Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis.

PURPOSE: To describe the imaging findings and determine the incidence of a characteristic worm-like pattern along the white matter tracts in neurolisteriosis on CT/MRI. METHODS: An IRB-approved retrospective study in 21 consecutive neurolisteriosis cases during January 2002-July 2020. At least one of the following is required: (1) Positive Listeria monocytogenes (LM) in blood with clinical signs of meningeal irritation and/or abnormal CSF profile, (2) positive LM in blood with signs of encephalitis, (3) positive LM in CSF, (4) positive LM from brain biopsy/aspiration. Six cases were excluded due to the lack of contrast-enhanced images, leaving a total of 15 cases for analysis (mean age 53.5 years ± 18.8 SD). The imaging studies were independently reviewed by two blinded readers. Demographic data, imaging findings, and incidence of the worm-like pattern were reported. The Cohen's kappa was used to calculate interrater reproducibility. RESULTS: Of the 12 patients with relevant imaging findings, nine cases (75%) had parenchymal lesions (eight cases in supratentorial compartment and one case in infratentorial compartment), four cases (33.3%) had leptomeningeal enhancement and two cases (16.7%) had hydrocephalus. Brain abscesses were found in eight cases and nodules evocative of abscess in one case. Restricted diffusion in the central area and hemosiderin deposition were observed in all cases. The involvement of white matter tract in a worm-like pattern was demonstrated in eight of nine patients with parenchymal lesions (88.9%). CONCLUSION: Abnormal findings in brain CT/MRI images are common in neurolisteriosis. The incidence of worm-like spread along the white matter tracts is high and may help diagnose suspicious patients.

Worm-like appearance of Listeria monocytogenes brain abscess: presentation of three cases.

Brain abscess caused by Listeria monocytogenes (LM) is a rare, yet serious condition with high mortality if not recognized and treated timely. We present a series of three cases of LM brain abscesses and describe their characteristic radiological appearances which can be considered very typical. LM abscesses frequently present as markedly irregular formations, revealing characteristic worm-like tubular pattern of chaotic curvilinear arrangement. Knowledge of this imaging pattern can be very helpful in early recognition of LM abscesses whose initial differential diagnosis can often be misleading initially.

Listeria monocytogenes infectious periaortitis: a case report from the infectious disease standpoint.

BACKGROUND: Endograft infection is a rare but extremely dangerous complication of aortic repair (25-100% of mortality). We describe here the first case of Listeria monocytogenes abdominal periaortitis associated with a vascular graft. We also discuss the differential diagnosis of periaortitis and provide a literature review of L. monocytogenes infectious aortitis. CASE PRESENTATION: Nine months after endovascular treatment of an abdominal aortic aneurysm (abdominal stent graft), a 76-year-old man was admitted for severe abdominal pain radiating to the back. Laboratory tests were normal apart from elevated C-reactive protein (CRP). Injected abdominal computed tomography (CT) showed infiltration of the fat tissues around the aortic endoprosthesis and aneurysmal sac expansion; positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) showed a hypermetabolic mass in contact with the endoprosthesis. Blood cultures were negative. At surgical revision, an infra-renal peri-aortic abscess was evident; post-operative antibiotic therapy with ciprofloxacin and doxycycline was started. Cultures of intraoperative samples were positive for L. monocytogenes. Results were further confirmed by a broad-range polymerase chain reaction (PCR) and next-generation sequencing. Antibiotic treatment was switched to intravenous amoxicillin for 6 weeks. Evolution was uneventful with decrease of inflammatory parameters and regression of the abscess. CONCLUSION: An etiologic bacterial diagnosis before starting antibiotic therapy is paramount; nevertheless, culture-independent methods may provide a microbiological diagnosis in those cases where antimicrobials are empirically used and when cultures remain negative.

Vaccine strain Listeria monocytogenes abscess in a dog: a case report.

