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Infection of the brainstem by Listeria monocytogenes
Abstract:
A case of brainstem infection by Listeria monocytogenes is described. The patient was a 63 year old man previously in good health and his illness did not follow the usual bi-phasic pattern. There was no prodromal phase, and the progressive brainstem signs with a lymphocytosis and a normal sugar level in the CSF led to a tentative diagnosis of viral brainstem encephalitis. Ampicillin was begun only when signs of pulmonary infection developed. Clinical diagnosis is difficult but ampicillin should probably be used in any doubtful case in which a "viral" brainstem encephalitis is being considered.
Insights
This case study highlights a rare brainstem infection caused by Listeria monocytogenes in an otherwise healthy adult. Early ampicillin treatment is recommended for suspected viral brainstem encephalitis due to diagnostic challenges.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Listeria monocytogenes can cause serious infections, including central nervous system involvement.
- Brainstem encephalitis is often presumed to be viral, complicating diagnosis of bacterial etiologies.
Observation:
- A 63-year-old man presented with progressive brainstem signs, CSF lymphocytosis, and normal glucose, mimicking viral encephalitis.
- The illness lacked the typical biphasic pattern and prodromal phase associated with Listeria infections.
Findings:
- The patient was diagnosed with Listeria monocytogenes brainstem infection.
- Delayed antibiotic treatment with ampicillin was initiated only after pulmonary infection signs emerged.
Implications:
- Clinical diagnosis of Listeria brainstem infection can be challenging, especially without typical presentation.
- Empirical ampicillin use is advised in suspected "viral" brainstem encephalitis cases to cover potential Listeria infections.