Listeria rhombencephalitis mimicking stroke in a patient with giant cell arteritis

Listeria monocytogenes sometimes causes central nervous system infections. However, rhombencephalitis is a rare form of L. monocytogenes infection. Its clinical symptoms and magnetic resonance imaging (MRI) findings are often similar to those of vertebrobasilar stroke. We present the case of a 79-year-old woman with Listeria rhombencephalitis presenting with rhinorrhea and productive cough. She had giant cell arteritis (GCA) treated with prednisolone and methotrexate. She was admitted for loss of appetite, rhinorrhea, and productive cough. These symptoms were alleviated without specific treatment; however, she suddenly developed multiple cranial nerve palsies, and MRI showed hyperintense signals on diffusion-weighted imaging and hypointense signals on apparent diffusion coefficient in the brainstem. Ischemic stroke due to exacerbation of GCA was suspected, and treatment with intravenous methylprednisolone was initiated; however, seizures occurred, and a lumbar puncture was performed. Cerebrospinal fluid and blood cultures revealed L. monocytogenes, and she was diagnosed with Listeria rhombencephalitis. Although antibiotic treatment was continued, the patient died. Thus, when patients with rhinorrhea or productive cough develop sudden cranial nerve palsy, Listeria rhombencephalitis should be considered as a differential diagnosis, and lumbar puncture should be performed.     

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 in platelets: a case report

BACKGROUND: Efforts to reduce bacterial contamination in platelets (PLTs) have led to implementation of tests for bacterial detection before product release. Although relatively rare as a human pathogen, Listeria monocytogenes often causes serious illness and has a case-fatality rate of 20 percent. CASE REPORT: PLTs from an asymptomatic 58- year-old Hispanic male with a long history of PLT donation were culture-positive for the presence of L. monocytogenes. The pulsed-field gel electrophoresis (PFGE) pattern of the isolate matched two other L. monocytogenes isolates in the CDC National PulseNet database. Public health investigation found no evidence that the other two isolates were epidemiologically related to the PLT donor, who remained asymptomatic. CONCLUSION: A cluster of listeriosis cases was detected by PFGE but the significance is unknown. Organisms of public health significance should be reported to health departments. Better surveillance and reporting are needed in the efforts to improve blood product safety.     

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.     

Secondary bacterial peritonitis due to Listeria monocytogenes after paracentesis

Although it is a relatively rare cause of peritonitis, Listeria monocytogenes must be considered in cirrhotic patients with ascites and a suggestive clinical presentation. We believe this is the first report of a case of peritonitis due to L monocytogenes in a patient without sepsis, and the sixth reported case of bacterial peritonitis in a patient with cirrhosis.     

Listeria monocytogenes-induced monomicrobial non-neutrocytic bacterascites

Spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis of the liver. The organisms most commonly involved in this infection are gram-negative bacteria like Escherichia coli and Klebsiella pneumoniae, and gram-positive bacteria like Streptococcus pneumoniae and Staphylococcus aureus. Listeria monocytogenes is an uncommon gram-positive bacillus implicated in infections in neonates, pregnant females, the elderly, and immunocompromised patients. Listeria monocytogene-induced SBP is rare, with less than 40 cases reported in the medical literature. Monobacterial non-neutrocytic bacterascites (MNB) is a variant of SBP, where the ascitic fluid culture is positive but the ascitic neutrophil count is less than 250/mm3. Forty percent of these patients will subsequently have SBP. Only 2 cases of MNB from L monocytogenes have previously been reported. We report a case of MNB in a patient with cirrhosis whose ascitic neutrophil count was 164/mm', but Gram stain and microbiologic culture showed the growth of L monocytogenes.     

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.     

Aneurysmal subarachnoid hemorrhage: neurosurgical frontiers and nursing challenges

Despite increases in survival beyond the initial hemorrhage, the devastating consequences of subarachnoid hemorrhage persist. Ruptured intracranial aneurysms are the most likely cause of subarachnoid hemorrhage, with morbidity and mortality rates approaching 75%. Complications arising from aneurysmal subarachnoid hemorrhage include rebleeding, delayed cerebral ischemia, hydrocephalus, hypothalamic dysfunction, and seizure activity. In order to positively influence outcome after subarachnoid hemorrhage, preservation of an adequate cerebral blood flow and prevention of secondary aneurysmal rupture is essential. This article reviews aneurysmal subarachnoid hemorrhage, relating the management of complications to currently accepted treatment strategies.     

