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Listeria monocytogenes Infection of the Brain
Published on: October 2, 2018
Listeria monocytogenes bacteremia in a centenarian and pathogen traceability: A case report
Zhong-Ying Zhang1, Xiao-Ai Zhang2, Qian Chen2
1Department of Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. univadiszzy@163.com.
Background:
Early diagnosis and appropriate antibiotic treatment are important to survival of Listeria monocytogenes (L. monocytogenes) bacteremia. Penicillin tends to be the most commonly used antibiotic. However, there are limited data on antibiotic use in elderly patients with serious complications. We describe the clinical presentation, antibiotic therapy, and traceability of L. monocytogenes in a centenarian with a history of eating frozen food.
Case Summary:
A 102-year-old man suffered from high fever with chill after hematochezia. Tentative diagnoses were lower gastrointestinal hemorrhage and localized peritonitis. Meropenem and ornidazole were the empirical therapy. The patient did not respond and developed multiple system dysfunction even after teicoplanin was added to the therapy. L. monocytogenes was identified from blood cultures on day 5 of admission. The patient had a history of consuming frozen dumplings. Meropenem/ornidazole/teicoplanin were replaced with meropenem/linezolid. The patient gradually became afebrile. He received meropenem/linezolid for 10 d, and piperacillin/tazobactam was applied as step-down treatment for 2 wk with good clinical results. There was no sign of relapse during follow-up after discharge. L. monocytogenes isolates from the patient and frozen dumplings belonged to different serotypes and sequence types (STs): 1/2b and ST5 from the patient and 1/2c and ST9 from the dumplings.
Conclusion:
More awareness of listeriosis should be raised. Linezolid might be an option for listeriosis in elderly people with serious complications.
Insights
Listeriosis in the elderly is serious. Linezolid may be an effective treatment for complicated Listeria monocytogenes infections in older adults, offering a potential alternative to standard therapies.
Area of Science:
- Infectious Diseases
- Geriatrics
- Antimicrobial Therapy
Background:
- Listeria monocytogenes (L. monocytogenes) bacteremia requires prompt diagnosis and antibiotic treatment for survival.
- Penicillin is a common antibiotic, but data on its use in elderly patients with severe complications are limited.
- This case highlights L. monocytogenes in a centenarian with a history of consuming frozen food.
Observation:
- A 102-year-old male presented with fever, chills, and hematochezia, initially suspected as gastrointestinal hemorrhage and peritonitis.
- Empirical treatment with meropenem and ornidazole, later supplemented with teicoplanin, was ineffective, leading to multiple system dysfunction.
- L. monocytogenes was identified on day 5, with isolates differing in serotype and sequence type from consumed frozen dumplings.
Findings:
- Switching to meropenem/linezolid resulted in gradual defervescence and clinical improvement.
- The patient completed 10 days of meropenem/linezolid followed by 2 weeks of piperacillin/tazobactam without relapse.
- L. monocytogenes isolates from the patient (1/2b, ST5) and dumplings (1/2c, ST9) were distinct.
Implications:
- Increased awareness of listeriosis, particularly in vulnerable elderly populations, is crucial.
- Linezolid presents a potential therapeutic option for severe listeriosis in elderly individuals.
- Distinguishing sources of infection is important, as foodborne pathogens may exhibit diverse strains.