BACKGROUND: Listeria monocytogenes is a promising therapeutic vaccine vector for cancer immunotherapy. Although highly attenuated, three cases of systemic listeriosis have been reported in people following treatment with Listeria-based therapeutic vaccines. This complication has thus far not been reported in canine patients. CASE PRESENTATION: A dog previously diagnosed with osteoblastic osteosarcoma was presented for care following administration of three doses of the Canine Osteosarcoma Vaccine-Live Listeria Vector. On routine staging chest radiographs, mild sternal lymphadenopathy and a right caudoventral thoracic mass effect were noted. Further evaluation of the mass effect with computed tomography and ultrasound revealed a cavitated mass associated with the 7th right rib. Aspirates of the mass cultured positive for Listeria monocytogenes. The mass and associated ribs were surgically removed. Histopathology was consistent with metastatic osteoblastic osteosarcoma. Treatment was continued with doxorubicin chemotherapy and at the time of publication, the dog was alive over 1 year following diagnosis with no evidence of further disease progression. Genotyping of the abscess-derived L. monocytogenes was consistent with the vaccine strain. CONCLUSIONS: This case represents the first veterinary case to describe development of a Listeria abscess following administration of a Listeria-based therapeutic vaccine.

Imaging of Human Neurolisteriosis: A Prospective Study of 71 Cases.

Background: Neurolisteriosis ranks among the most severe neurological infections. Its radiological features have not been thoroughly studied. We describe here the neuroradiological features of neurolisteriosis and assess their prognostic value. Methods: Patients with microbiologically proven neurolisteriosis were enrolled from November 2009 to October 2013 in MONALISA study. Magnetic resonance and computed tomography images were studied by 2 independent neuroradiologists. Predictors of 3-month mortality were determined using logistic regression. Results: Seventy-one patients were included; 42 were men (59%). Mean age was 64 years. Sixty patients (85%) reported signs of encephalitis, with clinical brainstem involvement in 16 (23%). Images were abnormal in 87% of cases (62/71). Main neuroradiological images were meningeal enhancement (25/71, 35%), abscess(es), or nodular image(s) evocative of abscess (10/71, 14%), hemorrhages (11/71, 15%), contrast-enhancing ventricles, or hydrocephalus (7/71, 10%). White-matter images (42/71, 59%), dilated Virchow-Robin spaces (22/71, 31%), and cerebral atrophy were also reported (34/71, 48%). Brainstem involvement (meningeal enhancement, abscess) was reported in only 7/71 cases (10%). Three-month survival was lower in patients with hydrocephalus or contrast-enhancing ventricles (1/7 [14%] than without [47/64, 73%], P = .005) and in patients with parenchymal images (abscess[es], nodule[s]\, or white matter images; 25/46 [54%] vs 23/25 without [92%], P = .004). Parenchymal images were associated with lower 3-month survival in the multivariable model (odds ratio 5.60, 95% confidence interval [1.42-29.6], P = .02). Conclusions: Neurolisteriosis presents as a combination of neuroradiological images, none being specific. Radiological signs of rhombencephalitis are uncommon, whereas, unexpectedly, hemorrhagic images are frequent. The negative prognostic value of parenchymal neuroradiological images was evidenced. Clinical Trials Registration: NCT01520597.

Chorioamnionitis caused by Listeria monocytogenes: a case report of ultrasound features of fetal infection.

Maternal listeriosis is often associated with mild symptoms for the patient, but fetal infection can lead to severe adverse perinatal outcome. The most described antenatal symptoms are reduced fetal movements and an abnormal fetal heart rate trace. We present a case of fetal listeriosis suspected by ultrasound findings of fetal gastrointestinal compromise, neonatal diagnosis and outcome.

Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess.

Listeria monocytogenes (LM) bacterium is a cause of central nervous system (CNS) infection and the most common cause of rhombencephalitis in immunocompetent elderly.A prompt identification of this condition should be always desirable, since its clinical manifestations are often unspecific with prodromal symptoms leading to high rates of morbidity and mortality if underestimated.CNS listeriosis magnetic resonance imaging (MRI) findings are generally not specific. However, in the appropriate clinical setting, focal brainstem hyperintensity on T2-weighted pulse sequences associated with ring-enhancement pattern after i.v. contrast media injection should be suspicious of LM abscess. The diagnosis cannot exempt from anamnestic-clinical-investigation data correlation to exclude mimicking.

Good clinical outcome in a case of Listeria-associated multiple liver abscesses and clinical hepatitis.

This case report describes a patient with the rare phenomenon of multiple liver abscesses and signs of hepatitis, secondary to disseminated listeriosis. All signs and symptoms resolved with antibiotic treatment only, contradicting current literature. This suggests that the development of multiple liver abscesses following infection with Listeria monocytogenes does not necessarily yield a poor prognosis, even without drainage.

