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Listeria monocytogenes meningitis in previously healthy adults
1Department of Medicine and Infectious Diseases, General Hospital, Middlesbrough, Cleveland, UK.
Abstract:
A retrospective study of four sporadic cases of Listeria monocytogenes meningitis is reported. Contrary to the conventional epidemiology these patients were adults who were not immuno-compromised. Although all four cases produced positive cerebrospinal fluid cultures, in three, listeria was not microscopically identified. Protein and glucose contents of cerebrospinal fluids were variable and all samples showed lymphocytic pleocytosis. All four had neutrophil leucocytosis in peripheral blood. The unwary may dismiss lymphocytic meningitis as being of 'viral' origin, thereby making an important diagnostic misjudgement of vital therapeutic importance. Intravenous ampicillin is the drug of first choice for treatment of listeria meningitis; third generation cephalosporins are ineffective.
Insights
This study highlights that non-immuno-compromised adults can develop Listeria monocytogenes meningitis. Early diagnosis is crucial, as symptoms can mimic viral meningitis, and prompt treatment with intravenous ampicillin is essential.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Listeria monocytogenes meningitis typically affects immuno-compromised individuals and neonates.
- The diagnosis can be challenging due to non-specific cerebrospinal fluid findings.
Observation:
- A retrospective analysis of four sporadic cases of Listeria monocytogenes meningitis in adults.
- Patients were not immuno-compromised, deviating from established epidemiological patterns.
- Cerebrospinal fluid cultures were positive for Listeria, but microscopic identification was absent in most cases.
- Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with variable protein and glucose levels.
- Peripheral blood showed neutrophil leucocytosis in all patients.
Findings:
- Lymphocytic meningitis in adults may be misdiagnosed as viral meningitis.
- Microscopic examination of cerebrospinal fluid may not detect Listeria.
- Neutrophil leucocytosis in peripheral blood can be an indicator.
Implications:
- Clinicians must consider Listeria monocytogenes meningitis in non-immuno-compromised adults presenting with lymphocytic meningitis.
- Prompt diagnosis and treatment are critical to avoid therapeutic misjudgement.
- Intravenous ampicillin is the recommended first-line treatment for Listeria meningitis.
- Third-generation cephalosporins are ineffective against Listeria meningitis.