Neurolisteriosis in a previously asymptomatic patient with serum IgM deficiency: a case report.

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.

Characterization of a Listeria monocytogenes meningitis mouse model.

BACKGROUND: Listeria monocytogenes is a common cause of bacterial meningitis. We developed an animal model of listerial meningitis. METHODS: In survival studies, C57BL/6 mice received intracisternal injections with different L. monocytogenes sequence type 1 (ST1) colony forming units per milliliter (CFU; n = 48, 105, 106, 107, 108, and 109 CFU/ml). Second, mice were inoculated with 108 CFU/ml ST1 and sacrificed at 6 h and 24 h (n = 12/group). Outcome parameters were clinical score, CFUs, cyto- and chemokine levels, and brain histopathology. Third, 84 mice were inoculated (109 CFU/ml ST1) to determine optimal antibiotic treatment with different doses of amoxicillin and gentamicin. Fourth, mice were inoculated with 109 CFU/ml ST1, treated with amoxicillin, and sacrificed at 16 h and 24 h (n = 12/group) for outcome assessment. Finally, time point experiments were repeated with ST6 (n = 24/group). RESULTS: Median survival time for inoculation with 108 and 109 CFU/ml ST1 was 46 h and 40 h; lower doses of bacteria led to minimal clinical signs of disease. Brain levels of IL-6, IL-17A, and IFN-γ were elevated at 24 h, and IL-1ß, IL-6, IL-10, IFN-γ, and TNF-α were elevated in blood at 6 h and 24 h. Histopathology showed increased meningeal infiltration, vascular inflammation of meningeal vessels, hemorrhages, and ventriculitis. In the treatment model, brain levels of IL-6 and IL-17A and blood levels of IL-6 and IFN-γ were elevated. Compared to ST6, infection with ST1 led initially to higher levels of IL-1ß and TNF-α in blood and more profound neuropathological damage. At 16 h post inoculation, IL-1ß, IL-10, and TNF-α in blood and IL-6, IL17A, TNF-α, and IFN-γ levels in brain were higher in ST1 compared to ST6 without differences in CFUs between STs. At 24 h, neuropathology score was higher in ST1 compared to ST6 (p = 0.002) infected mice. CONCLUSIONS: We developed and validated a murine model of listerial meningitis. ST1-infected mice had a more severe inflammatory response and brain damage as compared to ST6-infected mice.

Listeria monocytogenes meningitis in an immunocompromised patient.

This report describes a case of meningitis caused by Listeria monocytogenes in a stem cell transplant recipient on immunosuppressive therapy for cutaneous chronic graft-versus host disease. A 59-year-old woman had undergone allogeneic stem cell transplantation (from a matched unrelated donor) 13 months previously for chronic lymphocytic leukemia. She was on regular hematologic follow-up. Though her previous malignancy has been in remission, she was immunosuppressed due to the pharmacological treatment. We describe a meningitis caused by a typical food-borne pathogen, dangerous in patients with impaired cell-mediated immunity. Moreover the bacterium had a multidrug resistance, a rare characteristic in clinical listeriosis. Rapid diagnosis and treatment are key factors in these cases. We chose ampicillin and rifampicin that allowed a complete resolution of the clinical manifestations.

Systemic Listeria monocytogenes infection in a 2-year-old immunocompetent child.

Central nervous system infection and sepsis are the most frequently observed clinical presentations of listeriosis infection; however, they are rare in immunocompetent children beyond the neonatal period. In the presented case, we described gastrointestinal involvement, subacute meningitis, sinusitis and sepsis in a two-year-old previously healthy child with acute infection caused by Listeria monocytogenes. We suggest that the infection was probably enhanced by an inappropriate corticosteroid treatment at the onset of the disease, while immunological testing did not confirm the primary deficiency of cellular immunity.

Listeria meningitis and ventriculitis in an immunocompetent child: case report and literature review.

Listeria monocytogenes meningitis is very rare in immunocompetent children. We present a case of a previously healthy 6-year-old girl who developed L. monocytogenes meningitis and ventriculitis. We also review the medical literature on non-neonatal L. monocytogenes meningitis in immunocompetent children.

Multiple brain abscesses due to Listeria monocytogenes infection in a patient with systemic lupus erythematosus: A case report and literature review.

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.

Listeria meningitis: identification of a cerebrospinal fluid inhibitor of macrophage listericidal function as interleukin 10.

The killing of bacteria gaining access to the central nervous system is insufficient and requires bactericidal antibiotics for treatment. The inefficient host response in cerebrospinal fluid (CSF) is thought to be due to impaired phagocytosis in CSF, and low local concentration of antibody and complement. In addition, the CSF may contain inhibitors, disabling phagocytes to eliminate bacteria. We have assessed the bactericidal activity of macrophages in the presence of CSF from mice infected intracerebrally with Listeria monocytogenes (LM). Pretreatment of J774A.1 macrophages with interferon gamma (IFN-gamma) resulted in high levels of nitric oxide-dependent intracellular killing of LM. CSF taken from mice 24 h after infection (CSF-LM 24) contained IFN-gamma and induced killing of LM by macrophages. However, pulsing J774A.1 cells with IFN-gamma in the presence of CSF obtained from mice at later time points (48 h) rendered macrophages partly permissive for intracellular Listeria growth. The inhibitor detected in CSF-LM 48 was identified as IL-10 since: (a) IL-10 dose dependently impaired the listericidal activity of IFN-gamma-activated macrophages; (b) anti-IL-10 antibodies abrogated the bacterial growth permissive effect of CSF-LM 48; and (c) IL-10 was detected in CSF-LM 48 but not in CSF-LM 24 or CSF of mock-injected animals (CSF-Co). Likewise, IL-10 was found in the CSF of 95% of patients with bacterial meningitis.

