 2021; 12:2509-2545. [PMID: 34612177 PMCID: PMC8496543 DOI: 10.1080/21505594.2021.1975526] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/02/2023] Open
Abstract
Listeria monocytogenes is a saprophytic gram-positive bacterium, and an opportunistic foodborne pathogen that can produce listeriosis in humans and animals. It has evolved an exceptional ability to adapt to stress conditions encountered in different environments, resulting in a ubiquitous distribution. Because some food preservation methods and disinfection protocols in food-processing environments cannot efficiently prevent contaminations, L. monocytogenes constitutes a threat to human health and a challenge to food safety. In the host, Listeria colonizes the gastrointestinal tract, crosses the intestinal barrier, and disseminates through the blood to target organs. In immunocompromised individuals, the elderly, and pregnant women, the pathogen can cross the blood-brain and placental barriers, leading to neurolisteriosis and materno-fetal listeriosis. Molecular and cell biology studies of infection have proven L. monocytogenes to be a versatile pathogen that deploys unique strategies to invade different cell types, survive and move inside the eukaryotic host cell, and spread from cell to cell. Here, we present the multifaceted Listeria life cycle from a comprehensive perspective. We discuss genetic features of pathogenic Listeria species, analyze factors involved in food contamination, and review bacterial strategies to tolerate stresses encountered both during food processing and along the host's gastrointestinal tract. Then we dissect host-pathogen interactions underlying listerial pathogenesis in mammals from a cell biology and systemic point of view. Finally, we summarize the epidemiology, pathophysiology, and clinical features of listeriosis in humans and animals. This work aims to gather information from different fields crucial for a comprehensive understanding of the pathogenesis of L. monocytogenes.
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Affiliation(s)
- Juan J. Quereda
- Departamento de Producción y Sanidad Animal, Salud Pública Veterinaria y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities. Valencia, Spain
| | - Alvaro Morón-García
- Departamento de Biología Celular. Facultad de Ciencias Biológicas, Universidad Complutense de Madrid. Madrid, Spain
| | - Carla Palacios-Gorba
- Departamento de Producción y Sanidad Animal, Salud Pública Veterinaria y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities. Valencia, Spain
| | - Charlotte Dessaux
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología (CNB)- Consejo Superior De Investigaciones Científicas (CSIC), Madrid, Spain
| | - Francisco García-del Portillo
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología (CNB)- Consejo Superior De Investigaciones Científicas (CSIC), Madrid, Spain
| | - M. Graciela Pucciarelli
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología (CNB)- Consejo Superior De Investigaciones Científicas (CSIC), Madrid, Spain
- Centro de Biología Molecular ‘Severo Ochoa’. Departamento de Biología Molecular, Facultad de Ciencias, Universidad Autónoma de Madrid. Madrid, Spain
| | - Alvaro D. Ortega
- Departamento de Biología Celular. Facultad de Ciencias Biológicas, Universidad Complutense de Madrid. Madrid, Spain
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología (CNB)- Consejo Superior De Investigaciones Científicas (CSIC), Madrid, Spain
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27
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Zhang N, Sun W, Zhou L, Chen M, Dong X, Wei W. Multiple brain abscesses due to Listeria monocytogenes infection in a patient with systemic lupus erythematosus: A case report and literature review. Int J Rheum Dis 2021; 24:1427-1439. [PMID: 34633142 DOI: 10.1111/1756-185x.14226] [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] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022]
Abstract
AIM To review the clinical features of systemic lupus erythematosus (SLE) complicated by central nervous system (CNS) infection due to Listeria monocytogenes. METHOD A patient with SLE receiving high-dose glucocorticoids combined with cyclophosphamide who developed multiple brain abscesses due to Listeria infection is described. The case is compared with known cases in a literature review. RESULTS A review of the literature showed that CNS infections are rare bacterial complications of SLE, but they can be a significant cause of mortality, especially those due to L. monocytogenes. The most significant risk factor for listerial meningitis is a prior history of receiving immunosuppressive therapy. At-risk patients should avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products. The case we report is the fifth SLE patient with multiple brain abscesses due to L. monocytogenes, and the first to be discharged with no sequelae. Timely and accurate identification and treatment of CNS infections and neuropsychiatric lupus are very important for favorable disease prognosis. CONCLUSION Repeated blood culture is helpful for early diagnosis, and empirical anti-infective treatment that covers L. monocytogenes is recommended for SLE patients with risk factors when CNS infection occurs. A comprehensive assessment might be helpful to distinguish CNS infections from neuropsychiatric SLE. For severe infection, the dosage of steroids does not need to be reduced immediately but can be gradually adjusted based on the results of a comprehensive evaluation of the disease.
