BACKGROUND AND PURPOSE: Encephalitis caused by Listeria monocytogenes (L. monocytogenes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal fluid (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens. METHODS: This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis. RESULTS: Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocytogenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and sequenced reads corresponding to L. monocytogenes in all three cases. CONCLUSIONS: This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.
Central Nervous System ; Cerebrospinal Fluid ; Communicable Diseases ; Diagnosis ; Early Diagnosis ; Encephalitis ; Humans ; Listeria monocytogenes* ; Listeria* ; Magnetic Resonance Imaging ; Meningitis, Listeria ; Meningoencephalitis* ; Methods

Advances in neonatal intensive care have improved the chances for survival of extremely low birth weight (ELBW) infants. However, ELBW infants are at high risk of meningitis and resulting neurologic complications. The most common organisms associated with neonatal bacterial meningitis include Listeria monocytogenes, Escherichia coli, and Group B Streptococcus. Bacillus cereus (B. cereus), an organism commonly found in soil, vegetation, and daily products, can sometimes cause meningitis owing to preformed toxins. We report a rare case of meningoencephalitis caused by B. cereus that resulted in a detrimental neurological outcome in an ELBW infant.
Bacillus cereus* ; Escherichia coli ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Listeria monocytogenes ; Meningitis ; Meningitis, Bacterial ; Meningoencephalitis* ; Soil ; Streptococcus

Brain ; pathology ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Meningitis, Listeria ; diagnosis ; drug therapy

Listeria monocytogenes has been recognized as a pathogen in elderly and immunecompromised hosts with malignancies, alcohol abuse, diabetes mellitus, transplanted organs, liver cirrhosis, renal failure, or acquired immunodeficiency syndrome (AIDS). In adults, it usually presents as neuromeningeal infection, such as meningitis, meningoencephalitis, or encephalitis, or as primary bacteremia. Involvement of the liver with L. monocytogenes is uncommon. We report on a case of multiple liver abscesses and bacteremia associated with L. monocytogenes in a 67-year-old diabetic female with concomitant active multidrug-resistant pulmonary tuberculosis. Blood cultures were positive for L. monocytogenes. In patients with liver abscess with advanced age or who are immune-compromised, including those with diabetes, clinicians should consider Listeria infection as a differential diagnosis.
Acquired Immunodeficiency Syndrome ; Adult ; Aged ; Alcoholism ; Bacteremia ; Diabetes Mellitus ; Diagnosis, Differential ; Encephalitis ; Female ; Humans ; Listeria ; Listeria monocytogenes ; Listeriosis ; Liver ; Liver Abscess ; Liver Cirrhosis ; Meningitis ; Meningoencephalitis ; Renal Insufficiency ; Transplants ; Tuberculosis, Pulmonary

Listeria monocytogenes is a facultative anaerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria occurs predominantly in the elderly, immunocompromised patients, pregnant women and newborns. Infections by this microorganism are rare in healthy infants and children. L. monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in children. The course of meningoencephalitis by listeria is often severe and even fatal. Acute hydrocephalus can develop as a complication and the mortality associated with listeriosis is significantly high. We present a case of meningoencephalitis caused by L. monocytogenes in a previously healthy 7-year-old girl.
Aged ; Animals, Domestic ; Arthritis ; Bacillus ; Brain Abscess ; Child ; Female ; Humans ; Hydrocephalus ; Immunocompromised Host ; Infant ; Infant, Newborn ; Listeria ; Listeria monocytogenes ; Listeriosis ; Liver Abscess ; Meningitis ; Meningoencephalitis ; Osteomyelitis ; Pregnant Women ; Soil ; Vegetables

Listeria monocytogenes (L. monocytogenes) is a foodborne anaerobic gram-positive rod and the third most common pathogen for neonatal meningitis. Although the mortality and morbidity of L. monocytogenes infections are high, thus causing serious problems in Western populations, neonatal listeriosis is relatively rare in Eastern countries, including Korea. Possible routes for intrauterine infection or vertical transmission of L. monocytogenes include infected placentas and the reproductive tract. Intrauterine infections may cause chorioamnionitis, preterm labor, spontaneous abortion, stillbirth, or neonatal infection. A high index of suspicion and early empirical antibiotic treatment are critical to achieve a favorable prognosis for neonatal listeriosis. We managed a case of L. monocytogenes sepsis and pneumonia in a premature neonate born at 26 weeks of gestational age from an asymptomatic mother with culture-proven placental infection. The neonate was successively treated with ampicillin and gentamicin.
Abortion, Spontaneous ; Ampicillin ; Chorioamnionitis ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Korea ; Listeria ; Listeria monocytogenes ; Listeriosis ; Meningitis ; Mothers ; Obstetric Labor, Premature ; Placenta ; Pneumonia ; Pregnancy ; Prognosis ; Sepsis ; Stillbirth

