RESUMO
Introducción: La meningitis por Listeria monocytogenes (MLM) es una entidad grave con complicaciones a corto plazo. La reacción de polimerasa en cadena (RPC) puede ayudar a mejorar su diagnóstico y pronóstico. Objetivos: Conocer las características de los pacientes diagnosticados de meningitis por L. monocytogenes en los últimos años, a través de diferentes métodos microbiológicos. Pacientes y Métodos: Serie de casos de pacientes adultos ingresados con MLM en el Hospital Clínico San Carlos, Madrid, España, durante doce años (2009-2021). Se describieron variables epidemiológicas, clínicas, microbiológicas, radiológicas y terapéuticas. Resultados: Se registraron doce pacientes con MLM (edad media 67,5 años, 75% varones). En ocho se obtuvo un cultivo positivo a L. monocytogenes. La RPC en líquido cefalorraquídeo (LCR) fue positiva en los dos casos en los que se realizó la prueba. El tratamiento dirigido en todos los casos fue ampicilina durante 21 días. Se registraron complicaciones en un cuarto de los casos. Del total de pacientes uno falleció. Conclusiones: La MLM es una enfermedad poco frecuente y de difícil diagnóstico. En nuestra serie de casos los dos pacientes diagnosticados por RPC tuvieron resultado de cultivo de LCR negativo, y presentaron buena evolución. La determinación de RPC podría permitir diagnosticar un mayor número de casos y con mayor precocidad.
Background: Listeria monocytogenes meningitis (LMM) is a serious entity with short-term complications. Polymerase chain reaction (PCR) can help to improve its diagnosis and prognosis. Aim: To know the characteristics of patients diagnosed with meningitis by L. monocytogenes in recent years, through different microbiological methods. Methods: Case series of adult patients admitted with LMM at the Hospital Clínico San Carlos of Madrid, Spain, during twelve years (2009-2021). Epidemiological, clinical, microbiological, radiological and therapeutic variables were described. Results: Twelve patients with LMM were recorded (mean age 67.5 years, 75% male). Eight had a positive culture for L. monocytogenes. cerebrospinal fluid (CSF) PCR was positive in the two cases in which the test was performed. Treatment in all cases was ampicillin for 21 days. Complications were recorded in a quarter of the cases. One patient died. Conclusions: LMM is a rare and difficult to diagnose disease. In our series of cases, the two patients diagnosed by PCR had negative CSF culture results, and presented good evolution. PCR determination could allow a greater number of cases to be diagnosed earlier.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Meningite por Listeria/diagnóstico , Meningite por Listeria/epidemiologia , Líquido Cefalorraquidiano/microbiologia , Reação em Cadeia da Polimerase , Hospitais Universitários/estatística & dados numéricos , Listeria monocytogenes/isolamento & purificação , Meningite por Listeria/microbiologia , Meningite por Listeria/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Resumen Listeria monocytogenes es una bacteria grampositiva, considerada oportunista, que produce enfermedad en huéspedes susceptibles y excepcionalmente en pacientes inmunocompetentes. Se incluye dentro de las enfermedades trasmitidas por alimentos (ETA). Su importancia radica en la dificultad diagnóstica, la alta mortalidad pese a la sensibilidad de la bacteria a la ampicilina, y a las medidas de prevención que pueden evitar la transmisión al hombre. Presentamos el caso clínico de una niña de 9 años previamente sana que cursó una infección grave y de evolución fatal.
Summary Listeria monocytogenes is a gram-positive opportunistic bacteria that can cause a disease in vulnerable hosts and exceptionally, in immunocompetent patients. The infection caused by it is included in the foodborne diseases group. The condition is relevant given its diagnostic difficulties and its high mortality, in spite of it being sensitive to ampicillin and the prophylactic measures defined to avoid it being transmitted to humans. The study presents the case of a previously healthy 9 year old girl, who suffered a severe infection and died.