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Affiliation(s)
- Na Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Wenwen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Lei Zhou
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Ming Chen
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Xiaoying Dong
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Clinical Research Center for Rheumatic and Immune Diseases, Tianjin, China
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28
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Vishnevetsky A, Anand P. Approach to Neurologic Complications in the Immunocompromised Patient. Semin Neurol 2021; 41:554-571. [PMID: 34619781 DOI: 10.1055/s-0041-1733795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.
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Affiliation(s)
- Anastasia Vishnevetsky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pria Anand
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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29
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Andriyanov PA, Zhurilov PA, Liskova EA, Karpova TI, Sokolova EV, Yushina YK, Zaiko EV, Bataeva DS, Voronina OL, Psareva EK, Tartakovsky IS, Kolbasov DV, Ermolaeva SA. Antimicrobial Resistance of Listeria monocytogenes Strains Isolated from Humans, Animals, and Food Products in Russia in 1950-1980, 2000-2005, and 2018-2021. Antibiotics (Basel) 2021; 10:antibiotics10101206. [PMID: 34680788 PMCID: PMC8532776 DOI: 10.3390/antibiotics10101206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/04/2022] Open
Abstract
Susceptibility of 117 L. monocytogenes strains isolated during three time periods (1950–1980; 2000–2005, and 2018–2021) to 23 antibiotics was tested by the disk diffusion method. All strains were sensitive to aminoglycosides (gentamicin, kanamycin, neomycin, streptomycin), glycopeptides (vancomycin and teicoplanin), clarithromycin, levofloxacin, amoxicillin/clavulanic acid, and trimethoprim/sulfamethoxazole. Resistance to clindamycin was observed in 35.5% of strains. Resistance to carbapenems, imipenem and meropenem was found in 4% and 5% of strains, respectively. Resistance to erythromycin, penicillin G, trimethoprim, and ciprofloxacin was found in 4%, 3%, 3%, and 2.5% of strains, respectively. Resistance to tylosin, ampicillin, enrofloxacin, linezolid, chloramphenicol, and tetracycline was found in less than 2%. Three strains with multiple antibiotic resistance and 12 strains with resistance to two antibiotics were revealed. Comparison of strains isolated in different time periods showed that the percentage of resistant strains was the lowest among strains isolated before 1980, and no strains with multiple antibiotic resistance were found among them. Statistical analysis demonstrated that the temporal evolution of resistance in L. monocytogenes has an antibiotic-specific character. While resistance to some antibiotics such as ampicillin and penicillin G has gradually decreased in the population, resistance to other antibiotics acquired by particular strains in recent years has not been accompanied by changes in resistance of other strains.
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Affiliation(s)
- Pavel A. Andriyanov
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
| | - Pavel A. Zhurilov
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
| | - Elena A. Liskova
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
| | - Tatyana I. Karpova
- Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia; (T.I.K.); (O.L.V.); (I.S.T.)
| | - Elena V. Sokolova
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
| | - Yulia K. Yushina
- Federal Scientific Centre for Food Systems n.a. V.M. Gorbatov, 109316 Moscow, Russia; (Y.K.Y.); (E.V.Z.); (D.S.B.)
| | - Elena V. Zaiko
- Federal Scientific Centre for Food Systems n.a. V.M. Gorbatov, 109316 Moscow, Russia; (Y.K.Y.); (E.V.Z.); (D.S.B.)
| | - Dagmara S. Bataeva
- Federal Scientific Centre for Food Systems n.a. V.M. Gorbatov, 109316 Moscow, Russia; (Y.K.Y.); (E.V.Z.); (D.S.B.)
| | - Olga L. Voronina
- Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia; (T.I.K.); (O.L.V.); (I.S.T.)
| | - Ekaterina K. Psareva
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
| | - Igor S. Tartakovsky
- Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia; (T.I.K.); (O.L.V.); (I.S.T.)
| | - Denis V. Kolbasov
- Federal Research Center for Virology and Microbiology, 601125 Volginsky, Russia;
| | - Svetlana A. Ermolaeva
- Federal Research Center for Virology and Microbiology, Branch in Nizhny Novgorod, 603950 Nizhny Novgorod, Russia; (P.A.A.); (P.A.Z.); (E.A.L.); (E.V.S.); (E.K.P.)
- Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia; (T.I.K.); (O.L.V.); (I.S.T.)
- Correspondence: ; Tel.: +7-909-939-9612
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30
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Cipriani D, Trippel M, Buttler KJ, Rohr E, Wagner D, Beck J, Schnell O. Cerebral Abscess Caused by Listeria monocytogenes: Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:194-205. [PMID: 34496414 DOI: 10.1055/s-0041-1729174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon. CASE PRESENTATION We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes. CONCLUSIONS This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.