Encephalitis caused by Listeria monocytogenes in a healthy adult male in China: A case report.

RATIONALE: Listeria monocytogenes rarely affects immunocompetent adults, and only a few cases of encephalitis caused by L monocytogenes in humans have been reported in China. PATIENT CONCERNS: A 37-year-old male patient presented with headache and fever of 38°C to 39°C for 2 days and dysphoria and dystrophy for 1 day. DIAGNOSIS: The patient was diagnosed as having encephalitis, and his cerebrospinal fluid (CSF) and blood cultures tested positive for L monocytogenes. INTERVENTIONS: The patient was treated with intravenous vancomycin, meropenem, mannitol, methylprednisolone, and enteral nutrition. The computed tomography (CT) scan showed swelling of the brain and hydrocephalus. The patient was treated with emergent surgery, a ventricular drainage tube was inserted, and the CSF was drained daily. OUTCOMES: Despite adequate therapy, the illness was severe and progressed rapidly. The patient died 2 weeks after admission. LESSONS: We report a rare case of L monocytogenes encephalitis in a previously healthy immunocompetent adult in China. The patient's CT scans showed increasing brain swelling and hydrocephalus, and the patient's condition progressively deteriorated.

Neuroinvasive Listeriosis: Could Petechial Hemorrhages be a Diagnostic Clue?

INTRODUCTION: Listeria monocytogenes-related central nervous system infections may involve the cerebral parenchyma. Meningitis and meningoencephalitis are the most commonly seen forms and mainly affect immunocompromised patients; however, a less frequent form, rhombencephalitis, can occur in otherwise healthy people. Early treatment with appropriate antibiotic therapy is crucial for this otherwise fatal disorder. However, it is not always possible to rapidly establish the diagnosis because of varying presentations and discrepancies in diagnostic tests. CASE REPORT: Herein we report 3 cases of listerial infections involving the central nervous system parenchyma, with versatile diagnostic challenges and related possible solutions and radiologic hints to overcome similar issues in the future. CONCLUSIONS: We point out the importance of nonconventional magnetic resonance imaging techniques in the diagnosis, as we detected petechial hemorrhages in the brain parenchyma in all cases, which can be a diagnostic clue.

[Cardiac infection by Listeria monocytogenes]. / Infezione cardiaca da Listeria monocytogenes.

We report the case of a 56-year-old man showing numerous cardiovascular manifestations of Listeria infection (myo-pericarditis, coronary vasospasm, intracavitary vegetations/thrombus, sinoatrial blocks). Cardiac magnetic resonance and echocardiography images provided an unexpected picture of this infection, and were relevant for the appropriate clinical management. Transthoracic and transesophageal echocardiography were useful for assessing the presence of an endocavitary mass. Tissue characterization by cardiac magnetic resonance confirmed the presence of a thrombus and revealed signs of active inflammation in the myocardial wall, pericardium and vascular pedicle.

Linezolid and dexamethasone experience in a serious case of listeria rhombencephalitis.

Listeria rhombencephalitis is a rare cause of brain stem encephalitis. We report a case with a history of immunosupressive therapy due to Takayasu's arteritis that was treated with corticosteroids and linezolid for Listeria rhombencephalitis. A 63-year-old woman was admitted to the hospital with fever, headache, nausea, and vomiting. The patient's body temperature was 38°C, and she had a stiff neck. Listeria monocytogenes was isolated from the cerebrospinal fluid (CSF), and penicillin G and gentamicin treatment was initiated. Linezolid and dexamethasone were added. Due to hematuria and thrombocytopenia, the linezolid was discontinued. In immunocompromised patients with CNS infections, Listeria rhombencephalitis should be suspected. Linezolid can be used in combination with dexamethasone.

Listeria cerebritis: relapse of infection in renal transplant patients.