[A case of listeria meningitis showed high levels of adenosine deaminase in cerebrospinal fluid].

An 83-year-old woman developed high fever and headache for four days. She had disturbance of consciousness and was admitted to our hospital. A lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 268/mm3 and culture became positive for Listeria monocytogenes. Six days after admission, the adenosine deaminase (ADA) level in CSF markedly elevated (43.3 IU/L) with pleocytosis, but a negative PCR test for tuberculosis in CSF, sputum, gastric fluid. She recovered by antibiotics for 45 days and ADA level in CSF was normalized. She was diagnosed as listeria meningitis. High levels of ADA in CSF have high sensitivity and high specificity for tuberculous meningitis, but there are some reports that high ADA levels in CSF in other meningitis. The main biological role of ADA is related to proliferation and differentiation of lymphocytes, and specific activity of this enzyme is slightly higher in T-lymphocytes than in B-lymphocytes. Protective immunity to Listeria monocytogenes is exclusively exhibited by T-lymphocytes. We consider that increased ADA levels in listeria meningitis associated with elevation of T-lymphocytes in CSF. This report suggests that listeria meningitis must be included in the differential diagnosis of high levels of ADA in CSF.

Rapid detection of Listeria monocytogenes rhombencephalitis in an immunocompetent patient by multiplexed PCR.

A 46-year-old previously healthy man presented with 1 week of headache, nausea, vomiting and dizziness. He was found to have cranial nerve deficits, his cerebrospinal fluid (CSF) demonstrated a lymphocytic pleocytosis and brain MRI suggested rhombencephalitis. Although Gram stains and cultures of his CSF did not identify a pathogen, Listeria monocytogenes DNA was detected by the FilmArray Meningitis/Encephalitis panel within 2 hours of performing a lumbar puncture. He was treated with ampicillin and gentamicin and had a near-complete recovery. This case highlights the importance of recognising L. monocytogenes infection as a cause of acute cranial nerve impairment with MRI findings suggestive of brainstem encephalitis. It also highlights the frequently atypical CSF profile and low yield of culture in L. monocytogenes rhombencephalitis and the value of multiplex PCR testing of CSF to rapidly identify this pathogen and permit targeted therapy.

Listeria monocytogenes Meningitis Complicating Rotavirus Gastroenteritis in an Immunocompetent Child.

Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems.

Listeria monocytogenes meningitis in the elderly: epidemiological, clinical and therapeutic findings.

Listeria monocytogenes is a Gram-positive bacillus and facultative intracellular bacterium whose transmission occurs mainly through the consumption of contaminated food, L. monocytogenes invades the host cells using various protein and can escape to the human T-cell immune system by cell-to-cell spreading. If the infection is not controlled at the stage in which the bacterium is in the liver, for instance, due to a severe immunodepression, a secondary bacteraemia can be developed and L. monocytogenes reaches the preferred sites transgressing the blood-brain barrier or the placental barrier. Individuals with T-cell dysfunction, such as pregnant women, the elderly, and those receiving immunosuppressive therapy are at the highest risk of contracting the disease. Average life expectancy throughout developed countries has rapidly increased during the latter half of the 20th century and geriatric infectious diseases have become an increasingly important issue. L. monocytogenes meningitis in young previously healthy adults has been reported only in anecdotal observations. Differently, L. monocytogenes is the third most common cause of bacterial meningitis in the elderly population, after Streptococcus pneumoniae and Neisseria meningitidis. Patients with L. monocytogenes meningitis presented with signs and symptoms that were similar to those of the general population with community-acquired bacterial meningitis, but reported a longer prodromal phase. According to literature data, the prevalence of the classic triad of fever, neck stiffness, and altered mental status is 43%, and almost all patients present with at least 2 of the 4 classic symptoms of headache, fever, neck stiffness, and altered mental status. On the basis of our published data, in patients aged over 50 years, diagnosing L. monocytogenes meningitis was more challenging than pneumococcal meningitis, as demonstrated by the lower percentage of cases receiving a correct diagnosis within 48 hours from the onset of symptoms. No significant difference was observed in respect to the presenting symptoms, but progression to respiratory failure was not as rapid as pneumococcal meningitis.

Neuropathological findings in 9 cases of listeria monocytogenes brain stem encephalitis.