Computed tomographic scanning in Listeria monocytogenes meningitis

Seven adults with Listeria monocytogenes infection of the central nervous system had computed X-ray tomography of the head performed. One patient had a normal scan, three had hydrocephalus; cerebral edema, an arachnoid cyst and hyperemia were each noted in one patient. Atrophy of the vermis of the cerebellum was demonstrated on follow-up scans in two patients. Further studies are necessary to determine whether such atrophy is a frequent sequelae of L. monocytogenes central nervous system infection.     

Intracerebral activity of antibiotics against Listeria monocytogenes during experimental rhombencephalitis

We used a model of rhombencephalitis in gerbils to test the efficacy of various antibiotics against Listeria monocytogenes. Gerbils were inoculated in the middle ear with strain EGD and treated subcutaneously with various antibiotics alone or in combination. We found that the most active antibiotics on intracerebral bacteria were amoxycillin, co-trimoxazole, rifampicin and imipenem. Vancomycin, gentamicin and ciprofloxacin were weakly or not active. The combinations amoxycillin-co-trimoxazole, amoxycillin-gentamicin and co-trimoxazole-rifampicin were highly active against intracerebral bacteria.     

Comparative in vitro activity of moxifloxacin against Gram-positive clinical isolates

The in vitro activity of moxifloxacin was compared with that of 15 antibacterial agents against 513 Gram-positive microorganisms. The MIC(90) (mg/L) of moxifloxacin was 0.06 for quinolone-susceptible Staphylococcus aureus and Staphylococcus epidermidis, 0.12 for Streptococcus pyogenes and Streptococcus agalactiae; 0.25 for Streptococcus pneumoniae, Streptococcus mitis, Streptococcus bovis, Streptococcus anginosus and Actinomyces pyogenes; 0.5 for Streptococcus sanguis and Listeria monocytogenes, 2 for Corynebacterium jekeium and Bifidobacterium bivius. Over 50% of Enterococcus faecalis, Enterococcus faecium, quinolone-resistant staphylococci, Nocardia steroides and Clostridium difficile were susceptible to 2 mg/L moxifloxacin. Moxifloxacin and trovafloxacin demonstrated comparably high activity towards Gram-positive cocci; moxifloxacin and clinafloxacin were most active against Gram-positive bacilli.     

单增李斯特菌1/2c血清型菌株生物膜形成能力的研究

目的 比较在不同压力条件下,单增李斯特菌1/2c血清型与其他血清型菌株生物膜形成能力,以了解单增李斯特菌1/2c血清型菌株的环境适应能力。方法 采用96孔培养板结晶紫染色法,检测不同温度、不同培养基、不同pH值条件下,单增李斯特菌1/2c血清型与其他血清型菌株的生物膜形成能力。结果 在25 ℃、TSB、10%TSB和pH 7~8条件下,1/2c血清型菌株生物膜形成能力强于其他血清型菌株(P0.05)。结论 在室温、富营养/低营养条件、中性略偏碱性环境中单增李斯特菌1/2c血清型菌株的生物膜形成能力强于其他血清型菌株,提示可能是食源性单增李斯特菌1/2 c血清型菌株分离率较高的原因之一,为该菌的预防控制措施提供了参考依据。     

Detection of Listeria monocytogenes from food samples by PCR after IMS-plating

For rapid, accurate and sensitive detection of Listeria monocytogenes in food samples, colonies developed on the selective agar (Oxford agar) after immunomagnetic separation (IMS) were subjected to polymerase chain reaction (PCR) assay with the prf A1-2 primer pair. The proposed assay system was shown experimentally to be capable of specifically detecting the bacteria from food samples contaminated at more than 10(2) cfu/g. However, the enrichment culture after a short period of 16 h with the appropriate selective broth was needed before IMS-plating, because the bacterial contents in most actual food were as low as less than 10(2) cfu/g. However, even if the enrichment cultivation was employed before IMS, L. monocytogenes was detected within 3 days.     

