Central nervous system infection caused by Listeria monocytogenes: Clinical analysis of 12 cases
10.3760/cma.j.issn.1674-2397.2024.05.007
- VernacularTitle:单核细胞增生性李斯特菌致中枢神经系统感染12例临床分析
- Author:
Xuemei DING
1
;
Xiang YIN
1
;
Li CUI
1
Author Information
1. 吉林大学第一医院神经内科，长春 130031
- Publication Type:Journal Article
- Keywords:
Central nervous system infection;
Listeria monocytogenes;
Metagenomic next-generation sequencing;
Brain abscess;
Clinical characteristics
- From:
Chinese Journal of Clinical Infectious Diseases
2024;17(5):383-388
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features of patients with Listeria monocytogenes（LM）infection in the central nervous system. Methods:The clinical data of 12 patients with central nervous system LM infection admitted to the Department of Neurology of the First Hospital of Jilin University from January 2020 to December 2023 were retrospectively analyzed，in terms of the clinical manifestations，laboratory results，imaging findings，treatment and prognosis. SPSS 27.0 software was used to analyse the data.Results:The clinical manifestations were fever（12/12），headache（10/12）and neck stiffness（10/12）. There were 2 cases with focal neurological deficit symptoms and mental behavior abnormalities respectively. Seven patients（7/12）had autoimmune diseases and received immunosuppressive therapy. Laboratory tests showed that in cerebrospinal fluid（CSF），protein and leukocytes levels were elevated in all patients，chloride levels were decreased in 8 cases（8/12），and glucose levels were decreased in 3 cases（3/12）. The metagenomic next-generation sequencing（mNGS）test was performed in CSF samples of 10 patients，and all showed positive results for LM. The bacterial culture was performed in 11 cases and showed positive results for 5 blood samples and 2 CSF samples，respectively. Eleven patients underwent enhanced MRI scan，which showed meningeal enhancement in 3 cases and thalamic nodular enhancement in 1 case. In addition，MRI also showed single brain abscess in 2 cases，hydrocephalus in 2 cases，and rhombencephalitis in 1 case. The time from onset to definitive diagnosis was 5.00（4.25，6.75）days. All patients were treated with a first-line regimen（ampicillin + gentamicin）after being definitively diagnosed，4 patients subsequently received second-line antimicrobial therapy（cotrimoxazole and/or meropenem）. Of the 12 patients，2 cases were cured，1 case was dead against medical advice，and 9 cases were clinically improved，of whom 3 had neurological sequelae 3 months after discharge.Conclusions:The clinical manifestations and imaging of Listeria monocytogenes infection in the central nervous system are varied. The disease can be easily misdiagnosed，and detection rate of mNGS in CSF was higher than that of traditional methods. In the treatment the empiric antimicrobial spectrum should be covered LM.
