Community acquired Listeria monocytogenes meningitis in adults

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Author:
JIANG Xiu-guo(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
WANG Hui()
GU Ming(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
XU Jin(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
XU Sheng-yong(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
CHAI Jing-jing(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
YU Xue-zhong(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
XU Teng-da(Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)
Journal Title:
Chinese Journal of Emergency Medicine
Issue:
Volume 21, Issue 10, 2012
DOI:
10.3760/cma.j.issn.1671-0282.2012.10.018
Key Word:
Listeria monocytogenes; Acute community acquired bacterial meningitis; Clinical feature ; Adult ; Predisposing factor ; Empirical antimicrobial therapy, Ampicillin, China

Abstract: Objective To study risk factors associated with predisposition to Lm -ABM in adult patients and to evaluate the clinical features,management and out in this cohort of patients because Listeria monocytogenes (Lm) is the third most common cause of acute community acquired bacterial meningitis (Ac-ABM),after Streptococcus pneumoniae and Neisseria meningitides aetiologies.Methods A descriptive,prospective study carried out in a tertiary grade medical center emergency department in Beijing over a 10 -year period.During the study period,15 patients of Lm- ABM were included.Comparison of episodes of Lm - ABM versus other aetiologies was made.Results Fifteen episodes of Lm - ABM were identified in327 adult Ac - ABM patients.Three cohorts of individuals were vulnerable to Lm - ABM:the elderly ( RR=3.14; 95% CI 1.84-5.35),the immunocompromised (RR =3.34; 95% CI2.08-5.38),and pregnant women ( RR 12.48 ; 95% CI 3.29 ~ 47.39 ).The classic triad of fever,neck stiffness,and altered mental status was present in 40% (6 of 15) Lm - ABM patients.Similarly,40% patients had at least one of cerebrospinal fluid (CSF) samples with features met the criteria of typical bacterial meningitis.The coverage of empirical antimicrobial therapy was microbiologically inadequate for 13 ( 86.7% ) patients.The mortality rate was 33.3% (5 of 15),and 7 (46.7% ) of 15 patients led to an unfavorable outcome ( GOS < 4),both of which were significantly higher than those in other aetiologies of Ac - ABM ( P =0.015P =0.009 respectively). Conclusions Our study showed the elderly,the immunocompromised patients,and pregnant women predisposed to Ac - ABM most likely to be Listeria monocytogenes aetiology.In contrast with similar previous reports, the current study showed that patients with meningitis due to Listeria monocytogenes did not present with atypical clinical features.A high proportion of patients received empirical antimicrobial therapy that did not cover Listeria monocytogenes.Lm - ABM is still a serious disease that leads to high morbidity and mortality rates.With these important caveats in mind,our findings have implications for clinical practice and food safety policy makers.

  • [1]van de Beek D,de Gans J,Spanjaard L,et al.Clinical features and prognostic factors in adults with bacterial meningitis[J].N Engl J Med,2004,351 (18):1849-1859.
  • [2]Lorber B.Listeriosis[J].Clin Infect Dis,1997,24 (1):1-11.
  • [3]Amaya-Villar R,García-Cabrera E,Sulleiro-Igual E,et al.Three-year multicenter surveillance of communityacquired Listeria monocytogenes meningitis in adults[J].BMC Infect Dis,2010,10 (11):324-331.
  • [4]原英,陈民钧.血液中分离产单核细胞李斯特菌5株[J].中华检验医学杂志,2005,28 (10):1087.
  • [5]Spanos A,Harrell FE Jr,Durack DT.Differential diagnosis of acute bacterial meningitis:an analysis of the predictive value of initial observations[J].JAMA,1989,262 (19):2700-2707.
  • [6]Thigpen MC,Whitney CG,Schuchat A,et al,for the Emerging Infectious Program Network.Bacterial meningitis in the United States,1998-2007[J].N Engl J Med,2011,364 (21):2016-2025.
  • [7]Brouwer MC,van de Beek D,Heckenberg SG,et al.Community-Acquired Listeria onocytogenes Meningitis in Adults[J]. Clinic Infect Dis,2006,43 (10):1233-1238.
  • [8]Chau TT,Campbell JI,Schultsz C,et al.Three adult cases of Listeria monocytogenes meningitis in Vietnam [J]. PLoS Med.2010,7 (7):e1000306.
  • [9]Schlech WF,Ward JI,Band JD,et al.Bacterial meningitis in the United States, 1978 through 1981. The National Bacterial Meningitis Surveillance Study[J]. JAMA, 1985,253 (12):1749-1754.
  • [10]Mook P,O'Brien SJ,Gillespie IA.Concurrent conditions and human listeriosis,England,1999-2009[J].Emerg Infect Dis,2011,17 (1):38-43.
  • [11]Sigurdardottir B,Bjornsson OM,Jonsdottir KE,et al. Acute bacterial meningitis in adults:a 20-year overview[J].Arch Intern Med,1997,157 (4):425-430.
  • [12]Attia J, Hatala R, Cook DJ, et al. The rational clinical examination:does this adult patient have acute meningitis[J].JAMA,1999,282 (2):175-181.
  • [13]Coenraad MJ,Meinders AE,Taal JC,et al. Hyponatremia in intracranial disorders[J].Neth J Med,2001,58 (3):123-127.
  • [14]Rocourt J,BenEmbarek P,Toyofuku H,et al.Quantitative risk assessment of Listeria monocytogenes in ready-to-eat foods:the FAO/WHO approach[J]. FEMS Immunol Med Microbiol,2003,35 (3):263-267.
  • [15]Stavru F,Archambaud C,Cossart P.Cell biology and immunology of Listeria monocytogenes infections:novel insights[J].Immunol Rev,2011,240 (1):160-184.
  • [16]Orndorff PE,Hamrick TS,Smoak IW,et al.Host and bacterial factors in listeriosis pathogenesis[J].Vet Microbiol,2006,114(1/2):1-15.
  • [17]Lamont RF,Sobel J,Mazaki-Tovi S,et al.Listeriosis in human pregnancy:a systematic review[J].J Perinat Med,2011,39(3):227-236.
  • [18]Viale P,Furlanut M,Cristini F,et al.Major role of levofloxacin in the treatment of a case of Listeria monocytogenes meningitis[J].Diagn Microbiol Infect Dis,2007,58 (1):137-139.
  • [19]Beckham JD,Tyler KL; IDSA. Initial management of acute bacterial meningitis in adults:summary of IDSA guidelines[J].Rev Neurol Dis,2006,3 (2):57-60.
  • [20]de Gans J,van de Beek D.Dexamethasone in adults with bacterial meningitis[J].N Engl J Med,2002,347 (20):1549-1556.
  • [21]王苏平,赵耿义,王虹,等.脑脊液置换配合鞘内给药治疗化脓性脑膜炎[J].中华急诊医学杂志,2007,16 (1):54-56
  • [22]van de Beek D,de Gans J,McIntyre P,et al.Steroids in adults with acute bacterial meningitis:a systematic review[J].Lancet Infect Dis,2004,4 (3):139-143.
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