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Published on: October 2, 2018
Listeria monocytogenes peritonitis: presentation, clinical features, treatment, and outcome
George D Liatsos1, Spyridon Thanellas, Maria Pirounaki
12nd Department of Internal Medicine, General Hospital of Athens G. Gennimatas, Athens, Greece. geoliatsos@yahoo.gr
Background:
Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients. Gram (-) (E. coli, Klebsiella pneumoniae), and Gram (+) (Streptococci, Staphylococci) bacteria are most frequently cultured from patients'ascites. Listeria monocytogenes (Lm) is scarcely reported as a causative agent.
Objective:
Our objective is to describe Lm peritonitis as a clinical entity, including its presentation, clinical features, treatment, and the potential factors that might affect survival outcome.
Data Sources:
MEDLINE, Scholar.Google, Scopus databases, including English, Spanish, French, and German language papers published between 1966 and June 2011, and reference lists.
Data Extraction:
investigators abstracted details about medical history, disease presentation, laboratory data, treatment and outcome.
Data Synthesis:
One-hundred and twenty-eight cases with known survival outcome--eighty-six cirrhotics, seventeen individuals undergoing continuous ambulatory peritoneal dialysis and another twenty-five with other or no underline condition were reviewed. An additional number of twenty-five cases with unknown outcome were searched in Listeria studies published from 1990 to 2009 and were only used for calculating worldwide distribution.
Conclusion:
Cirrhotics, mostly alcoholics, presented with fever and abdominal pain. Those who succumbed had significantly higher peripheral WBC count (15622 vs. 8155 cells/mm(3), p = 0.01) and (%) polymorphonuclear cells in differential count (83.3 vs. 71%, p = 0.001). Higher mortality was experienced in those with comorbidities, and those who presented with encephalopathy. Lower mortality was experienced in patients on continuous ambulatory peritoneal dialysis. Ascites was neutrocytic in 86% of the samples. In the sum of the cases mortality was 27.3%, with significantly highest rates in the elderly, in patients with bacteremia, immunosuppression, hematological malignancies, and lowest rates in those who presented with abdominal pain and in diabetics (type I or II). The latter observation was surprising and could be considered a single fortuitous fact. Initial appropriate treatment was associated with significantly better outcome (p = 0.002) than inappropriate; combination therapy with an aminoglycoside was superior to monotherapy (p = 0.038).
Insights
Listeria monocytogenes peritonitis is a rare but serious infection in cirrhotic patients, often presenting with fever and abdominal pain. Appropriate antibiotic treatment and management of comorbidities significantly improve survival outcomes.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Spontaneous bacterial peritonitis (SBP) is a frequent complication in patients with cirrhosis.
- Common causative agents include Gram-negative and Gram-positive bacteria.
- Listeria monocytogenes (Lm) is an infrequently reported cause of peritonitis in this population.
Purpose of the Study:
- To characterize Listeria monocytogenes peritonitis as a distinct clinical entity.
- To elucidate its presentation, clinical features, and treatment strategies.
- To identify factors influencing patient survival outcomes.
Main Methods:
- Comprehensive literature search of MEDLINE, Scholar.Google, and Scopus databases (1966-2011).
- Inclusion of English, Spanish, French, and German language publications.
- Systematic abstraction of patient data including medical history, presentation, laboratory results, treatment, and outcomes.
Main Results:
- Reviewed 128 cases with known outcomes; 86 cirrhotic, 17 on continuous ambulatory peritoneal dialysis (CAPD), and 25 with other conditions.
- Cirrhotic patients typically presented with fever and abdominal pain; higher WBC and polymorphonuclear cell counts correlated with mortality.
- Factors associated with increased mortality included comorbidities and encephalopathy; CAPD patients had lower mortality. Overall mortality was 27.3%.
Conclusions:
- Listeria monocytogenes peritonitis requires prompt and appropriate treatment, with combination therapy including aminoglycosides showing superiority.
- Patient comorbidities, age, and presence of bacteremia significantly impact survival.
- Early, effective treatment is crucial for improving outcomes in Listeria monocytogenes peritonitis.
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