Assuntos
Humanos , Meningite por Listeria/diagnóstico , Doença Catastrófica , Doenças Transmitidas por Alimentos , Meningite por ListeriaRESUMO
Listeria monocytogenes es una bacteria grampositiva, considerada oportunista, que produce enfermedad en huéspedes susceptibles y excepcionalmente en pacientes inmunocompetentes. Se incluye dentro de las enfermedades trasmitidas por alimentos (ETA). Su importancia radica en la dificultad diagnóstica, la alta mortalidad pese a la sensibilidad de la bacteria a la ampicilina, y a las medidas de prevención que pueden evitar la transmisión al hombre. Presentamos el caso clínico de una niña de 9 años previamente sana que cursó una infección grave y de evolución fatal.
Assuntos
Humanos , Feminino , Criança , Meningite por Listeria/diagnóstico , Doenças Transmitidas por Alimentos , Doença Catastrófica , Meningite por Listeria/tratamento farmacológicoRESUMO
Listeria monocytogenes (L. monocytogenes) is an uncommon cause of bacterial meningitis in immunocompetent adults. Patients with immunosuppression are at increased risk of developing serious invasive diseases, particularly meningitis. We describe a case of meningitis caused by L. monocytogenes in an immunocompetent and previously healthy 34-year-old adult. The patient received treatment with intravenous ampicillin plus amikacin and made a full recovery. L. monocytogenes should be suspected in immunocompetent adults with bacterial meningitis who fail to respond to empirical antibiotic treatment.
Assuntos
Amicacina/uso terapêutico , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Meningite por Listeria/diagnóstico , Adulto , Quimioterapia Combinada , Humanos , Imunocompetência , Masculino , Meningite por Listeria/tratamento farmacológicoRESUMO
Listeria monocytogenes (L. monocytogenes) is an uncommon cause of bacterial meningitis in immunocompetent adults. Patients with immunosuppression are at increased risk of developing serious invasive diseases, particularly meningitis. We describe a case of meningitis caused by L. monocytogenes in an immunocompetent and previously healthy 34-year-old adult. The patient received treatment with intravenous ampicillin plus amikacin and made a full recovery. L. monocytogenes should be suspected in immunocompetent adults with bacterial meningitis who fail to respond to empirical antibiotic treatment.
Listeria monocytogenes (L. monocytogenes) é uma causa rara de meningite bacteriana em adultos imunocompetentes. Pacientes com imunossupressão têm maior risco de desenvolver graves doenças invasivas, especialmente a meningite. Descrevemos um caso de meningite por L. monocytogenes em um adulto imunocompetente e previamente sadio com idade de 34 anos. O paciente recebeu tratamento com ampicilina intravenosa mais amicacina e fez uma recuperação completa. L. monocytogenes deve ser suspeitada em imunocompetentes adultos com meningite bacteriana que não respondem ao tratamento antibiótico empírico.
Assuntos
Adulto , Humanos , Masculino , Amicacina/uso terapêutico , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Meningite por Listeria/diagnóstico , Quimioterapia Combinada , Imunocompetência , Meningite por Listeria/tratamento farmacológicoRESUMO
BACKGROUND: Improved diagnostic tests would aid in diagnosing and treating community-acquired meningitis. OBJECTIVE: To analyze the diagnostic value of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) of patients presenting with symptoms of acute meningitis. MATERIAL AND METHODS: In a 6-month prospective, observational, cross-sectional emergency department (ED) study, serum and CSF samples were obtained from all patients with a headache and fever in whom the physician suspected meningitis. Patients were excluded if computed tomography findings contraindicated a lumbar puncture, if they had bleeding disorders, or if their serum indicated bleeding. IL-6 levels were measured and compared in patients with (Group A) and without (Group B) bacterial meningitis. RESULTS: Samples were obtained from 53 patients, of whom 40 were ultimately found to have meningitis. These 40 patients averaged 49.6 ± 21.9 years, with number of men 18 (45%), hospitalizations 21 (52%), mortality 3 (.07%), and IL-6 average rating 491 (median: 14.5; range 0000-6000). Findings in the two groups were: Group A (with meningitis): n = 13, average IL-6 level: 1495 (median: 604; 25/75 percentiles: 232.5-2030; 95% confidence interval [CI] 371.7-2618.6; range 64-6000). Group B (with aseptic meningitis): n = 27, average IL-6 level: 7.34 (median: 5; 25/75 percentiles: 0.0/15.1; 95% CI 3.94-10.73; range 0-23.6). Mann-Whitney rank sum test: p < 0.0001. CONCLUSIONS: In patients with acute bacterial meningitis, CSF cytokine concentrations are elevated. Measuring CSF inflammatory cytokine levels in patients with acute meningitis could be a valuable ED diagnostic tool. Using this tool could improve the prognosis of patients with bacterial meningitis by allowing more rapid initiation of antibiotic treatment.
