Delayed presentation of prosthetic joint infection due to Listeria monocytogenes

Infection with Listeria monocytogenes is rare and has been described in prosthetic valves, stent grafts and prosthetic joints. The route of infection appears to be haematogenous. The choice between conservative treatment with antibiotics or surgical treatment with debridement and revision of the components remains controversial. The best antibiotic treatment is not known with ampicillin being the first choice in most cases. Prosthetic infections with Listeria monocytogenes usually occur in patients with malignancy, diabetes mellitus, chronic renal disease, liver disease, elderly patients and patients receiving immunosuppressive therapy. The hip is the commonest prosthetic joint affected followed by the knee. We report the seventh case of Listeria monocytogenes infection in a non-immunocompromised patient involving a prosthetic joint.     

成人社区获得性单核细胞增生李斯特菌脑膜炎

目的 单核细胞增生李斯特菌是继肺炎链球菌、脑膜炎奈瑟氏菌之后的成人急性社区获得性细菌性脑膜炎的第三位致病菌.本研究的主要目的是通过分析一组病例数据,了解单核细胞增生李斯特菌脑膜炎危险因素、临床特征、处理策略及其预后.方法 前瞻性队列观察研究,分析一家大型临床教学医院急诊科成人急性社区获得性单核细胞增生李斯特菌脑膜炎十年病例(2001-2010),并将其与同期其他病原体所致的急性细菌性脑膜炎临床特征进行比较.结果 纳入研究的有327例成人急性社区获得性细菌性脑膜炎( Ac-ABM),其中15例为单核细胞增生李斯特菌脑膜炎(Lm-ABM).老年人(RR =3.14;95％ CI 1.84 ～ 5.35)、免疫缺陷者(RR =3.34;95％ CI2.08 ～5.38)和孕妇(RR 12.48;95％ CI 3.29 ～ 47.39)患Lm-ABM风险明显增高.40％Lm-ABM病例有脑膜炎三联征表现,同样有40％患者至少有一份脑脊液标本符合经典急性细菌性脑膜炎标准.Lm-ABM经验性抗生素治疗(EAT)不充分率高达86.7％.Lm-ABM病死率为33.3％,不良临床预后率(GOS ＜4)为46.7％,两者均显著高于其他病原体所致的急性细菌性脑膜炎(P值分别为0.015和0.009).结论 老年人、免疫功能缺陷者和孕妇罹患急性细菌性脑膜炎时,要考虑感染单核细胞增生李斯特菌可能.单核细胞增生李斯特菌脑膜炎临床表现和脑脊液指标很难与其他急性细菌性脑膜炎相鉴别,且病死率和致残率高,因此,早期经验性抗生素治疗的充分性尤为关键,特别是在老年人、孕妇、免疫缺陷患者这些特殊群体中,抗生素选择要考虑覆盖单核细胞增生李斯特菌.     

单增李斯特菌EGD-e基因组的密码子使用分析

目的 以单增李斯特菌EGD-e为研究对象,分析其密码子使用模式及影响因素。 方法 利用Codon W在线工具分析单增李斯特菌EGD-e基因组的密码子使用情况;利用对应分析、ENC绘图(Nc-plot)等推测影响单增李斯特菌EGD-e密码子偏性的因素;利用高表达优越密码子分析法确定单增李斯特菌EGD-e基因组的主要偏爱密码子。 结果 单增李斯特菌EGD-e基因组中G+C含量仅为37%,偏爱使用以U或A结尾的密码子;对应分析显示第1条向量轴与G+C(R=-0.182, P0.01)、CAI(R=-0.740, P0.01)呈显著相关,且与后者的相关程度明显高于前者。 结论 单增李斯特菌EGD-e基因组的密码子使用具有一定的偏性;推测基因的表达水平是影响单增李斯特菌EGD-e基因组密码子使用的主要因素。同时,基因组密码子使用偏性还受到碱基组成的影响,而基因长度对密码子的使用偏性影响不大。最后确定了UUC、UUA等27个密码子为单增李斯特菌EGD-e的最优密码子。这些结果将为进一步研究单增李斯特菌的基因组学提供基础。     

