Listeria encephalitis in five renal transplant recipients

Histopathology of Listeria Meningitis

Listeria monocytogenes meningitis is the third most common cause of bacterial meningitis in adults and has high mortality and morbidity rates. We describe the clinical course and score brain pathology of 5 patients who died of listeria meningitis. All patients were immunocompromised and ages ranged between 48 and 76 years. Three cases were confirmed by cerebrospinal fluid culture; one was confirmed by brain culture; and one diagnosis was based on a positive blood culture and neuropathological findings. Mild inflammation of meningeal arteries was found in 3 of 5 cases (60%). Moderate/severe ventriculitis was seen in 4 of 4 cases (100%), abscesses in 3 of 4 cases (75%), mild vascular inflammation in 4 of 5 cases (80%), mild/moderate hemorrhage in 2 of 4 cases (50%), mild/moderate thrombosis of meningeal artery in 3 of 5 cases (60%), and 1 case (25%) showed a moderate infarct. The inflammatory cells present in the meninges were characterized by a mix of monocytes, macrophages, and neutrophils and removal of apoptotic inflammatory cells by macrophages (efferocytosis). Gram stain showed intra- and extracellular presence of rod-shaped bacteria in 3 cases. Pathological examination was characterized by moderate to severe ventriculitis, abscesses and abundant efferocytosis which has been suggested to be exploited by L. monocytogenes for cell-to-cell spread.

Clinical features of liver involvement in adult patients with listeriosis. Review of the literature

Clinical features of liver involvement due to Listeria monocytogenes infection in adults are rarely reported in literature. This is surprising, regarding the current opinion that the portal system is extensively involved in the first stages of pathogenesis in invasive L. monocytogenes disease. A literature search in the PubMed and Embase database revealed 34 cases with clinical features of hepatic involvement due to listeriosis. We systematically analyzed all case reports with respect to clinical manifestations, treatment and outcome. In addition, we added clinical information on a patient diagnosed with a solitary liver abscess due to L. monocytogenes, who was seen at our institution. This review describes the different presentations of liver-involvement reported in listeriosis; solitary liver abscess, multiple liver abscesses and diffuse or granulomatous hepatitis. Distinction between these different forms of liver involvement is clinically relevant as they have a different outcome. We delve into the different pathogenic events leading to different forms of liver involvement. In addition, diagnostic modalities and possible treatments are reviewed.

Infections in recipients of kidney transplants

A review of infections in kidney transplant recipients is presented in this article, beginning with a discussion of the pretransplant infectious diseases evaluation and an overview of the timing of infectious posttransplant, and then focusing on individual types of infection.

Listeria monocytogenes tricuspid valve endocarditis with septic pulmonary emboli in a liver transplant recipient

Listeria monocytogenes has long been known as a pathogen of immunocompromised hosts, including solid organ and bone marrow transplant recipients. Its principal manifestations include bacteremia and meningitis. Endocarditis due to Listeria is far less common and in general affects the left side of the heart. We here report an unusual case of Listeria tricuspid valve endocarditis and septic pulmonary emboli in a sulfa-intolerant liver transplant recipient with a history of relapsing cytomegalovirus (CMV) hepatitis and an indwelling Hickman catheter. The literature on Listeria endocarditis and infections in transplant recipients is reviewed. The possible relationship between susceptibility to Listeria infection and the discontinuation of trimethoprim-sulfamethoxazole prophylaxis is of interest.

Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature

We reviewed 776 previously reported and 44 new cases of CNS listeriosis outside of pregnancy and the neonatal period, and evaluated the epidemiologic, diagnostic, and therapeutic characteristics of this infection. Among patients with Listeria meningitis/meningoencephalitis, hematologic malignancy and kidney transplantation were the leading predisposing factors, but 36% of patients had no underlying diseases recognized. The infection occurred throughout life, with a higher incidence before the age of 3 and after the age of 45-50 years. Fever, altered sensorium, and headache were the most common symptoms, but 42% of patients had no meningeal signs on admission. Compared with patients with acute meningitis due to other bacterial pathogens, patients with Listeria infection had a significantly lower incidence of meningeal signs, and the CSF profile was significantly less likely to have a high WBC count or a high protein concentration. Gram stain of CSF was negative in two-thirds of cases of CNS listeriosis. One-third of patients had focal neurologic findings, and approximately one-fourth developed seizures over their course. Mortality was 26% overall, and was higher among patients with seizures and those older than 65 years of age. Relapse occurred in 7% of episodes. Ampicillin for a minimum of 15-21 days (with an aminoglycoside for at least the first 7-10 days) remains the treatment of choice. Cerebritis/abscess due to L. monocytogenes, without meningeal involvement, is less common but may be diagnosed by blood cultures and CNS imaging, or by stereotactic biopsy. Longer antibiotic therapy (at least 5-6 weeks) is needed in the presence of localized CNS involvement.