Assuntos
Interleucina-6/líquido cefalorraquidiano , Meningite Asséptica/líquido cefalorraquidiano , Meningite Asséptica/diagnóstico , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Febre/etiologia , Cefaleia/etiologia , Hospitalização , Humanos , Masculino , Meningite por Haemophilus/líquido cefalorraquidiano , Meningite por Haemophilus/diagnóstico , Meningite por Listeria/líquido cefalorraquidiano , Meningite por Listeria/diagnóstico , Meningite Meningocócica/líquido cefalorraquidiano , Meningite Meningocócica/diagnóstico , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/diagnóstico , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Estatísticas não Paramétricas , Adulto JovemRESUMO
São descritos sete casos de doença neurológica em ovinos por Listeria monocytogenes no Rio Grande do Sul e Paraná entre 2000 e 2007. Foram afetados ovinos com idades entre 12-24 meses. Os casos ocorreram no verão e início da primavera e os índices gerais de morbidade e letalidade foram de 3,15 por cento e 100 por cento, respectivamente. Quando essa informação estava disponível, nenhum dos ovinos afetados era alimentado com silagem. Em três propriedades havia contato próximo dos ovinos afetados com outras espécies. A evolução do quadro clínico foi de 12 horas a três dias e os sinais clínicos foram caracterizados por decúbito (7/7), desvio da cabeça (4/7), incoordenação (3/7), depressão (3/7), andar em círculos (2/7), cegueira unilateral, emagrecimento progressivo, febre, midríase, movimentos de pedalagem, nistagmo lateral, opistótono, paralisia flácida dos membros pélvicos ou dos quatro membros, salivação excessiva e tremores (1/7 cada). Histologicamente observou-se encefalite com microabscessos, predominantemente unilateral com variáveis graus de gliose e alterações degenerativas como esferóides axonais e infiltração de células Gitter. As lesões se estendiam desde a medula oblonga até o mesencéfalo. Antígenos de Listeria monocytogenes foram detectados por imuno-histoquímica em seções de tronco encefálico de todos os ovinos afetados. O diagnóstico foi realizado com base nos achados epidemiológicos e clinico-patológicos, e confirmado pela imuno-histoquímica (IHQ) utilizando anticorpo policlonal anti-L. monocytogenes.