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Affiliation(s)
- Debora Cipriani
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Michael Trippel
- Department of Stereotactic and Functional Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Klaus-Jürgen Buttler
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Eva Rohr
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Department of Medicine II, Division of Infectious Diseases, Medical Center University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
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31
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Silva C, Ferrão D, Almeida M, Nogueira-Silva L, Almeida JS. Neurolisteriosis: The Importance of a Prompt Diagnosis. Cureus 2021; 13:e16662. [PMID: 34458048 PMCID: PMC8384388 DOI: 10.7759/cureus.16662] [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] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
Immune thrombocytopenia (ITP) is a prevalent disease that may need immunosuppressant treatment, which increases the risk of an opportunistic infection. We present the case of a woman with corticosteroid-resistant ITP who was electively admitted to the hospital to initiate second-line treatment. On the second day, she presented with a high fever and altered mental status, with no lesions on the cerebral tomography and inconclusive cerebrospinal fluid analysis. Nonetheless, she was promptly started on empiric antibiotics for meningitis which were then adjusted for Listeria monocytogenes, isolated in blood culture. The cerebral magnetic resonance showed signs of cerebritis and pyogenic foci. The patient was discharged after 73 days of treatment, asymptomatic and with no neurological sequelae. The mortality rate of neurolisteriosis can be as high as 50%. The median time between the initial symptoms and their detection is seven days, with many patients already developing cerebral abscesses. The favorable outcome of this patient was due to the precocious detection and start of the treatment.
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Affiliation(s)
- Clara Silva
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Diana Ferrão
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Mariana Almeida
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Luis Nogueira-Silva
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT.,Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculty of Medicine of the University of Porto, Porto, PRT.,Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
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32
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Anand P. Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies. ACTA ACUST UNITED AC 2021; 27:1066-1104. [PMID: 34623105 DOI: 10.1212/con.0000000000000985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Both broadly immunosuppressive medications and selective immunomodulatory agents that act on particular components of the immune system are increasingly used in the treatment of neurologic and non-neurologic diseases. These therapies predispose patients to particular infections, some of which may affect the nervous system. Therefore, familiarity with the clinical and radiologic features of neurologic infections associated with specific immunomodulatory therapies is of importance for the practicing neurologist. This article reviews these neuroinfectious conditions, as well as other neurologic complications unique to transplant recipients and other patients who are immunocompromised. RECENT FINDINGS Diagnosis of infectious pathogens in patients who are immunocompromised may be particularly challenging because a decreased immune response can lead to atypical imaging or laboratory findings. Next-generation sequencing and other novel diagnostic modalities may improve the rate of early identification of neurologic infections in patients who are immunocompromised and ultimately ameliorate outcomes in this vulnerable population. SUMMARY A broad range of bacterial, viral, fungal, and parasitic infections of the nervous system can complicate solid organ and hematopoietic cell transplantation as well as other forms of immunocompromise. In addition to neurologic infections, such patients are at risk of neurotoxic and neuroinflammatory complications related to immunomodulatory and immunosuppressive therapies. Early recognition of infectious and noninfectious complications of immunocompromise is essential to guide appropriate treatment, which can include antimicrobial therapy and, in some cases, withdrawal of the predisposing medication with a transition to an alternative regimen.
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33
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Listeria Rhomboencephalitis in an Immunocompetent Host. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Meningitis caused by Listeria monocytogenes in a locally advanced cervical cancer patient with pyometra: A case report. Gynecol Oncol Rep 2021; 37:100799. [PMID: 34150974 PMCID: PMC8190492 DOI: 10.1016/j.gore.2021.100799] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
Locally advanced cervical cancer occasionally induces pyometra, but there have been no reports of meningitis where pyometra is the cause of infection. Here, we report a case of Listeria monocytogenes meningitis related to pyometra during concurrent chemoradiotherapy (CCRT) in a cervical cancer patient. The patient, a 77-year-old woman, was diagnosed with Stage IIB (FIGO 2018) cervical adenocarcinoma, and CCRT was initiated. Pyometra was exacerbated during CCRT, and after her first brachytherapy, she presented at our hospital with fever and decreased consciousness level. After admission to the Intensive Care Unit, the patient lost consciousness and experienced frequent seizures; tracheal intubation was required. Whole-body computed tomography revealed pyometra; therefore, transvaginal removal of the abscess was performed. Laboratory tests and vital signs indicated septic shock, and meropenem was administered. L. monocytogenes was detected in the abscess from the uterine cavity and the blood cultures on the third day of hospitalization. A lumbar puncture was performed on the same day to investigate whether the patient had meningitis. A FilmArray meningitis/encephalitis panel test of the spinal fluid revealed L. monocytogenes. After the diagnosis of meningitis with L. monocytogenes, ampicillin and gentamicin were started, and the blood test results gradually improved. Five months after the initial episode, her consciousness recovered, however she still received mechanical ventilatory support. L. monocytogenes infections can occur in patients undergoing chemotherapy, even without the use of steroids or immunosuppressive agents. In cases with pyometra, intrauterine manipulation can increase the risk of severe infection.
