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High incidence of Listeria monocytogenes meningitis in a north-eastern Italian area

Abstract number: R2198

Libanore M., Rossi M.R., Bicocchi R., Antonioli P., Leclercq A., Ghinelli F.

Background:Listeria monocytogenes (LM) is a Gram positive rod agent of meningoencephalitis, expecially in immunoompromised patients. Host factors that increase the risk of listeria infection are: pregnancy, acuired immunosuppression, haematological malignancies, diabetes mellitus, renal failure and chronic alcoholism. In northeastern Italy the incidence of listeria infection with cerebral involvement is unknown since it's unsuspected.

Objective: to study the incidence, epidemiologcal and clinical features of meningitis due to LM in a NorthEastern Italian area.

Methods: we have analyzed by means of computed database all the cases of acute meningitis in HIV negative patients admitted to our department of Infectious Diseases between January 1989 and December 2008. Demographic data, predisposing conditions, underlying diseases, CSF cell count, CSF chemical data, CSF bacterial antigens, CSF and blood coltures, clinical therapeutic and outcomes were investigated with an accurate flow-chart. he diagnosis of listeriosis was confirmed by the Centre de Reférences des Listeria of Pasteur Institute in Paris.

Results: during the study period, 183 cases of meningitis have been observed: 91 with purulent CSF and 92 with clear CSF; ratio males/females 1.4; median age 53.5 years patients with purulent CSF and 46.5 years patients with clear CSF (range 16–88). The study was divided infour compaired periods: 1988–1993, 1994–1998, 1999–2003, 2004–2008. The incidence of listeria infection has been increased: from no cases in the first period, 4.4% in the second, 6.7% in the third and 19% in the last period. The incidence for 100,000 persons in the same periods was respectively: none, 0.28, 0.57 and 1.14. Risk factors of the 7 observed cases were: chronic alcoholism, haematological malignancies and advanced age. Symptomatology: fever, confusional state, rigor nucalis, indisposition. In 6/7 cases LCF was purulent with cell count between 700 and 2500/mmc. The last 3 observed cases presented in vitro resistance to ampicillin, so was employed levoflxacin i.v. in association with ceftriaxone. Two patients developped hydrocephalus.

Conclusions: LM is increased in our area and it's related to the global consumption of food. This is an important fact in order to high percentual of isolation (17.4%) in cheese, vegetables and chicken. On th high observed incidence it's indispensable that empirical therapy of acute mininitis contemplate the employ of an active chemioterapic against LM.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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