Seven cases of neurological disease in sheep caused by Listeria monocytogenes in Rio Grande do Sul and Paraná state, southern Brazil are described. The cases occurred between 2000 and 2007 and 12-24-month-old sheep were affected. Overall morbidity and lethality rates were 3.15 percent and 100 percent, respectively. Cases occurred in the summer and early spring. When this information was available, affected sheep had not been fed with silage. In three farms there were close contact among affected sheep and other species. Clinical signs were characterized by recumbency (7/7), head tilt (4/7), incoordination (3/7), depression (3/7), circling (2/7), unilateral blindness, wasting, fever, midriasis, paddling, opisthotonus, hind or hind and fore limb paralysis, drooling, and muscle tremors (1/7 each). Clinical evolution varied from 12 hours to three days. Histological findings consisted of predominantly unilateral, microabscedative encephalitis with variable degrees of gliosis and degenerative lesions characterized by axonal spheroids and infiltration by Gitter cells. These lesions were observed extending from medulla oblongata to mesencephalon. Listeria monocytogenes antigen was showed by imunohistochemistry in routinely processed sections of brainstem from all seven affected sheep. The diagnostic was based on epidemiological, clinical, and pathological findings and confirmed by immunohistochemistry (IHQ) using polyclonal anti-L. monocytogenes antibody.
Assuntos
Animais , Listeriose/patologia , Listeriose/veterinária , Meningite por Listeria/diagnóstico , Meningite por Listeria/fisiopatologia , Imuno-Histoquímica , Listeria monocytogenes , OvinosRESUMO
São descritos sete casos de doença neurológica em ovinos por Listeria monocytogenes no Rio Grande do Sul e Paraná entre 2000 e 2007. Foram afetados ovinos com idades entre 12-24 meses. Os casos ocorreram no verão e início da primavera e os índices gerais de morbidade e letalidade foram de 3,15% e 100%, respectivamente. Quando essa informação estava disponível, nenhum dos ovinos afetados era alimentado com silagem. Em três propriedades havia contato próximo dos ovinos afetados com outras espécies. A evolução do quadro clínico foi de 12 horas a três dias e os sinais clínicos foram caracterizados por decúbito (7/7), desvio da cabeça (4/7), incoordenação (3/7), depressão (3/7), andar em círculos (2/7), cegueira unilateral, emagrecimento progressivo, febre, midríase, movimentos de pedalagem, nistagmo lateral, opistótono, paralisia flácida dos membros pélvicos ou dos quatro membros, salivação excessiva e tremores (1/7 cada). Histologicamente observou-se encefalite com microabscessos, predominantemente unilateral com variáveis graus de gliose e alterações degenerativas como esferóides axonais e infiltração de células Gitter. As lesões se estendiam desde a medula oblonga até o mesencéfalo. Antígenos de Listeria monocytogenes foram detectados por imuno-histoquímica em seções de tronco encefálico de todos os ovinos afetados. O diagnóstico foi realizado com base nos achados epidemiológicos e clinico-patológicos, e confirmado pela imuno-histoquímica (IHQ) utilizando anticorpo policlonal anti-L. monocytogenes.(AU)
Seven cases of neurological disease in sheep caused by Listeria monocytogenes in Rio Grande do Sul and Paraná state, southern Brazil are described. The cases occurred between 2000 and 2007 and 12-24-month-old sheep were affected. Overall morbidity and lethality rates were 3.15% and 100%, respectively. Cases occurred in the summer and early spring. When this information was available, affected sheep had not been fed with silage. In three farms there were close contact among affected sheep and other species. Clinical signs were characterized by recumbency (7/7), head tilt (4/7), incoordination (3/7), depression (3/7), circling (2/7), unilateral blindness, wasting, fever, midriasis, paddling, opisthotonus, hind or hind and fore limb paralysis, drooling, and muscle tremors (1/7 each). Clinical evolution varied from 12 hours to three days. Histological findings consisted of predominantly unilateral, microabscedative encephalitis with variable degrees of gliosis and degenerative lesions characterized by axonal spheroids and infiltration by Gitter cells. These lesions were observed extending from medulla oblongata to mesencephalon. Listeria monocytogenes antigen was showed by imunohistochemistry in routinely processed sections of brainstem from all seven affected sheep. The diagnostic was based on epidemiological, clinical, and pathological findings and confirmed by immunohistochemistry (IHQ) using polyclonal anti-L. monocytogenes antibody.(AU)