模拟粪便标本中的单增李斯特菌的分离和检测

目的 建立针对粪便标本中单增李斯特菌的分离鉴定方法,评价方法的检测下限,以提高感染人群标本中单增李斯特菌的检出率,了解我国人群中该菌的携带及感染情况。 方法 对模拟人粪便标本进行二次增菌,采用Real-time PCR检测,并同时分离培养获得该病原菌。 结果 当每克模拟粪便标本中含有7 cfu的单增李斯特菌时,经过增菌后的标本用Real-time PCR方法可检测出阳性结果,并能够通过单增李斯特菌的选择培养基分离得到病原菌。 结论 本研究为从粪便标本中分离单增李斯特菌和由单增李斯特菌引起的食物中毒事件的病原学调查提供了技术支持,有利于对我国人群中单增李斯特菌的携带或感染状况进行调查分析。     

118株单核细胞增生李斯特菌的毒力基因检测

目的 了解中国单核细胞增生李斯特菌(Lm)的毒力基因分布情况.方法 对Lm的6个毒力基因(hly、prfA、plcB、inlA、actA、iap)分别设计聚合酶链反应(PCR)引物,建立PCR检测方法.对hly、plcB、iap 3个基因的PCR方法进行了特异性试验.结果 对国内多个地区多种来源的118株Lm进行了PCR检测,结果表明除2株菌不含prfA基因外,其他菌株均包含6个毒力基因.PCR引物特异性试验结果表明hly、plcB、iap3个基因的PCR引物特异性良好,可用于Lm的鉴定.结论 Lm普遍具有毒力基因,具有潜在的爆发风险,应加强对其监测.     

一种基于光纤倏逝波生物传感器检测单核细胞增生李斯特氏菌方法的建立

目的建立一种应用光纤倏逝波生物传感器快速检测单核细胞增生李斯特氏菌的方法。方法用单核细胞增生李斯特氏菌单克隆抗体对光纤进行包被,制备检测光纤探针,用纳米量子点对单增李斯特氏菌多克隆抗体进行偶联标记,建立基于光纤倏逝波生物传感器检测单核细胞增生李斯特氏菌的方法。并对其检测的灵敏性及特异性进行了确定,同时通过对人工模拟样品的检测确认该方法检测实际样本的可能性。结果该方法检测单核细胞增生李斯特氏菌的灵敏度可达30CFU/mL,且具有较强的特异性同其他常见食源性病原菌无交叉反应,可用于实际样品的检测。结论应用该技术检测单核细胞增生李斯特氏菌是一种快速、准确的新方法,具有实际应用价值。     

One-year-old boy with refractory Listeria monocytogenes meningitis due to persistent hypercytokinemia

We had a case of Listeria monocytogenes (LM) meningitis complicated with hypercytokinemia and hemophagocytic lymphohistiocytosis in a healthy 22-month-old boy. He was admitted to our hospital with a fever, vomiting, mild consciousness disturbances, and extraocular muscle paralysis. Magnetic resonance imaging (MRI) revealed bilateral deep white matter lesions. After receiving ampicillin, meropenem, and gentamicin, his cerebrospinal fluid (CSF) culture results turned negative on the third day of hospitalization. However, the fever intermittently persisted, and it took approximately 40 days to completely resolve. During this period, various inflammatory cytokine levels, particularly neopterin, in the blood and CSF remained elevated. Therefore, long-term administration of corticosteroids in addition to antibiotics was required. The use of dexamethasone appeared to be effective for neurological disorders such as consciousness disturbance and extraocular muscle paralysis associated with abnormal brain MRI findings. LM meningitis may present with encephalopathy and persistent fever due to hypercytokinemia. In such cases, corticosteroid therapy should be considered.     

2011年北京市通州区分离单增李斯特菌的生物学及分子流行病学特征

目的 了解2007-2011年北京市通州地区食品及患者分离的单增李斯特菌的生物学和流行病学特征,为李斯特菌病的预防控制提供参考依据。 方法 对分离的单增李斯特菌进行6个毒力因子(prfA、actA、iap、hly、plcB、inlA)的检测、血清分型和脉冲场凝胶电泳分型。 结果 57株单增李斯特菌的6个毒力因子均为阳性,分为5种血清型,主要血清型为1/2a和1/2c型,PFGE分型分为19种带型,主要带型为GX6A16.CN0004。 结论 通州地区分离的单增李斯特菌全部携带6个主要毒力因子,分子型别呈现多态性。     

Rhombencephalitis due to Listeria monocytogenes infection with GQ1b antibody positivity and multiple intracranial hemorrhage: a case report and literature review

