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[Two cases of meningitis due to Listeria monocytogenes (author's transl)]
Abstract:
Two cases of meningitis due to Listeria monocytogenes in a 73-year-old man and a 77-year-old woman are described. Both patients were admitted to an Emergency Department in acute state, probably caused by cerebral stroke. Neither presented clinical symptoms of meningitis. No other concomitant conditions which might weaken the patient's general state were known to be present. The first patient died after 16 hours, the second after 5. The analysis of the cerebrospinal fluid gave the following information: Case 1: 1,500 cells, 80 percent of which were polynuclear neutrophils; Pandy's reaction was positive; albumin 1.5 g/l and glucose 0.65 g/l. Case 2: 197 cells/mm3, 90 percent of which were polynuclear neutrophils; Pandy's reaction was positive; albumin and glucose were 0.60 and 0.10 g/l respectively. Samples of the cerebrospinal fluid were cultured in various media and pure cultures of Listeria monocytogenes, subtype 4b, were isolated. The source of the infection could not be determined in either of the two cases.
Insights
Two elderly patients developed fatal meningitis caused by Listeria monocytogenes, presenting initially with stroke-like symptoms. This highlights the critical need to consider Listeria monocytogenes in severe neurological cases, even without typical meningitis signs.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Listeria monocytogenes is a significant cause of bacterial meningitis, particularly in vulnerable populations.
- Prompt diagnosis and treatment are crucial for improving outcomes in meningitis cases.
Observation:
- Two elderly patients presented with acute neurological deterioration, initially suspected as cerebral stroke.
- Neither patient exhibited classic meningitis symptoms, and no predisposing conditions were identified.
- Cerebrospinal fluid analysis revealed pleocytosis with neutrophilic predominance, elevated protein, and variable glucose levels, consistent with bacterial meningitis.
- Listeria monocytogenes subtype 4b was isolated from the cerebrospinal fluid in both cases, leading to rapid mortality.
Findings:
- Listeria monocytogenes meningitis can present atypically in the elderly, mimicking cerebrovascular events.
- Rapid progression and high mortality rates were observed in these two cases.
- The source of Listeria monocytogenes infection could not be identified in either patient.
Implications:
- Clinicians should maintain a high index of suspicion for Listeria monocytogenes meningitis in elderly patients with acute neurological decline, even in the absence of typical meningitis signs.
- Early diagnostic workup, including cerebrospinal fluid culture, is essential for timely and appropriate treatment.
- Further research is needed to understand the specific risk factors and transmission routes of Listeria monocytogenes in such cases.