Infection still remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Patients with SLE are well known to have an increased risk of various opportunistic infections, which can be fatal. Central nervous system (CNS) infections such as meningitis are rare complications to SLE. On occasion, nonspecific neurologic manifestations of infectious meningitis in SLE patients can be confused with neuropsychiatric lupus. Listeria monocytogenes is a less-commonly identified organism causing meningitis in SLE patients. Here, we describe a case of Listeria monocytogenes meningitis presenting with bilateral abducens nerve (sixth cranial nerve) palsy in a patient with SLE, who was successfully treated with systemic antibiotics.
Abducens Nerve ; Abducens Nerve Diseases ; Anti-Bacterial Agents ; Central Nervous System ; Humans ; Listeria ; Listeria monocytogenes ; Lupus Erythematosus, Systemic ; Meningitis ; Meningitis, Listeria ; Neurologic Manifestations ; Opportunistic Infections ; Paralysis

PURPOSE: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. PATIENTS AND METHODS: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. RESULTS: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. CONCLUSION: Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Ascitic Fluid/microbiology ; Female ; Humans ; Immunosuppressive Agents/*therapeutic use ; Listeria Infections/blood/cerebrospinal fluid/*drug therapy ; Listeria monocytogenes/*drug effects/growth & development/isolation & purification ; Male ; Meningitis, Bacterial/blood/cerebrospinal fluid/*drug therapy ; Middle Aged ; Retrospective Studies ; Sepsis/blood/cerebrospinal fluid/*drug therapy ; Treatment Outcome

Listeria monocytogenes is the causative agent in a spectrum of human disease ranging from gastroenteritis to invasive infections such as meningitis, encephalitis, and septicemia. Elderly patients or persons who have lower cell-mediated immunity with predisposing conditions such as transplants, lymphomas, and AIDS, are especially susceptible. The tropism of L.monocytogenes for the central nervous system leads to severe disease, often with high mortality. We report a case of L. monocytogenes meningitis in a 58-year old woman with end stage renal disease. The patient was discharged without neurological sequelae after antibiotic treatment.
Aged ; Central Nervous System ; Encephalitis ; Female ; Gastroenteritis ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic* ; Listeria monocytogenes* ; Listeria* ; Lymphoma ; Meningitis ; Meningitis, Listeria* ; Middle Aged ; Mortality ; Sepsis ; Tropism

We report a 43-year old woman of Listeria monocytogenes bacteremia associated with systemic lupus erythematosus (SLE). She had been treated with glucocorticoid pulse therapies and a cyclophosphamide pulse therapy for relapsed lupus nephritis class IV. After the immunosuppressive treatment, she complained of fever, vomiting, diarrhea, and abdominal pain. Diffuse edematous thickening of bowel wall was seen on abdominal CT scan and Listeria monocytogenes was identified on blood culture study. After antibiotic therapy that lasted for more than 4 weeks, her presenting symptoms were resolved and no more Listeria monocytogenes was identified on follow-up culture studies. Infection with Listeria monocytogenes, a rare food-borne illness, can be life-threatening with high fatality rates and is known to occur more frequently in immunocompromised patients, including those receiving high-dose glucocorticoid or immunosuppressive therapy for collagen vascular disease. In Korea, a case of Listeria meningitis was reported, but a case of bacteremia caused by Listeria monocytogenes enteritis has never been reported in SLE patients. Thus, we report a case of Listeria monocytogenes bacteremia that occurred due to food poisoning after aggressive immunosuppressive treatment in a patient with SLE.
Abdominal Pain ; Adult ; Bacteremia* ; Collagen ; Cyclophosphamide ; Diarrhea ; Enteritis ; Female ; Fever ; Follow-Up Studies ; Foodborne Diseases ; Humans ; Immunocompromised Host ; Korea ; Listeria monocytogenes* ; Listeria* ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Meningitis, Listeria ; Tomography, X-Ray Computed ; Vascular Diseases ; Vomiting