Clinical and Epidemiological Study

Infection

, Volume 42, Issue 5, pp 817-827

First online:

Listeria monocytogenes meningoencephalitis in adults: analysis of factors related to unfavourable outcome

  • I. PelegrínAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge Email author 
  • , M. MoragasAffiliated withNeurology Department, IDIBELL-Hospital Universitari de Bellvitge
  • , C. SuárezAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge
  • , A. RiberaAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge
  • , R. VerdaguerAffiliated withMicrobiology Department, IDIBELL-Hospital Universitari de Bellvitge
  • , S. Martínez-YelamosAffiliated withNeurology Department, IDIBELL-Hospital Universitari de Bellvitge
  • , F. Rubio-BorregoAffiliated withNeurology Department, IDIBELL-Hospital Universitari de Bellvitge
  • , J. ArizaAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge
  • , P. F. ViladrichAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge
    • , C. CabellosAffiliated withInfectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge

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Abstract

Purpose

To analyse the short-term outcome in patients with Listeria monocytogenes meningoencephalitis (LMME) to improve management and outcome.

Methods

Observational study with adult patients with LMME between 1977 and 2009 at a tertiary hospital in Barcelona, Spain. Parameters that predicted outcome were assessed with univariate and logistic regression analysis.

Results

Of 59 cases of LMME, 28 occurred in the last decade. Since 1987, a new protocol has been used and 29/45 patients (64 %) treated since then received adjuvant dexamethasone. In patients who received this treatment there was a trend towards fewer neurological sequelae (5 vs 33 %; p = 0.052). Antiseizure prophylaxis with phenytoin was administered in 13/45 (28 %) patients. Seizures occurred in 7/45 (16 %) patients, all in the group who did not receive phenytoin. Hydrocephalus presented in 8/59 (14 %). It was never present at admission and five patients needed neurosurgical procedures. Sequelae after 3 months were present in 8/45 (18 %), mostly cranial nerve palsy. Rhombencephalitis (RE) was related to the presence of neurologic sequelae (OR: 20.4, 95 % CI: 1.76–236). Overall mortality was 14/59 (24 %), 9/59 (15 %) due to neurological causes related to hydrocephalus or seizures. Mortality was defined as early in 36 % and late in 64 %. In the multivariate analysis, independent risk factors for mortality were presence of hydrocephalus (OR: 17.8, 95 % CI: 2.753–114) and inappropriate empirical antibiotic therapy (OR: 6.5, 95 % CI: 1.201–35).

Conclusions

Outcome of LMME may be improved by appropriate empirical antibiotic therapy, suspicion and careful management of hydrocephalus. Use of adjuvant dexamethasone or phenytoin in a subgroup of these patients might have a benefit.

Keywords

Meningitis Listeria monocytogenes Outcome Hydrocephalus