Pleural-pulmonary aspects of Listeria monocytogenes infection

The most common forms of Listeria monocytogenes infection in adults are meningitis-encephalitis and sepsis. Infection of the pulmonary parenchyma and pleura have rarely been reported. A case of listeria meningitis presenting with pleural space infection in an immunosuppressed patient is presented and a review of 5 additional patients with listeria infection of the respiratory tract is included. All 6 patients described in this report had L. monocytogenes infections presenting with respiratory tract symptomatology, although 4 patients subsequently had positive blood or cerebrospinal fluid cultures. It is emphasized that a culture report of 'diphtheroids' from a thoracentesis specimen should not be automatically dismissed as contamination, particularly in an immune compromised patient.     

Listeriosis in immunosuppressed patients: A cluster of eight cases

Bacteremia due to Listeria monocytogenes developed in eight patients who were receiving immunosuppressive medications during a 15 month period at one hospital. Seven survived. Meningitis was documented in only the four who received kidney transplants. Their neurologic signs were minimal, indicating a need to treat any immunosuppressed patient with Listeria bacteremia for meningitis.During this period the incidence of Listeria bacteremia in immunosuppressed patients greatly exceeded that previously observed in this hospital or reported elsewhere, but the incidence of infection with other opportunistic agents was not increased. As with previously described Listeria outbreaks in nonimmunosuppressed patients, no source or mechanism of spread could be identified. Thus, disease due to L. monocytogenes may occur focally among immunosuppressed populations, a pattern which also appears to be emerging for other opportunistic agents. A patient's exposure to different opportunistic agents may be as important as the kind of immunosuppressive therapy he receives in determining which opportunistic infection he will acquire or even whether any infection will occur.     

Pneumonia involving Legionella pneumophila and Listeria monocytogenes in an immunocompromised patient: an unusual coinfection

Recently, empirical therapy has been recommended for severe community-acquired pneumonia. We report the case of a 68-year-old prednisone-treated man with multiple myeloma who developed a fatal pneumonia due to Legionella pneumophila and Listeria monocytogenes confirmed by immunohistochemistry on postmortem lung sampling. Involvement of the latter bacteria and association of two different pathogens are both highly uncommon features in pneumonia. The route of infection with L. monocytogenes is discussed and the literature on respiratory infections with L. monocytogenes is briefly reviewed. This case highlights the need to consider unusual pathogens when facing pneumonia in immunocompromised patients, and to perform extensive microbiological investigations even if broadspectrum antibiotic therapy is the treatment of choice.     

Listeria infection after liver transplantation: report of a case and review of the literature

Listeria monocytogenes is a well-recognized cause of bacteremia and meningitis in immunocompromised individuals, including recipients of solid organ transplants, but has only rarely been reported following orthotopic liver transplantation (OLT). Most previously reported cases of listeriosis occurred months to years following liver transplantation; we describe a case of listeriosis that occurred within 1 wk of liver transplantation, shortly after discontinuation of trimethoprim-sulfamethoxazole prophylaxis, and review the English literature on Listeria infection after OLT. The patient developed abdominal pain and fever that suggested a bile leak, but was definitively diagnosed with Listeria infection by blood culture. The infection was successfully treated with 3 wk of intravenous ampicillin. We conclude that serious systemic infection with Listeria monocytogenes is uncommon following OLT, may occur early in the postoperative period, and responds well to treatment with high dose ampicillin.     

In Process Citation

To review the epidemiology, risk factors, clinical features and outcomes of Listeria monocytogenes infection in the Eastern Townships of Quebec, a retrospective study was completed over the period 1976 to 1995. Cases were identified from positive cultures and diagnosis given by the infectious diseases service of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec. A total of 12 cases were in the study. Septicemia not related to pregnancy (four of 12) and meningitis (six of 12) were the major clinical presentations. There was one case of listeriosis associated with pregnancy and one case of granulomatosis infanti septica. Ten patients had at least one predisposing underlying condition. Only one death was related to L monocytogenes infection. Neurological sequelae were observed in half of the cases of meningitis, whereas no sequelae were noted in cases of septicemia. In conclusion, listeriosis is predominantly a disease of elderly and immunosuppressed patients. The clinical presentation and outcome are not different from those reported in other industrialized countries.     

A case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid

Infection of the central nervous system due to Listeria monocytogenes is uncommon. The treatment of choice is ampicillin. We describe in this report a case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid. To the best of our knowledge, this is the first case in which linezolid was used to treat infection of the central nervous system caused by this organism.     

