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Non-neonatal infection due to Listeria monocytogenes
Abstract:
In the period from 1969 through 1983, four cases of non-neonatal Listeria monocytogenes meningitis were encountered in Dallas, representing an incidence rate of 0.3%. Three cases occurring in immunocompetent patients are the subject of this report. A review of the literature since 1945 produced 87 cases of Listeria infections in patients who were from 2 months to 20 years of age. Of these, 54% occurred in immunocompetent persons. The case-fatality rate was 15% in the immunocompetent patients, compared with 42% in immunocompromised patients and with 35% in patients with other underlying illnesses. The diagnosis of listeriosis causes concern about the possibility of an underlying occult malignancy or disorder of T cell function, but on the basis of our review these underlying abnormalities are usually clinically apparent at the time of infection. A rational approach to the child with Listeria infection, who is not known to be a compromised host, would be to examine the history and patient carefully to consider documenting normal numbers of T lymphocytes and assessing delayed hypersensitivity by skin testing.
Insights
Listeria monocytogenes meningitis in children, particularly those without known immune issues, is rare but serious. Early diagnosis and assessment of immune function are crucial for better outcomes in Listeria infections.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Immunology
Background:
- Listeria monocytogenes meningitis is a rare but severe infection, particularly in non-neonatal pediatric populations.
- Understanding the epidemiology and clinical presentation in immunocompetent children is essential for timely diagnosis and management.
Observation:
- A review identified 87 pediatric cases of Listeria infections since 1945, with 54% occurring in immunocompetent individuals.
- The case-fatality rate for Listeria infections was significantly lower in immunocompetent patients (15%) compared to immunocompromised (42%) or those with other underlying illnesses (35%).
Findings:
- Non-neonatal Listeria monocytogenes meningitis incidence was 0.3% in Dallas between 1969-1983.
- Infections in immunocompetent children, while less fatal, still warrant careful evaluation for potential underlying, though usually apparent, immune deficiencies or malignancies.
Implications:
- Diagnosis of Listeria infection in children should prompt a thorough clinical evaluation, including assessment of T lymphocyte numbers and delayed hypersensitivity skin testing, even in seemingly immunocompetent hosts.
- This approach aids in identifying potential occult disorders and guides appropriate patient management strategies for Listeria infections.