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Listeria monocytogenes Infection of the Brain
Published on: October 2, 2018
Rhombencephalitis in Pregnancy-A Challenging Case of Probable Listeria Infection
Alison E P Ho1,2, Zahirrah B M Rasheed3,4, James Norman1
1St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
Abstract:
Rhombencephalitis refers to inflammation of the brainstem and cerebellum, and can be caused by infections, autoimmune disorders or paraneoplastic syndromes. The most common infective cause is the bacterium Listeria monocytogenes. Listeria monocytogenes is the predominant species to cause human listeriosis, and is commonly due to the ingestion of contaminated foods. Symptoms include a mild gastroenteritis, fever (often with extreme temperature variations), headache, and myalgia. In more severe cases, invasive disease may lead to bacteraemia and neurolisteriosis. Pregnant women are more susceptible to listeriosis, which is believed to be due to pregnancy-related immune modulation. Maternal-neonatal infection with adverse pregnancy outcomes include neonatal listeriosis, spontaneous miscarriage and intrauterine fetal demise. Diagnosis may be challenging due to initial nonspecific symptoms and low sensitivity and specificity of confirmatory diagnostic laboratory tests. Here, we describe a case of rhombencephalitis in pregnancy, attributed to Listeria, and review the clinical features, diagnosis and multidisciplinary management. Lastly, we describe the immunological response to Listeria monocytogenes and show in vitro pro-inflammatory effects of Listeria monocytogenes on peripheral blood mononuclear cells and placental explants.
Insights
Rhombencephalitis, an inflammation of the brainstem and cerebellum, is often caused by Listeria monocytogenes. This case highlights Listeria rhombencephalitis in pregnancy and its immunological effects.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
- Obstetrics
Background:
- Rhombencephalitis is inflammation of the brainstem and cerebellum, with Listeria monocytogenes being the most common infectious etiology.
- Listeriosis, caused by Listeria monocytogenes, typically results from consuming contaminated food and can lead to severe neurological complications, particularly in pregnant women.
- Pregnancy-associated immune modulation increases susceptibility to listeriosis, posing risks for both maternal and fetal health, including miscarriage and intrauterine fetal demise.
Observation:
- A case of rhombencephalitis during pregnancy attributed to Listeria infection is presented.
- The study reviews the clinical presentation, diagnostic challenges, and multidisciplinary management strategies for Listeria rhombencephalitis in pregnancy.
- In vitro experiments demonstrate the pro-inflammatory effects of Listeria monocytogenes on peripheral blood mononuclear cells and placental explants.
Findings:
- Listeria monocytogenes is identified as a significant cause of rhombencephalitis, especially in pregnant individuals.
- The diagnosis of Listeria rhombencephalitis can be complicated by nonspecific initial symptoms and limitations in laboratory diagnostic tests.
- Listeria monocytogenes induces pro-inflammatory responses in human immune cells and placental tissues.
Implications:
- This study underscores the importance of considering Listeria monocytogenes in the differential diagnosis of rhombencephalitis, particularly in pregnant patients.
- Understanding the immunological mechanisms of Listeria monocytogenes infection can inform the development of targeted diagnostic and therapeutic interventions.
- Effective multidisciplinary management is crucial for improving outcomes in cases of rhombencephalitis during pregnancy.
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