Assuntos
Animais , Meningite por Listeria/diagnóstico , Meningite por Listeria/fisiopatologia , Listeriose/patologia , Listeriose/veterinária , Listeria monocytogenes , Ovinos , Imuno-Histoquímica/veterináriaRESUMO
Listeria Monocytogenes is a gram-positive Bacillus that affects immunocompromised patients, newborn, pregnant women and persons over 65 years. Infection is acquired through contaminated food. The Bacillus has predilection for the central nervous system. Its presents most commonly as an acute meningitis, it also presents as a chronic meningitis, cerebritis, rhomboencephalitis, brain and spinal abscess. Diagnosis for L. monocytogenes is made through positive cultures in blood and cerebrospinal fluid (CSF). Magnetic Resonance (MR) also helps to in the diagnosis of neurolisteriosis lesions. We described seven cases with L. Monocytogenes infection during 2007 and 2008, with four cases over the aged of 65 years old. Five presented acute meningitis; two rhomboencephalitis and one patient had meningoencephalitis. Six cases showed inflammatory CSF with pleocytosis with polymorphonuclear prevail and normal glycorrachia. MR showed inflammatory findings in five patients and focal brainstem lesions in two cases, one had acute hydrocephalus due arachnoiditis. Five patients improve clinically and two fatal cases were described. Listeriosis is the third cause of meningitis and should be consider in the differential diagnosis of meningitis with clear fluid, especially with pleocytosis and normal glycorrachia. Other clues of the diagnosis are dizziness with or without nystagmus and brainstem compromise. Arachnoiditis should be avoided with steroidal use. The diagnostic imaging test of choice for brain stem compromise is MR.
La Listeria Monocytogenes es un bacilo Gram-positivo que afecta a pacientes inmunocomprometidos, a niños, embarazadas y personas mayores de 65 años. El modo de adquirirla es la ingestión de alimentos contaminados. El bacilo tiene predilección por el sistema nervioso central, donde su expresión más frecuente es la meningitis aguda, también puede presentarse como meningitis crónica, cerebritis, rombencefalitis, abscesos cerebrales y espinales. El cultivos positivos de L. monocytogenes en muestras de sangre o líquido cefalorraquídeo, permite confirmar el diagnóstico. La Resonancia Magnética de cerebro también contribuye al diagnóstico de las lesiones por neurolisteriosis. Se analizan siete casos de neurolisteriosis ocurridos los a±os 2007 y 2008, entre ellos cuatro pacientes mayores de 65 años. La meningitis aguda fue la forma de presentación en cinco de ellos, dos evolucionaron como rombencefalitis y uno como meningoencefalitis. El LCR fue inflamatorio en seis de los pacientes, con pleocitosis depredominio polinuclear, pero glucorraquia normal. La RM mostró imágenes de aspecto inflamatorio en cinco de los enfermos, dos de ellos tenían lesiones focales del tronco cerebral, uno hizo un hidrocéfalo agudo por aracnoiditis. Cinco pacientes presentaron una evolución clínica favorable y dos fallecieron. Siendo la listeriosis la tercera causa etiológica de meningitis, debe ser considerada en el diagnóstico diferencial de meningitis a líquido claro, especialmente en LCR con abundantes polinucleares y glucosa en rangos normales. Otras claves son la sensación vertiginosa con o sin nistagmus y el compromiso de nervios craneales de origen protuberancial. Debe prevenirse las aracnoiditis con el uso precoz de corticoides. Es obligatorio el estudio con RM en toda sospecha de neurolisteriosis.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Pessoa de Meia-Idade , Meningite por Listeria/diagnóstico , Meningite por Listeria/etiologia , Meningite por Listeria/tratamento farmacológico , Doença Aguda , Antibacterianos/uso terapêutico , Evolução Clínica , Líquido Cefalorraquidiano/microbiologiaAssuntos
