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Percuoco V, Kemp O, Bolognese M, von Hessling A, Scholte JBJ, Schneider UC. A Case of Fulminant Listeria Rhombencephalitis with Brainstem Abscesses in a 37-Year-Old Immunocompetent Patient: From Vestibular Neuritis to Ondine's Curse. J Neurol Surg A Cent Eur Neurosurg 2024; 85:422-426. [PMID: 36481996 DOI: 10.1055/a-1994-9207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present a rare case of Listeria monocytogenes (LM) rhombencephalitis with the formation of multifocal abscesses in a young immunocompetent patient. His initial symptoms of dizziness, headache, and feeling generally unwell were put down to a coincidental coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The unfortunate rapid progression to trigeminal, hypoglossal, vagal, facial, and abducens nuclei palsies, and then an acquired central hypoventilation syndrome, known as Ondine's curse, required a prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation. As they continued to deteriorate despite targeted antibiotic treatment, surgical drainage of the abscesses was seen as the only meaningful available treatment option left to contain the disease. Postoperatively, the patient's strength rapidly improved as well as the severity of the cranial nerve palsies. After prolonged rehabilitation, at 3 months of follow-up, the patient was weaned off mechanical ventilation, independently mobile, and was left with only minor residual neurologic deficits. This case highlights a number of interesting findings only touched upon in current literature including the route of entry of LM into the central nervous system, the rare entity of acquired central hypoventilation syndrome, and finally the use of surgical intervention in cerebral LM infections.
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Affiliation(s)
- Veronica Percuoco
- Department of Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Oliver Kemp
- Department of Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Manuel Bolognese
- Department of Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Johannes B J Scholte
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Ulf C Schneider
- Department of Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Bristowe H, Dissanayake K, Chandra J, Arias M. Listeria brain abscess: a therapeutically challenging rare presentation of listeriosis. BMC Infect Dis 2024; 24:477. [PMID: 38720244 PMCID: PMC11080074 DOI: 10.1186/s12879-024-09295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
We report a very rare case of Listeria multiple brain abscesses manifested as delirium, which represented diagnostic and therapeutic challenges overcome only by the close cooperation between Infectious Diseases and Neuroradiology, without which a satisfactory outcome would not be achieved.An elderly man presented with confusion and drowsiness with a background of type-II diabetes mellitus. Although computed tomography of the brain only showed frontal lobe oedema, contrast magnetic resonance (MR) imaging showed numerous irregular rim-enhancing lesions containing central diffusion restriction, suggesting multiple pyogenic cerebral abscesses of unclear aetiology. Thereafter, Listeria monocytogenes was isolated from blood cultures, suggesting this as the causative organism. Deemed unsuitable for neurosurgical drainage, the patient received medical management with a protracted course of antibiotics. This case was extremely challenging, due to 1) the impossibility of source control, 2) the small number of effective antibiotics available to treat this condition, and 3) the inevitable antibiotic side-effects, derived from long-term exposure. A successful outcome was only possible thanks to strict close multidisciplinary follow up, requiring frequent MR imaging and a judicious antibiotic choice, including monitoring of their side-effects. Due to the rarity of this condition, there is lack of guidance on its management, hence the importance of multidisciplinary involvement with very close imaging and antibiotic monitoring.
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Affiliation(s)
- Henrietta Bristowe
- Department of Infectious Sciences, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, England
| | - Kishan Dissanayake
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, England
| | - Julie Chandra
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, England
| | - Mauricio Arias
- Department of Infectious Sciences, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, England.
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Kim DD, Sadic M, Yarabe B, Loftus JR, Lieberman E, Young MG, Jain R, Dogra S. Listeria monocytogenes brain abscesses presenting as contiguous, tubular rim-enhancing lesions on Magnetic Resonance Imaging: Case series and literature review. Neuroradiol J 2024:19714009241240054. [PMID: 38494758 DOI: 10.1177/19714009241240054] [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: 03/19/2024] Open
Abstract
Listeriosis has more than a 50% mortality when the central nervous system is involved, necessitating rapid diagnosis and treatment. We present four patients with brain abscesses in the setting of diagnosed neurolisteriosis, all of which demonstrated an odd presentation of multiple small, contiguous tubular lesions with rim enhancement on magnetic resonance imaging. Our review of published cases of neurolisteriosis suggests that this may be a useful pattern to identify neurolisteriosis abscesses, allowing earlier detection and therapy.
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Affiliation(s)
- Daniel D Kim
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mohammad Sadic
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Boniface Yarabe
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - James R Loftus
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Evan Lieberman
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Matthew G Young
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Rajan Jain
- Department of Radiology, New York University Langone Health, New York, NY, USA
- Department of Neurosurgery, New York University Langone Health, New York, NY, USA
| | - Siddhant Dogra
- Department of Radiology, New York University Langone Health, New York, NY, USA
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Dragomir RM, Mattner O, Hagan V, Swerdloff MA. Listeria monocytogenes Brain Abscess Presenting With Stroke-Like Symptoms: A Case Report. Cureus 2024; 16:e52216. [PMID: 38347999 PMCID: PMC10859722 DOI: 10.7759/cureus.52216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
We present a case of Listeria monocytogenes brain abscess in an immunocompromised patient admitted for stroke-like symptoms of headache and aphasia. Computerized tomography of the head revealed a 1.7 x 1.3 cm left frontal lobe lesion with surrounding edema, secondary to stroke, tumor, or abscess. Magnetic resonance imaging brain revealed a ring-enhancing lesion and a small contralateral area of restricted diffusion. Two of the two blood cultures grew an organism identified as L. monocytogenes using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Treatment with ampicillin and trimethoprim-sulfa yielded marked symptomatic improvement. A brain biopsy was consistent with bacterial abscess. The patient's clinical course was favorable, with improved aphasia and negative follow-up blood cultures. A literature review found a limited number of L. monocytogenes abscess cases and none had clear guidelines for diagnosis. Recent studies have proposed five criteria for diagnosis. Our patient fulfilled three of these proposed guidelines.