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35
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Paranjape N. Rhombencephalitis due to Listeria monocytogenes. IDCases 2021; 24:e01081. [PMID: 33850723 PMCID: PMC8022819 DOI: 10.1016/j.idcr.2021.e01081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Brain stem encephalitis is an unusual form of CNS listeriosis that is associated with a high mortality. This is a case of a 46 year-old male with a history of dermatomyositis on methotrexate who presented with fever, headache, assymetrical cranial nerve palsy and right hemiparesis. MRI showed a ring-enhancing lesions in medulla oblongata. CSF cultures grew Listeria monocytogenes. Despite treatment with ampicillin and gentamicin, the patient developed three rare manifestations of neurolisteriosis namely rhombencephalitis, hydrocephalus and brainstem hemorrhage and did not survive. Early detection and treatment is vital in preventing adverse outcomes.
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36
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Abstract
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies.
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37
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Hauser N, Luethy PM, Stamatos N. Listeria Meningitis: An Inconsistent Organism Causing an Inconsistent Disease. Am J Med 2021; 134:e64-e65. [PMID: 32717187 DOI: 10.1016/j.amjmed.2020.06.028] [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: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Naomi Hauser
- Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore.
| | - Paul M Luethy
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Nicholas Stamatos
- Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore
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38
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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.
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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
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39
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Pérez‐Pereda S, González‐Quintanilla V, Toriello‐Suárez M, Malet Pintos‐Fonseca A, Sánchez Rodríguez A, Gallo Valentín D, Pascual J. Isolated De Novo Headache as the Presenting Symptom of
Listeria
Meningitis: A Report of 2 Cases. Headache 2020; 60:2573-2577. [DOI: 10.1111/head.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sara Pérez‐Pereda
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
| | - Vicente González‐Quintanilla
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
| | - María Toriello‐Suárez
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
| | | | - Antonio Sánchez Rodríguez
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
| | - Daniel Gallo Valentín
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
| | - Julio Pascual
- Service of Neurology University Hospital Marqués de Valdecilla University of Cantabria and IDIVAL Santander Spain
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40
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Patas K, Mavridis T, Psarra K, Papadopoulos VE, Mandilara G, Tsirogianni A, Vassilopoulou S, Chatzipanagiotou S. Neurolisteriosis in a previously asymptomatic patient with serum IgM deficiency: a case report. BMC Neurol 2020; 20:323. [PMID: 32867717 PMCID: PMC7457472 DOI: 10.1186/s12883-020-01900-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Listeria monocytogenes is an opportunistic pathogen of the central nervous system commonly associated with impaired cell-mediated immunity. We hereby present a case of adult neurolisteriosis where the only immunological feature persistently present was serum IgM deficiency, suggesting that non-specific humoral immunity may also play a central role in the control of neuroinvasion by Listeria monocytogenes. Case presentation A 62-year-old male who had never experienced severe infections presented with headache, nuchal rigidity and confusion. Neuroimaging was normal and lumbar puncture revealed pleiocytosis (760 leukocytes/mm3) and hypoglycorrhachia (34 mg/dL). The patient was treated empirically for bacterial meningitis. Indeed, further analysis of the CSF showed infection by Listeria monocytogenes, which was accompanied by reduced serum IgM levels that persisted well beyond the period of acute bacterial infection. Levels of IgG and IgA isotypes, along with peripheral blood counts of major leukocyte subsets, were at the same time largely preserved. Intriguingly, the absence of membrane-bound IgM on B cells was essentially complete in the acute post-infection period leading to a remarkable recovery after 12 months, suggesting that mechanisms other than defective membrane expression are underlying serum deficiency. Conclusions As far as we know, this is the first reported case of neurolisteriosis associated with IgM deficiency in an adult individual without a history of severe infections or other underlying conditions. A possible role of circulating IgM against invasive disease caused by Listeria monocytogenes, particularly in the early course of host-pathogen interaction, is discussed.