Rapid detection of Listeria monocytogenes by a PCR assay specific for an aminopeptidase

Specific and rapid detection of Listeria monocytogenes is very important with regard to food safety since all other species of Listeria appear to be non-pathogenic to humans. Conventional microbiological detection methods are very time consuming. The polymerase chain reaction (PCR) is one of the most promising techniques for rapid detection of micro-organisms in food products. We have developed a PCR assay, specific for L. monocytogenes, based on the gene encoding an aminopeptidase, which previously has not been described for this species. The L. monocytogenes aminopeptidase shares strong sequence similarity with aminopeptidase C from Streptococcus thermophilous, Lactobacillus lactis, Lactobacillus helveticus, and with a cysteine proteinase from Saccharomyces cerevisiae. Polymerase chain reaction primers were synthesized based on the DNA sequence of the aminopeptidase gene. A 90 bp product was apparent with all L. monocytogenes strains tested but not with other species of Listeria or other bacterial genera. The PCR assay, which is performed directly from whole bacterial cells, does not involve DNA purification and can be conducted in 4 h. It provided positive identification of L. monocytogenes in mixed culture.     

Infection of the central nervous system by Listeria monocytogenes: a review of 54 adult and juvenile cases

The clinical features in 54 juvenile and adult patients with Listeria monocytogenes infection of the central nervous system are described. Thirty-one of the patients had pre-existing chronic disease; the remainder were previously healthy. Twenty of the patients, the 'meningo-encephalitic group' developed focal neurological signs. The remaining 34, the 'meningitic group' exhibited no focal signs other than those caused by increased intracranial pressure. The 'meningitic group' differed from the 'meningo-encephalitic group' in that the cerebrospinal fluid white cell count, protein and glucose levels were markedly more abnormal and the prognosis worse. Evidence of septicaemia was found only in the 'meningitic group'. Meningo-encephalitis may represent a modified response to listerial infection typified by granulomatous rather than a suppurative response. The predominance of this response that was demonstrated in females may indicate partial immunity, the result of previous Listeria monocytogenes colonisation of the female genital tract. Listeria monocytogenes infection is treatable and should be considered in patients with meningitic or encephalitic illness. Repeated blood cultures may be required to establish the diagnosis.     

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。     

Severe intracranial and intraspinal subarachnoid hemorrhage after lumbar puncture: a rare case report

The lumbar puncture is considered as a safe routine procedure in widespread clinical use for nearly a century. To the best of our knowledge, intracranial and intraspinal subarachnoid hemorrhage has never been reported as a complication after a lumbar puncture. We presented a case of a 76-year-old woman who fell in a deep coma after a lumbar puncture with diffuse subarachnoid hemorrhage and acute obstructive hydrocephalus on computed tomographic scans. Magnetic resonance imaging studies of the whole spine showed the hematoma spread along the spinal cord upward to the intracranial subarachnoid space. Remarkably, an extravasation of contrast medium presented at the level of L1 through L2, which was subsequently evaluated using the spinal angiography. There was an ongoing bleeding at the terminus of L1 lumbar segmental artery that lay within the spinal cord. Then a transarterial embolization followed and the hemorrhage stopped immediately. This case reminds us that although lumbar puncture is safe and simple, severe potential complication, such as intracranial and intraspinal subarachnoid hematoma, could occur.     

单核细胞增生性李斯特菌致病相关机制的研究进展

单核细胞增生性李斯特菌(Listeria monocytogens,LM)是一种重要的食源性疾病病原菌,能引起人和动物较为严重的感染症状.LM采用多种策略逃逸宿主天然防御屏障,进而侵入宿主细胞并复制生存.本文结合近年来LM致病机制方面的研究,介绍了致病相关毒力因子的分子特点及其在致病过程中的作用.     

Listeria monocytogenes infection with brain abscess formation--the first case in Miyagi Prefecture

A rare type of brain abscess formation caused by infection with Listeria monocytogenes was observed in a 2-year-old boy. The patient did not respond to treatment with various antibiotics. The isolated organisms were found to be sero-type 4b. This is the first report of Listeria monocytogenes infection in Miyagi Prefecture.