Infections in solid-organ transplant recipients

Solid-organ transplantation is a therapeutic option for many human diseases. Infections are a major complication of solid-organ transplantation. All candidates should undergo a thorough infectious-disease screening prior to transplantation. There are three time frames, influenced by surgical factors, the level of immunosuppression, and environmental exposures, during which infections of specific types most frequently occur posttransplantation. Most infections during the first month are related to surgical complications. Opportunistic infections typically occur from the second to the sixth month. During the late posttransplant period (beyond 6 months), transplantation recipients suffer from the same infections seen in the general community. Opportunistic bacterial infections seen in transplant recipients include those caused by Legionella spp., Nocardia spp., Salmonella spp., and Listeria monocytogenes. Cytomegalovirus is the most common cause of viral infections. Herpes simplex virus, varicella-zoster virus, Epstein-Barr virus and others are also significant pathogens. Fungal infections, caused by both yeasts and mycelial fungi, are associated with the highest mortality rates. Mycobacterial, pneumocystis, and parasitic diseases may also occur.

Infecção por listeria monocytogenes pós-transplante renal: relato de seis casos

São relatados 6 casos de listeriose em pacientes transplantados renais, que ocorreram entre 13 dias e 57 meses após iniciarem imunossupressão clássica, sendo 3 casos classificados como meningite, 2 casos como meningoencefalite e 1 caso como bacteremia. Houve um óbito e os 5 pacientes restantes apresentaram boa evolução. Com dados adicionais da literatura, são discutidos a epidemiologia, o diagnóstico e tratamento, da listeriose pós-transplante renal.

Listeria monocytogenes cerebritis, bacteremia, and cutaneous lesions complicating hairy cell leukemia

Hairy cell leukemia is a lymphoreticular malignancy characterized by a chronic course and multiple defects in host defense mechanisms. Infections are the major cause of morbidity and mortality in this malignancy. Opportunistic infections due to pathogens normally controlled by cell-mediated immune mechanisms have been increasingly described but have not included listerial infections. This report describes a case of disseminated Listeria monocytogenes infection including the uncommon manifestations of cerebritis and cutaneous lesions in a patient with hairy cell leukemia.

Listeria meningitis: report of ten recent cases and review of current therapeutic recommendations

Ten cases of meningitis due to Listeria monocytogenes were admitted to three hospitals in Berlin between 1978 and 1983. One patient was a premature infant in whom meningitis was diagnosed as part of typical granulomatosis infantiseptica. Another presented with signs of brainstem encephalitis which was confirmed post mortem. Positive blood cultures were obtained from five of the patients. Two strains of listeria were resistant and one was only moderately sensitive to penicillin. The three most recently isolated strains were tested for sensitivity to the third generation cephalosporins. All were resistant to latamoxef, and two were resistant to cefotaxime. The implications of these findings for the empirical treatment of purulent meningitis are discussed.

Status of renal transplantation. A clinical perspective

Although the survival of patients on chronic dialysis has improved in recent years, the quality and status of rehabilitation remains poor. Renal transplantation must be used to complement chronic dialysis in the management of these patients. Physicians should not be biased and commit their patients to one or the other form of long-term treatment.

Severe meningitis due to Listeria monocytogenes. A review of 40 cases in adults

During a 10-yr period, 40 cases of severe Listeria monocytogenes meningitis were observed. All patients showed consciousness disturbances and 27 of them (68%) focal neurologic signs. Cranial nerve palsies were common (57%). Early general seizures (13 patients) and presence of underlying disease (12 patients) were associated with a high mortality rate. Although the management of antibiotic therapy is open for discussion, chloramphenicol (used in 7 patients) seems to be more effective than other drugs.

Listeria monocytogenes abscess in the basal ganglia

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Listerial meningitis and renal allografts: a life-threatening affinity

Two cases of Listeria monocytogenes infection in patients receiving immunosuppressive treatment after kidney transplantation are described. In the first, the infection, which occurred soon after transplantation and was accompanied by signs of mild chronic rejection, was the immediate cause of death. The other case occurred in a patient whose transplanted kidney had been functioning well for more than four years; this patient recovered. These cases, plus a review of 40 similar cases in the literature, point out the importance of anticipating possible listerial infection when septic meningitis arises in a patient with a transplanted kidney.

Hospital outbreak of Listeria monocytogenes septicaemia: a problem of cross infection?

A 74-year-old man was admitted to hospital with septicaemia and meningitis caused by Listeria monocytogenes. Subsequently 3 inpatients developed listeria septicaemia. Case-to-case transmission of the infection seems possible, although the method of transmission remains obscure.