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Affiliation(s)
- Roxana M Dragomir
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Olivia Mattner
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Veronica Hagan
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Marc A Swerdloff
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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Garrì F, Puthenparampil M, Simonato D, Rinaldi F, Gallo P. A rare case of Listeria rhombencephalitis with a sudden onset and unusual brain MRI features. Neurol Sci 2024; 45:353-355. [PMID: 37735306 DOI: 10.1007/s10072-023-07080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Federica Garrì
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy.
| | - Marco Puthenparampil
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
| | - Davide Simonato
- Neuroradiology Unit (DS), University Hospital of Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
| | - Paolo Gallo
- Department of Neurosciences, University of Padua, via Giustiniani 5, 35128, Padua, Italy
- Multiple Sclerosis Centre, University Hospital of Padua, via Giustiniani 5, 35128, Padua, Italy
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LaHue SC, Guterman EL, Mikhail M, Li Y, Cha S, Richie MB. Clinical and Radiographic Characteristics of Nocardia vs Non- Nocardia Brain Abscesses. Neurol Clin Pract 2023; 13:e200134. [PMID: 37064583 PMCID: PMC10101715 DOI: 10.1212/cpj.0000000000200134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 04/18/2023]
Abstract
Background and Objectives Diagnosis and treatment of CNS nocardiosis is challenging and often delayed, which increases morbidity and mortality. The primary objective was to compare the clinical and radiographic characteristics of patients with CNS nocardiosis with non-Nocardia bacterial brain abscesses. Methods We performed a case-control study of patients with brain abscesses diagnosed between 1998 and 2018 at a tertiary academic center. We identified 56 patients with brain MRI demonstrating brain abscess from the institutional imaging database: 14 with culture-confirmed nocardiosis and 42 randomly selected prevalent controls with culture-confirmed non-Nocardia bacterial infection. The primary outcomes were the diagnosis of concomitant lung infection and history of immunosuppression. Secondary outcomes included abscess radiographic characteristics: multifocality, occipital lobe and/or infratentorial location, and bilobed morphology. Results Compared with patients with non-Nocardia brain abscesses, patients with CNS nocardiosis were older (median 61 years [IQR 59-69] vs 48 years [IQR 34-61]; p = 0.03), more likely to be immunosuppressed [71% (10) vs 19% (8); p < 0.001), have diabetes (36% (5) vs 10% [4]; p = 0.03), or a concomitant lung infection (86% [12] vs 2% [1]; p < 0.001). Radiographically, more cases of CNS nocardiosis exhibited multifocal abscesses (29% [4] vs 2% [1]; p = 0.01), which were located in the infratentorial (43% [6] vs 10% (4); p = 0.01) or occipital (36% [5] vs 5% [2]; p = 0.008) regions and had a bilobed (as opposed to unilobed) morphology (79% [11] vs 19% [8]; p < 0.001). Blood and CSF cultures were negative in most of the cases and controls, whereas neurosurgical specimen culture yielded a diagnosis in 100% of specimens. Discussion Patients with CNS nocardiosis were more likely to be older, have a history of diabetes or immunosuppression, or have a concomitant lung infection compared with those with non-Nocardia brain abscesses. Abscesses because of CNS nocardiosis were more likely to be multifocal, affect the infratentorial region or occipital lobe, or have a bilobed appearance. Neurosurgical specimen culture was most likely to yield a diagnosis for both Nocardia and non-Nocardia abscesses. The combination of clinical and imaging findings may suggest CNS nocardiosis and inform early initiation of targeted empiric treatment.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Elan L Guterman
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Mathew Mikhail
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Yi Li
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Soonmee Cha
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Megan B Richie
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
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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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Bokhari SFH, Sattar H, Abid S, Jaffer SR, Sajid S. Listerial Meningitis and Brain Abscess With Coexisting COVID-19 Infection in a Young, Immunocompetent Male: A Case Report. Cureus 2022; 14:e29455. [PMID: 36299945 PMCID: PMC9587750 DOI: 10.7759/cureus.29455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
Listeria monocytogenes (LM) is a gram-positive intracellular pathogen that can cause central nervous system infections such as meningitis, meningoencephalitis, rhombencephalitis, or cerebritis. It rarely causes a brain abscess. Listerial meningitis and brain abscess most commonly occur in immunocompromised individuals, neonates, pregnant females, alcoholics, and the elderly. We present a unique case of a young immunocompetent male who presented with listerial meningitis and brain abscess. Coexisting coronavirus disease 2019 (COVID-19) infection was also present. Since LM was not included in the differentials, the standard antibiotic regimen started for the meningitis therapy was ineffective. Remdesivir was administered to treat the coexisting COVID-19 infection. When the lumbar tap polymerase chain reaction pointed out that the causative agent was Listeria, we shifted to ampicillin and gentamicin therapy, to which the patient responded very effectively.LM is an atypical cause of meningitis and brain abscesses. A high index of suspicion is therefore required for early detection and effective treatment of listerial meningitis and brain abscess.
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