Listeria encephalitis in five renal transplant recipients

Listeria encephalitis has occurred recently in 5 renal transplant recipients at the Transplantation Unit in Stockholm. Symptoms from the central nervous system, such as coma, hemiparesis and cranial nerve paresis, dominated the clinical picture. Listeria monocytogenes was isolated from the blood of all the patients, from the cerebrospinal fluid in two, from the urine in one and post mortem from the brain in one patient. Pleocytosis never exceeded 200 leucocytes/mm3 and the glucose ratio was normal or near normal. Complement fixation test for Listeria was negative in all 5 patients. Four patients expired in spite of treatment with large doses of penicillin and other antibiotics to which the isolated strains were sensitive in vitro. At autopsy, inflammation and necrosis were observed in the brain, especially the brain stem, and there was mild lymphocytic infiltration of the meninges. The surviving patient was treated with a combination of chloramphenicol and ampicillin.