Neurolisteriosis. Review of 22 cases
Abstract number: R2433
Artigas B., Granados A., Font B., Navarro M., Fontanals D., Segura F.
Objectives: To analyse the epidemiologic and clinical features of central nervous system (CNS) infection by Listeria monocytogenes (LM) in a general hospital in the last 11 years and review of the literature.
Methods: We reviewed the medical and laboratory records of all patients diagnosed of CNS infection by LM between January 1996 and September 2007. Inclusion criteria were: adults, with blood or cerebro-spinal fluid (CSF) positive cultures for LM and symptoms of SNC infection.
Results: 22 patients were recruited, men 52%, mean age 64 years (range 2890). The number of cases has been increasing during these years. 10 patients (45.5%) were not immunocompromised. The most frequent clinical form was meningoencephalitis with 14 patients (64%). The clinical picture was different depending on clinical presentation. Blood cultures were done in all patients and were positive in 86% of them. CSF culture was done in 19 patients (86%), 53% of them were positive for LM. In CSF, lymphocytes dominated in 58% of patients, 74% had a protein level over 0.45 g/L and only 21% had glucose levels below 40 mg/dL, but with a CSF/plasma ratio below 0.5 in 15 patients (79%). Gram stain was done in 17 cases and was negative in all of them. A computed tomography brain scan was performed in 91% of patients, being altered in 30% of them. Magnetic resonance imaging scan of the brain was obtained in 59%, showing abnormal images in 63% of cases. Mean time between admission and diagnosis was 2.3 days (range 06). Mean time between admission and treatment was 1.1 days (range 04). A correct double antilisterial treatment was prescribed in 11 cases (50%). Mean duration of treatment was 27.6 days (range 170). Any of the patients with brain abscess needed surgical treatment. General mortality was 36% (6 patients), 4 of them (18.2%) directly related to LM infection. Surviving patients presented neurological sequelae in 4 cases (18.2%). Mean survival was 10.8 days (range 138).
Conclusion: LM must be considered in CNS infection especially in the elderly and immunosupressed patients. Its incidence in not immunocompromised patients is increasing. Early diagnosis and empirical treatment including an antilisterial drug are very important for prognosis. Domination of lymphocytes in CSF differential cell count and a CSF/plasma glucose ratio below 0.5 can suggest LM and it can be advisable to include an antilisterial drug empirically. CSF Gram stain is usefulness in many cases.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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