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Community-acquired Listeria monocytogenes meningitis in adults

Abstract number: 1733_705

Amaya-Villar R., Garcia Cabrera E., Sulleiro E., Jiménez-Mejías M.E., Roriguez D., Fernández-Viladrich P., Coloma A., Catalan P., Rodrigo C., Fontanals D., Grill F., Juliá M.L., Vázquez J.A., Pachón J., Prats G.

Methods: A descriptive, prospective, and multicentre study carried out in 9 hospitals of the Spanish Network for the Research in Infectious Diseases (REIPI) between 1/11/2003 and 31/07/2006. Patients: Three hundred and twenty-four adult patients with acute community-acquired bacterial meningitis were included. Forty-five episodes of Listeria monocytogenes meningitis were identified in 45 adult patients. All these cases were diagnosed on the basis of a compatible clinical and biological picture and a positive cerebrospinal fluid (CSF) or blood cultures.

Results: All 45 patients were either immunocompromised or aged over 60 years. The classic triad of fever, neck stiffness and altered mental status was present in 21 (46.7%) patients, however, almost all patients (95%) had at least 1 or more of these symptoms. CSF samples obtained through lumbar puncture showed a median WBC count of 550 per mm3 (interquartile range 0–70.000 per mm3); a glucose level of 39 (0.4–158) mg/dL; a ratio of CSF glucose to blood glucose of 0.27 (0.0–0.65); and a protein level of 181 (20–674) mg/dL. Gram stain of CSF samples was performed for 97.8% patients and it was positive in 12 (27.7%) of 44 cases. CSF and blood cultures were positive in 88.8% and 67.4%, respectively. The serotype more frequently found was the 4b in 16 (72.2%) of 22 cases. In 18 (40%) of 45 cases, the patients received empirical antimicrobial therapy. The initial antimicrobial therapy was ampicillin based for 35 (77.7%) of 45 patients, in 12 (34.3%) of them associated to aminoglycosides. Twenty-one patients (46.6%) received adjunctive therapy with dexamethasone; in 16 cases, the first dose was given previously or concomitantly to the first antibiotic dose. The median length of hospital stay was 20 (7–34) days. The mortality rate was 28.9% (13 of 45 patients) and 4 (8.9%) developed adverse clinical outcome (neurological and/or auditory sequels). Inadequate initial antimicrobial therapy was not related to outcome.

Conclusions:Listeria monocytogenes meningitis predominantly occurs in elderly or immunocompromised patients. Patients with Listeria monocytogenes meningitis often present with classic symptoms of bacterial meningitis. This clinical process also remains a serious disease that carries high morbidity and mortality rates.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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