Brain stem encephalitis is a particular manifestation of infection with the bacterium Listeria monocytogenes. Here, we present the neuropathological findings in 9 such cases. In the brain stem, the inflammatory infiltrates were located predominantly within nuclei and tracts of cranial nerves innervating the oropharynx. These findings support the hypothesis that the food-borne bacterium Listeria monocytogenes invades the brain stem along cranial nerves.

[Lymphocytis meningitis: Listeria monocytogenes is a potential risk in a immunocompetent child]. / Méningite lymphocytaire: Listeria monocytogenes, une étiologie à ne pas négliger chez l'enfant immunocompétent.

UNLABELLED: Meningoencephalitis due to Listeria monocytogenes is a rare and serious form of brainstem infection in childhood. OBSERVATION: We report the case of a 7 year-old girl presenting lymphocytic meningitis with a high CRP level. Parenteral antibiotics combining ceftriaxone and vancomycine led initially to clinical improvement. Ten days later, secondary brainstem inflammation with hydrocephalus appeared and led to the detection of L. monocytogenes during external ventricular bypass. CONCLUSION: This observation of paediatric lymphocytic meningoencephalitis suggests a prescription of amoxicillin in association with first line antibiotics, particularly when an important inflammatory syndrome exists, immunocompetent children included.

[Increased risk of infection with biological immunomodifying antirheumatic agents. Clear guidelines are necessary as shown by case reports]. / Okad risk för infektion med biologiska immunmodifierande antireumatika.

Several potent immunosuppressive drugs have become available in the new millennium for patients with rheumatologic diseases, Crohn's disease and other autoimmune disorders. Five patient cases from Växjö central hospital (uptake area 178 000 individuals) with Listeria meningitis, Pneumocystis jiroveci and tuberculosis pneumonia, Listeria sepsis, Legionella pneumonia and E coli sepsis are described. A doubled risk for infections has previously been observed for RA patients, as compared to healthy individuals. There is clearly an increased risk of tuberculosis (depending on the actual and historic environmental prevalence) for patients on TNF antagonists, and therefore tuberculosis screening is now mandatory before start of therapy. Since TNF has a central role in the immune defence, an increased risk of opportunistic infections like listeriosis. mycobacteriosis, and invasive fungal infections has been established. Eight hospitals in southern Sweden participate in a register for the use of TNF blockers in rheumatologic diseases (South Swedish Arthritis Treatment Group, SSATG). Guidelines for screening and treatment of latent and active tuberculosis, possible prophylactic antibiotic treatment for endocarditis and vaccination programs for patients on TNF antagonists are discussed.

Fatal listeria meningitis in an immunocompromised infant: therapeutic implications.

Infection with Listeria monocytogenes is rare in infants and children. Listeriosis has been made a notifiable condition in the State of California since 1985. From January 1985 to December 1990, only seven cases of listeriosis have been reported in children less than or equal to 13 years of age. This brief report summarises the features of a fatal case of listeria meningitis in an immunocompromised 4-month-old infant, discusses diagnostic and therapeutic implications, and describes the other six cases.

Listeria monocytogenes meningitis.

The history and findings of all patients with Listeria meningitis admitted to the University Hospital of Leuven from 1967 to 1987 were reviewed. Listeriosis during pregnancy or the perinatal natal period was not considered. Predisposing conditions in these 23 patients included renal transplants (9), immunosuppressive therapy (2), diseases of the lympthoreticular system (3) and chronic alcoholism (1). One man had an inversed T4/T8 ratio. In 7 patients no underlying disorder was detected. Disease onset may be acute or subacute. There are no clinical features distinguishing Listeria meningitis from other acute bacterial meningitides. The number of leukocytes in the CSF varied from 3 to 3700, most often with a predominance of mononuclear cells. A decrease of the glucose level in the CSF was not always present. The initial gram stain was often unrevealing and it took up to 4 days for CSF cultures to become positive. Blood cultures were often important for the identification of the organism.

[Recovery from from Listeria monocytogenes meningitis in an adult]. / Meningite da Listeria monocytogenes ad esito in guarigione in adulto.

The authors describe a case of meningitis by Listeria monocytogenes from which the patient, an adult suffering from a chronic lymphatic leukosis, recovered completely. Both the immune-suppressor treatment and the basic lymphoproliferative disease may have given rise to this infective disease. The diagnosis has been obtained by isolating the germ in liquor-cultures. We want to point out the importance of a specific and early antibiotic treatment.

[Meningitis due to Listeria monocytogenes as a complication of infliximab therapy]. / Meningitis door Listeria monocytogenes als complicatie van behandeling met infliximab.

A 41-year-old woman was admitted to the hospital with meningitis caused by Listeria monocytogenes. Because of her Crohn's disease she used prednisolone and azathioprine. Two weeks before presenting with meningitis, infliximab had been given as the other immunosuppressant drugs had no effect. This tumour necrosis factor alpha (TNF alpha) blocking agent is known to increase the risk of opportunistic infections. This is the first Dutch patient described with meningitis caused by L. monocytogenes after treatment with infliximab. She recovered after antibiotic therapy. When antibiotic treatment is chosen, the possibility of opportunistic infections in patients who use infliximab concurrently with other immunosuppressant drugs should be taken into account.