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Affiliation(s)
- Kostas Patas
- Department of Medical Biopathology, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Mavridis
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Katerina Psarra
- Department of Immunology and Histocompatibility, Evangelismos General Hospital, Athens, Greece
| | - Vassilis E Papadopoulos
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Mandilara
- National School of Public Health & Central Public Health Laboratory, Hellenic Centre of Disease Control and Prevention, Vari, Greece
| | - Alexandra Tsirogianni
- Department of Immunology and Histocompatibility, Evangelismos General Hospital, Athens, Greece
| | - Sophia Vassilopoulou
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Stylianos Chatzipanagiotou
- Department of Medical Biopathology, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece. .,Department of Clinical Microbiology and Medical Biopathology, National and Kapodistrian University of Athens, Aeginition Hospital, Ave. Vassilissis Sophias 72-74, 115 28, Athens, Greece.
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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.
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Ranson E, Ship H, Garner O, Yang S, Bhattacharya D. Unusual presentation of meningococcal meningitis in the elderly and utility of CSF PCR testing. Access Microbiol 2020; 2:acmi000158. [PMID: 33195972 PMCID: PMC7660242 DOI: 10.1099/acmi.0.000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
We present an unusual case of a previously healthy 74-year-old man who presented with diffuse weakness, severe myalgias, petechial palmar rash and hypotension, but without fever, altered mental status, nuchal rigidity or headache, who was ultimately found through PCR testing to have meningococcal meningitis.
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Affiliation(s)
- Elizabeth Ranson
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, USA
| | - Hannah Ship
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, USA
| | - Omai Garner
- Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, USA
| | - Shangxin Yang
- Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, USA
| | - Debika Bhattacharya
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, 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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Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient. Case Rep Infect Dis 2020; 2020:8498216. [PMID: 32655957 PMCID: PMC7327578 DOI: 10.1155/2020/8498216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/26/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
A 54-year-old male, five months postorthotopic heart transplantation, presented with intermittent fevers, headaches, and “soupy” stools. Prior to presentation, he had low-level cytomegalovirus (CMV) viremia for two straight weeks. Given his immunosuppression, diarrhea, and low-level CMV viremia, he was presumed to have cytomegalovirus and/or C. difficile colitis and treated empirically for both on hospital day one. However, he developed neck pain/stiffness, diaphoresis, and worsening fevers on hospital day three. Blood cultures eventually grew Listeria monocytogenes; MRI of the brain with gadolinium showed left brain meningoencephalitis with early cerebral abscess formation. Lumbar puncture revealed elevated opening pressure, CSF neutrophilic pleocytosis, and elevated CSF protein and lactate but negative gram stain and cultures. First-line agent for Listeria meningoencephalitis is ampicillin. However, he reported amoxicillin allergy. Desensitization to ampicillin failed because ampicillin was too unstable per the allergist. He was therefore treated with penicillin monotherapy for eight weeks with complete resolution of his brain lesions and without any residual neurologic deficits.
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Pereira MEVDC, Gonzalez DE, Roberto FB, Foresto RD, Kirsztajn GM, Durão MDS. Listeria monocytogenes meningoencephalitis in a patient with Systemic Lupus Erythematosus. J Bras Nefrol 2020; 42:375-379. [PMID: 32406475 PMCID: PMC7657045 DOI: 10.1590/2175-8239-jbn-2019-0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/08/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents. METHODS We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection. DISCUSSION Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid. CONCLUSION The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.
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Affiliation(s)
| | - Diego Ennes Gonzalez
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Fernanda Badiani Roberto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Renato Demarchi Foresto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Gianna Mastroianni Kirsztajn
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
| | - Marcelino de Souza Durão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, Brasil
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Aspectos actuales de la listeriosis. Med Clin (Barc) 2020; 154:453-458. [DOI: 10.1016/j.medcli.2020.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022]
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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.
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Abstract
Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the organism can develop after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described. Listeria monocytogenes can cause a number of clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. The latter syndrome mimics the veterinary infection in ruminants called "circling disease". Neonatal infection can occur as a result of maternal chorioamnionitis ("early onset" sepsis) or through passage through a birth canal colonized with Listeria from the gastrointestinal tract. ("late onset" meningitis). Treatment of listeriosis is usually with a combination of ampicillin and an aminoglycoside but other regimens have been used. The mortality rate is high, reflecting the combination of an immunocompromised host and an often delayed diagnosis.
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49
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Le Guennec L. Manifestazioni neurologiche delle infezioni. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Affiliation(s)
- Geren S Stone
- From the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - McKinley Glover
- From the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Nikolaus Jilg
- From the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Maroun M Sfeir
- From the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (G.S.S., N.J.), Radiology (M.G.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
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