Clinical characteristics and next generation sequencing of three cases of <italic>Listeria monocytogenes</italic> meningitis with complications

Muhan LI; Yongjun LI; Bing HU; Lingyun Guo; Xin Guo; Hongzhi Guan; Jianzhao Zhang; Gang Liu

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Clinical characteristics and next generation sequencing of three cases of Listeria monocytogenes meningitis with complications

VernacularTitle: 有并发症的产单核细胞李斯特菌脑膜炎三例临床特点与二代测序结果分析
Author: Muhan LI ¹ ; Yongjun LI ² ; Bing HU ¹ ; Lingyun GUO ¹ ; Xin GUO ¹ ; Hongzhi GUAN ³ ; Jianzhao ZHANG ⁴ ; Gang LIU ¹
Author Information

1. Department of Infectious Diseases, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
2. Shenzhen Huada Gene Research Institute, Shenzhen 518083, China
3. Department of Neurology, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100730, China
4. Department of Neurology, Children′s Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
Publication Type:Journal Article
Keywords: Child; Meningitis, Listeria; Next generation sequencing technology
From: Chinese Journal of Pediatrics 2019;57(8):603-607
CountryChina
Language:Chinese
Abstract: Objective:To summarize the clinical characteristics of Listeria monocytogenes meningitis (LMM) with complications, and analyze the outcomes of next generation sequencing.
Methods:Clinical characteristics, laboratory findings, imaging features, antibiotics treatment, and next generation sequencing of cerebrospinal fluid were analyzed in 3 LMM patients who were hospitalized in the Department of Infectious Diseases of Beijing Children′s Hospital Affiliated to Capital Medical University from July 2015 to November 2017.
Results:The three patients were 1-year-old girl, 2-year-old girl, and 9-year-old boy, with normal immune function. They had eaten refrigerated food, milk or dairy products before onset. Symptoms included fever, headache, abdominal pain, diarrhea, vomiting, and convulsions, etc. The complications of two cases (case 2 and 3) were appendicitis and Meckel′s diverticulitis. The other one (case 1) was with sepsis and pneumonia. Leukocyte counts in cerebrospinal fluid were elevated in all the three cases, and cranial magnetic resonance imaging showed meningeal or periventricular involvement. All the children were diagnosed with LMM by positive CSF culture. CSF for next generation sequencing was sent after carbapenem antibiotics using, yet all the results were positive. The positive results were returned 2, 9, and 9 days earlier than culture results, respectively. The gene coverage was 5.00%, 7.00%, 0.04%, and the reads was 2 561, 1 011 and 8, respectively. All the three children had recurrent fever despite using cephalosporin. Levels of leukocytes in the blood and CSF further elevated. After using carbapenem antibiotics, patients improved eventually and were discharged from hospital.
Conclusions:LMM can occur in children with normal immune function and is usually associated with digestive system symptoms. Listeria monocytogenes can be detected quickly and accurately by the next generation sequencing technology, without being limited to sampling time and antibiotics application.