Listeria monocytogenes is a Gram-positive facultative intracellular bacterium that causes central nervous system infection. We report a case of rhombencephalitis caused by L. monocytogenes infection, which mimicked Bickerstaff’s brainstem encephalitis, and GQ1b antibody positivity and multiple intracranial foci were observed. A 68-year-old male patient presented with a nonspecific prodrome of faintness, forehead tightness, and walking instability. This was followed by progressive cranial nerve palsies, limb weakness, cerebellar signs, hyperpyrexia, and impaired consciousness. Brain imaging showed multiple abnormal brainstem and cerebellar signals that were accompanied by blood infiltration without any lesion enhancement. Serum GQ1b antibody positivity led to an initial diagnosis of Bickerstaff’s brainstem encephalitis, which was treated with immunosuppressive therapy with limited efficacy. A pathogen examination helped confirm L. monocytogenes infection. A combination of meropenem and trimethoprim-sulfamethoxazole therapy was applied and the patient recovered without sequelae. The symptoms and imaging of Listeria rhombencephalitis are nonspecific. Accurate diagnosis and prompt treatment of this condition are essential. Whether Listeria infection triggers an autoimmune response remains unclear.     

Listeria monocytogenes bacteremia in a centenarian and pathogen traceability: A case report

BACKGROUNDEarly diagnosis and appropriate antibiotic treatment are important to survival of Listeria monocytogenes (L. monocytogenes) bacteremia. Penicillin tends to be the most commonly used antibiotic. However, there are limited data on antibiotic use in elderly patients with serious complications. We describe the clinical presentation, antibiotic therapy, and traceability of L. monocytogenes in a centenarian with a history of eating frozen food.CASE SUMMARYA 102-year-old man suffered from high fever with chill after hematochezia. Tentative diagnoses were lower gastrointestinal hemorrhage and localized peritonitis. Meropenem and ornidazole were the empirical therapy. The patient did not respond and developed multiple system dysfunction even after teicoplanin was added to the therapy. L. monocytogenes was identified from blood cultures on day 5 of admission. The patient had a history of consuming frozen dumplings. Meropenem/ornidazole/teicoplanin were replaced with meropenem/linezolid. The patient gradually became afebrile. He received meropenem/linezolid for 10 d, and piperacillin/tazobactam was applied as step-down treatment for 2 wk with good clinical results. There was no sign of relapse during follow-up after discharge. L. monocytogenes isolates from the patient and frozen dumplings belonged to different serotypes and sequence types (STs): 1/2b and ST5 from the patient and 1/2c and ST9 from the dumplings.CONCLUSIONMore awareness of listeriosis should be raised. Linezolid might be an option for listeriosis in elderly people with serious complications.     

Major role of levofloxacin in the treatment of a case of Listeria monocytogenes meningitis

We report a case of acute bacterial meningitis due to Listeria monocytogenes whose successful treatment was mainly attributable to high-dose levofloxacin therapy (500 mg iv bid). This supports the hypothesis that levofloxacin may be an effective option for the treatment of listerial meningitis.     

Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage:A case report and review of the literature

BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.     

江门市区食品中单增李斯特菌污染及耐药状况调查

目的 了解广东省江门市区各类食品中单核细胞增生李斯特菌(Lm)的污染状况和耐药状况.方法 采用国家标准检测方法,并参照全国食源性检测工作手册,采集江门市区集贸市场、大型超市及个体熟食销售点等的非定型包装熟肉、生肉、生奶、水产品、冰淇淋、生食蔬菜等9类食品检测Lm,检出菌株做药物敏感试验.结果 从9类550份食品中,共检出Lm 40株,阳性率为7.27%.其中以非定型包装熟肉类检出Lm最高,阳性率为14.81%;生肉类(生鸡肉、生猪肉、生羊肉、生牛肉)阳性率分别为13.33%、8.33%、6.00%和3.64%;水产品和生食蔬菜阳性率分别为2.00%和1.40%.生奶和冰淇淋均未检出Lm.Lm对20种抗生素中的12种抗生素出现了不同程度的耐药.结论 江门市市区9种食品中存在发生Lm食物中毒的潜在危险,应加强食品卫生管理尤其是非定型包装熟肉和生肉类的管理,控制动物饲料亚治疗抗生素的使用并严格遵守休药期.     

A case of Listeria meningitis associated with increased adenosine deaminase in cerebrospinal fluid

We present, to the best of our knowledge, the first case of listeria meningitis with increased adenosine deaminase (ADA) in cerebrospinal fluid. Although some cases of other etiologies were also reported, this report informs those who manage patients with meningitis that not only Mycobacterium and Brucella spp. but also other facultative agents can increase ADA levels in cerebrospinal fluid, possibly through monocyte-macrophage activation.     