Bacterial peritonitis caused by Listeria monocytogenes: Case report and review of the literature

Although Listeria monocytogenes has been isolated from the gastrointestinal tract, it is an infrequent cause of bacterial peritonitis. Since 1963 only 23 cases of peritonitis caused by listeria have been reported. This report describes another case in a patient with cirrhosis and chronic renal failure and presents a review of the literature. Most (16) of the previous cases were cirrhotic while six were undergoing chronic ambulatory peritoneal dialysis. Eight patients were on immunosuppressive therapy. Blood cultures were positive in fewer than half (42%) of the cases and Gram stain of peritoneal fluid was positive only twice. The peritoneal fluid protein concentration was relatively high compared with other causes of bacterial peritonitis. Ampicillin was the drug most commonly used for treatment, and the majority of patients survived the acute infection.     

Disseminated listeriosis presenting as acute hepatitis: Case reports and review of hepatic involvement in listeriosis

We report three cases of disseminated listeriosls that presented as acute hepatitis characterized by striking increase of liver function test values and fever. Peak serum transaminases (SGOT) for each of three patients were 5,380, 2,350, and 443 mu/ml respectlvely. The correct diagnosis was not suspected in any of the patients until blood and cerebrospinal fluid cultures obtained routinely in the course of evaluation for fever grew Listeria monocytogenes. When antibiotic therapy was instituted, serum transaminase values plummeted in two patients; these two were eventually cured of their infection. The third patient succumbed to his infection; postmortem examination showed miliary abscesses of the liver which revealed L. monocytogenes. Review of the literature for previous reports of hepatic involvement in adult patients with Ilsterioris shows that hepatitis is an unusual mode of presentation. However, since we observed these three cases over a one-year period, we suspect this may not be an uncommon occurrence.     

Listeria monocytogenes peritonitis in cirrhotic patients: first description in Brazil

Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.     

Listeria monocytogenes Peritonitis: Case Report and Literature Review

Listeria monocytogenes is a Gram-positive bacillus that is pathogenic in both the normal and compromised host. We describe Listeria peritonitis and cerebritis in a patient with cirrhosis due to non-A, non-B hepatitis, and review the 11 other cases of Listeria peritonitis reported in the English-language literature. Listeria is a rare cause of peritonitis in debilitated, older patients, with two-thirds of the cases occurring in patients with chronic liver disease. Listeria peritonitis may also occur in patients undergoing peritoneal dialysis, or in those with malignancy. Peritonitis due to Listeria is clinically similar to spontaneous bacterial peritonitis, and is associated with fever, variable abdominal pain, and neutrocytic ascites; bacteremia commonly accompanies Listeria peritonitis. This syndrome can be successfully treated with antimicrobial drugs, although the third-generation cephalosporins commonly used in the therapy of spontaneous bacterial peritonitis are not recommended. Ampicillin may be the drug of choice, with combination therapy with an aminoglycoside reserved for cases that do not respond to ampicillin alone.     

Infección del sistema nervioso central por Listeria monocytogenes en pacientes con lupus eritematoso sistémico: análisis de 26 casos,incluyendo el reporte de un caso nuevo

IntroductionInfections in patients with systemic lupus erythematosus cause significant morbidity. Infection due to Listeria monocytogenes (LM) is considered an opportunistic disease, and has been published on rare occasions in patients with SLE.ObjectiveTo review the presentation of listeria infections in the central nervous system (CNS) in SLE patients.MethodologyWe conducted a literature review, selecting cases with central nervous system infection and confirmation of LM infection through culture.ResultsTwenty six cases are described. The most common presentation was meningitis, with meningoencephalitis and brain abscesses being less frequent. The predisposing factors are: use of glucocorticoids, immunosuppressants, renal replacement therapy and the activity flares.ConclusionCNS infection by listeria is rare and sometimes fatal. The atypical presentation may lead to a delay in diagnosis and appropriate treatment. L. monocytogenes should be included in the differential diagnosis of patients with SLE with neurological manifestations.     

Successful management of Listeria monocytogenes pericarditis: case report and review of the literature

Listeria monocytogenes, although an uncommon cause of illness in the general population, is feared principally because of the morbidity and mortality associated with CNS infections. Cardiovascular involvement with L. monocytogenes is very rare, and has been limited to endocarditis. We describe a case of Listeria pericarditis, which occurred in a 60-year-old man with Child-Pugh B cirrhosis who presented to the emergency department with asthenia, anorexia, and respiratory distress. The echocardiogram showed severe pericardial effusion and after pericardiocentesis, L. monocytogenes was isolated in the culture of pericardial fluid. After surgical pericardiectomy with draining of the pericardial effusion and antibiotic treatment with ampicillin, the patient experienced a slow, but full recovery. Documentation of L. monocytogenes pericarditis is an extremely rare entity with very scarce reports in medical literature, and is usually associated with a very poor prognosis. A case report is presented together with a review of the literature.     