In 3 cases of Listeria cerebritis, two of the patients had relapse with cerebritis after antimicrobial therapy for acute Listeria septicemia or meningitis. Each had received ten to 14 days of intravenous penicillin. Relapse occurred with fever and sudden focal cerebral dysfunction. Brain scans showed focal uptake; arteriograms and computerized tomography were normal. Cerebrospinal fluids were nondiagnostic; blood cultures yielded Listeria in two patients. Penicillin treatment for six weeks produced rapid clinical responses that were complete in one and minimal residual in two. Progress brain scans were normal. A relapse rate of 35% is reported in transplant patients with Listeria meningitis and/or bacteremia who are treated for less than three weeks; to our knowledge, cerebritis in such patients has not been reported previously. High-dose penicillin or ampicillin therapy for four to six weeks is recommended for Listeria infections in this select group.

[99mTc]Annexin V-128 SPECT Monitoring of Splenic and Disseminated Listeriosis in Mice: a Model of Imaging Sepsis.

PURPOSE: Here, we evaluate [(99m)Tc]annexin V-128, an in vivo marker of apoptosis, for single photon emission computed tomography (SPECT) imaging of localization and antibiotic treatment of disseminated bacterial infection, using a well-described mouse model that employs bioluminescent Listeria monocytogenes. PROCEDURES: Sixteen groups of five mice in six separate experiments were infected with bioluminescent Listeria, and in vivo bioluminescence imaging (BLI) was performed each day, to assess the location and extent of infection and response to antibiotics. [(99m)Tc]annexin V-128 was then injected for SPECT imaging, and the two sets of images were correlated and validated. RESULTS: Signals from BLI and [(99m)Tc]annexin V-128 SPECT co-localized within the spleen and other organs including bone marrow, intestine, nasopharynx, and brain. Decreases in [(99m)Tc]annexin V-128 uptake and BLI signal within the spleen directly reflected the reduction of bacterial infection by ampicillin treatment. CONCLUSIONS: Tc-99m-Annexin V-128 uptake as observed by SPECT allowed for the detection of systemic listeriosis and ampicillin treatment in mice. [(99m)Tc]annexin V-128 should be further explored for the assessment of bacterial spread and antibiotic efficacy in patients with disseminated bacterial infection.

Listeria monocytogenes brain abscesses in a girl with acute lymphoblastic leukaemia after late central nervous system relapse.

A case of Listeria monocytogenes bacteraemia and meningitis with intracerebral abscesses in a girl with acute lymphoblastic leukaemia in relapse is reported. The clinical features included subacute onset with fever and marked irritability followed by seizures, meningism and confusion. The pathogen was isolated from blood and cerebrospinal fluid. Computerised tomography of the brain showed two intracerebral parenchymal localisations, in the left frontal lobe and in the right occipital lobe, respectively. The patient survived this severe infection without neurological sequelae. 2 months later she underwent allogeneic bone marrow transplantation without major complications. This case report should alert pediatric oncologists about the possible occurrence of severe intracerebral listerial infections in the immunocompromised child and suggests that this infection can be treated successfully and should not necessarily preclude continuation of antineoplastic treatments.

Listeria monocytogenes and severe newborn respiratory failure supported with extracorporeal membrane oxygenation.

OBJECTIVE: To determine the efficacy of extracorporeal membrane oxygenation (ECMO) in newborn infants with early-onset Listeria monocytogenes infection, necrotizing pneumonia, and severe respiratory failure. DESIGN: Patient series. SETTING: ECMO referral centers. PARTICIPANTS: The Extracorporeal Life Support Organization Registry database of patients supported with ECMO between 1975 and 1991. INTERVENTION: ECMO. MEASUREMENTS AND RESULTS: Nine neonates were identified who were supported with ECMO for severe respiratory failure associated with L monocytogenes infection. Microbiologic studies demonstrated L monocytogenes organisms in the blood of all infants, and pneumonia was diagnosed by roentgenogram and/or isolation of L monocytogenes organisms in tracheobronchial secretions. All infants experienced progressive respiratory deterioration by age 36 hours and were placed on venoarterial bypass by 96 hours, having met institution-based criteria predictive of 80% to 90% mortality. The duration of ECMO for patients with Listeria infection (median, 210 hours; range, 137 to 454 hours) was prolonged compared with the duration of ECMO for neonates in all other registry diagnostic categories (median, 114 hours; range, 1 to 744 hours; N = 5146, P = .035). Six of the nine infants recovered completely. CONCLUSIONS: These data suggest that ECMO is efficacious in patients with severe respiratory failure secondary to Listeria sepsis. Prolonged time on bypass should be expected when Listeria sepsis is associated with severe necrotizing pneumonia.