Severe invasive Listeria monocytogenes rhombencephalitis mimicking facial neuritis in a healthy middle-aged man: a case report and literature review

Neurolisteriosis is a foodborne infection of the central nervous system that is easily misdiagnosed, especially in healthy adults with atypical symptoms. A 50-year-old man presented with a 3-day history of distortion of the oral commissure. Facial neuritis was diagnosed and treated with intravenous dexamethasone. His condition deteriorated rapidly, and he presented with a slow pharyngeal reflex, stiff neck, and signs of peripheral facial paralysis. Brain magnetic resonance imaging revealed multiple ring-enhanced foci in the brainstem. Routine and biochemical cerebrospinal fluid (CSF) analyses showed increased white blood cells and microproteins. Blood culture and high-throughput genome sequencing revealed Listeria monocytogenes DNA in the CSF. Ampicillin, amikacin, and meropenem were administered, and the patient was transferred from the intensive care unit to a standard medical ward after 2 months. The patient could walk and eat normally; however, he required intermittent mechanical ventilation at 11 months after discharge. Although L. monocytogenes meningitis is rare in healthy immunocompetent adults, it must be considered as a differential diagnosis, especially in adults whose conditions do not improve with cephalosporin antibiotic administration. L. monocytogenes rhombencephalitis mimics facial neuritis and develops quickly. Prompt diagnosis is essential for rapid initiation of antibiotic therapy to achieve the best outcome.     

Listerial meningitis in a patient with undiagnosed acquired immunodeficiency syndrome: ampicillin should be added to the empirical antibiotic coverage

Meningitis is an important differential diagnosis in patients with fever, headache, and/or altered consciousness in the emergency department (ED). With human immunodeficiency virus (HIV) infection becoming increasingly common, patients with acquired immunodeficiency syndrome (AIDS) need to be recognised promptly to facilitate the choice of appropriate antibiotic therapy for potential opportunistic infections. Physicians should be able to recognise a patient with undiagnosed AIDS who presents to the ED and perform further confirmational tests without violating the rights of the patient. Additional tests focusing on discovering potential opportunistic pathogens should be performed. Ampicillin should be added to the empirical regimen for the coverage of Listeria meningocerebritis, which should be considered in all potentially immunocompromised hosts with suggestive clinical presentations. Failure to recognise patients with AIDS and provide antibiotics active against L monocytogenes in such hosts may lead to a catastrophic outcome.     

Fatal lactic acidosis and hypoglycemia in a patient with relapsed natural killer/T-cell lymphoma

Presented here is the first reported case of natural killer (NK)/T-cell lymphoma associated with lactic acidosis (LA) and hypoglycemia. LA and hypoglycemia are rare complications of non-Hodgkin’s lymphoma. A 28-year-old male patient with NK/T-cell lymphoma had a relapse after 14 mo of initial remission and was admitted to the hospital because of altered mental status. He developed severe LA (pH, 7.17; lactate, 11.2 mmol/L) and hypoglycemia (42 mg/dL) that was resistant to sodium bicarbonate and glucose infusions. A very brief partial remission was achieved after a cycle of vincristine, dexamethasone, and L-asparaginase was given, but the disease recurred quickly after chemotherapy was discontinued and the patient did not respond to additional chemotherapy. The patient expired at 47 d after relapse. An extensive review of the literature reveals that only 2 of 28 patients have achieved complete remission, and more than 75% of patients died within 1 mo. Furthermore, 90% of previously reported cases had liver involvement. The case described here indicates that non-Hodgkin’s lymphoma-induced LA portends a poor prognosis.     

Antibiotic treatment for bacterial meningitis caused by Listeria monocytogenes in a patient with multiple myeloma

Multiple myeloma is a hematolymphoid malignancy, and patients with this disorder are frequently complicated by infection. An 80-year-old woman with multiple myeloma was complicated by bacterial meningitis, and was admitted to our hospital in August 2007. She initially received ceftriaxone, but culture of cerebrospinal fluid detected Listeria monocytogenes. Ampicillin was administered, but headache and pyrexia persisted for 2 weeks, and on cerebrospinal fluid examination, the proliferation of polymorphonuclear leukocytes had not resolved. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. The patient ultimately received meropenem for 27 days, resulting in a cure. In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. This agent is indicated when ampicillin shows inadequate effect or if the patient has an allergy to ampicillin.