Humanos , Masculino , Gravidez , Recém-Nascido , Feminino , Listeria monocytogenes/patogenicidade , Meningite por Listeria/diagnóstico , Complicações Infecciosas na Gravidez , Transmissão de Doença Infecciosa , Líquido Cefalorraquidiano/microbiologia , Listeria monocytogenes/isolamento & purificação , Listeria monocytogenes/ultraestrutura , Listeriose/classificação , Listeriose/diagnóstico , Listeriose/fisiopatologia , Meningite por Listeria/líquido cefalorraquidiano , Meningite por Listeria/congênito , Meningite por Listeria/tratamento farmacológico , Sepse/diagnóstico , Sinais e SintomasRESUMO
OBJECTIVE: Patients with connective tissue diseases (CTD) are prone to infections, either from the disease itself or secondary to treatment. The incidence of listeriosis in immunosuppressed patients is increasing. We therefore evaluated the frequency of listeriosis, an otherwise rarely reported infection in the rheumatologic literature, in patients with CTD. METHODS: Retrospective analysis of listeria positive cultures in patients with CTD between 1982 and 1992 at a tertiary care center in Mexico City. RESULTS: We identified 8 patients: 7 with systemic lupus erythematosus and one with dermatomyositis. At the time of the infection, 5 had active disease, 6 were receiving prednisone and/or other immunosuppressive drugs and 2 were receiving hemodialysis. L. monocytogenes was isolated from cerebrospinal fluid (5 patients), from blood (one patient) and from both sites (2 patients). Patients had bacteremia without a known focus of infection or meningitis as the 2 most common clinical forms of listeriosis. In spite of appropriate antibiotic therapy, 4 patients died. CONCLUSION: As in other immunosuppressed individuals, listeriosis is an aggressive infection in patients with CTD. Although rare, listeriosis should be included in the differential diagnosis of meningitis in patients with CTD and appropriate aggressive therapy rapidly instituted. To determine its frequency in rheumatic patients, multicentric prospective studies are required.
Assuntos
Doenças do Tecido Conjuntivo/complicações , Listeriose/complicações , Adulto , Idoso , Dermatomiosite/complicações , Feminino , Humanos , Listeriose/diagnóstico , Listeriose/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Meningite por Listeria/complicações , Meningite por Listeria/diagnóstico , Meningite por Listeria/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Estudos RetrospectivosRESUMO
Listeriosis is a not uncommon infection in humans, usually associated with immunodeficient states and with newborns. However, relatively few cases have been reported in HIV-infected patients. This scarcity of reported cases has aroused interest in the association of listeriosis and AIDS. In this paper we present a case of meningitis and septicemia caused by Listeria monocytogenes in a female patient with AIDS. A review of recent medical literature indicates that association of listeriosis and AIDS may be more common than it seems. Recent research in host-parasite interaction in listerial infection suggests an important role for tumor necrosis factor (TNF) and for integralin, a bacterial protein, in modulating listerial disease in AIDS patients. Inadequate diagnosis may be in part responsible for the scarcity of reports
Assuntos
Humanos , Feminino , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , HIV-1 , Meningite por Listeria/diagnóstico , Sepse/diagnóstico , Adulto , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Ampicilina/administração & dosagem , Diagnóstico Diferencial , Meningite por Listeria/tratamento farmacológico , Sepse/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
Listeriosis is a not uncommon infection in humans, usually associated with immunodeficient states and with newborns. However, relatively few cases have been reported in HIV-infected patients. This scarcity of reported cases has aroused interest in the association of listeriosis and AIDS. In this paper we present a case of meningitis and septicemia caused by Listeria monocytogenes in a female patient with AIDS. A review of recent medical literature indicates that association of listeriosis and AIDS may be more common than it seems. Recent research in host-parasite interaction in listerial infection suggests an important role for tumor necrosis factor (TNF) and for integralin, a bacterial protein, in modulating listerial disease in AIDS patients. Inadequate diagnosis may be in part responsible for the scarcity of reports.