Septic arthritis due to Listeria monocytogenes: report and review of the literature

Septic arthritis due to Listeria monocytogenes is an uncommon infection amenable to antibiotic therapy along with open or closed drainage. We report successful antibiotic treatment of a prosthetic joint infection in a man with seropositive rheumatoid arthritis and present a review of the literature describing this specific infection.     

Pleural fluid infection caused by Listeria monocytogenes: case report and review

Nine cases of pleural fluid infection caused by Listeria monocytogenes (one case described here and eight cases previously reported in the literature) were reviewed. Eight patients (88.9%) had an underlying malignancy (three had Hodgkin's disease, three had non-Hodgkin's lymphoma, and two had leukemia), and six (66.7%) were receiving immunosuppressive therapy at the time of presentation. Seven patients (77.8%) presented with fever and five (55.6%) with respiratory tract symptoms. Those with symptoms of greater than 3 weeks' duration had a relatively poor prognosis. Bacteremia was documented in five patients (55.6%). Examination of pleural fluid typically revealed normal levels of glucose, slightly elevated concentrations of protein, and a negative gram stain. Four patients died, for an overall mortality of 44.4%. Mortality appeared to be lower for patients who received a combination of penicillin or ampicillin plus an aminoglycoside and for those who underwent drainage of pleural fluid than for those not given such treatment. Rapid diagnosis, prompt institution of appropriate antimicrobial therapy, and drainage of the pleural fluid are likely to improve the chances for survival in listerial infection of pleural fluid.     

An unusual case of fatal pericarditis due to Listeria monocytogenes

Pericarditis due to Listeria monocytogenes is a very uncommon and serious disease. We describe a case of fatal subacute pericarditis that was caused by L. monocytogenes in a 61-year-old woman with Hodgkin's disease who was diagnosed in 1975 and considered cured. In addition, we review the literature on this condition.     

A rare case of Listeria monocytogenes presenting as prosthetic valve bacterial endocarditis and aortic root abscess

Listeria monocytogenes is a gram-positive bacillus that is rarely associated with infections in the general population. Those susceptible to this pathogen include neonates, pregnant women, and the immunocompromised. The most common clinical manifestations of listeriosis are bacteremia and meningitis. Endocarditis caused by L. monocytogenes is rare with less than 60 cases reported in the world literature. We report the case of an 81-year-old man who suffered aortic prosthetic valve listeria endocarditis, and examine the literature regarding this rare manifestation of human listeriosis.     

Spontaneous bacterial peritonitis caused by infection with Listeria monocytogenes: a case report and review of the literature

Spontaneous bacterial peritonitis is a frequent and often serious complication of long-standing ascites in the presence of advanced liver disease. Coliform bacteria account for the infection in most cases and are thought to be related to translocation of bacteria from the bowel into the peritoneal cavity. The empiric use of cefotaxime is well established as most of the causative organisms are sensitive to this antibiotic. However, we report on a case of spontaneous bacterial peritonitis in a patient with hepatitis C related cirrhosis who was awaiting liver transplantation caused by infection with Listeria monocytogenes , in which the patient did not improve with empiric antibiotic therapy. This case adds to the 23 others reported in the literature since 1966. Our case raises some concerns about the universal empiric usage of cefotaxime for spontaneous bacterial peritonitis because it does not offer adequate coverage against organisms such as Listeria , enterococci, Pasturella , and anaerobes.     

Listeriosis in second trimester of pregnancy: case report from India

Although Listeria monocytogenes infection occurs in sporadic and epidemic forms throughout the world, there are certain countries (especially Asian countries) that have reported only a few cases or failed to report even a single case. During her third visit at 17(+5) weeks of gestation, a 22-year-old primigravida presented with the complaint of an acute painful abdomen, leaking per vaginum and low-grade fever for the 2 preceding days. On ultrasonography, a single live fetus with no amniotic fluid was seen and the pregnancy was therefore terminated. L. monocytogenes was isolated from a high vaginal swab.     

Listeriosis following shigellosis

In 1987 an outbreak of illness due to Listeria monocytogenes occurred in Philadelphia. In contrast to previously studied outbreaks, no source of infection or vehicle of transmission could be identified, and several listerial strains were found to be involved. A hypothesis that was developed and eventually published suggests that clinical listeriosis may occur when individuals who are asymptomatic for listerial infection but whose gastrointestinal tract has been colonized by Listeria organisms become infected with another pathogen. The case of a farmer who developed a brain stem abscess due to L. monocytogenes following an episode of acute enteritis due to Shigella sonnei lends support to this hypothesis.     

Neonatal listeriosis: experience in Suffolk

Four cases of neonatal infection with Listeria monocytogenes are reported. Two of them resulted in neonatal death and two in long-term healthy survival. The literature on the subject is reviewed with particular reference to epidemiology, early recognition and treatment.