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The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study

  • F. ArslanEmail author
  • E. Meynet
  • M. Sunbul
  • O. R. Sipahi
  • B. Kurtaran
  • S. Kaya
  • A. C. Inkaya
  • P. Pagliano
  • G. Sengoz
  • A. Batirel
  • B. Kayaaslan
  • O. Yıldız
  • T. Güven
  • N. Türker
  • İ. Midi
  • E. Parlak
  • S. Tosun
  • S. Erol
  • A. Inan
  • N. Oztoprak
  • I. Balkan
  • Y. Aksoy
  • B. Ceylan
  • M. Yılmaz
  • A. MertEmail author
Article

Abstract

The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19–92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8 ± 7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01–1.16]] and seizures (OR, 3.41 [95 % CI, 1.05–11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006–1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73–748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients’ prognosis.

Keywords

Linezolid Bacterial Meningitis Epileptic Seizure Neurologic Sequela Listeriosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We would like to thank the European Study Group for Infections of the Brain for their collaboration in collecting and sharing patient data and Dr. Meagan Pate from the Baylor College of Medicine for helping us edit our manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • F. Arslan
    • 1
    Email author
  • E. Meynet
    • 2
  • M. Sunbul
    • 3
  • O. R. Sipahi
    • 4
  • B. Kurtaran
    • 5
  • S. Kaya
    • 6
  • A. C. Inkaya
    • 7
  • P. Pagliano
    • 8
  • G. Sengoz
    • 9
  • A. Batirel
    • 10
  • B. Kayaaslan
    • 11
  • O. Yıldız
    • 12
  • T. Güven
    • 13
  • N. Türker
    • 14
  • İ. Midi
    • 15
  • E. Parlak
    • 16
  • S. Tosun
    • 17
  • S. Erol
    • 18
  • A. Inan
    • 18
  • N. Oztoprak
    • 19
  • I. Balkan
    • 20
  • Y. Aksoy
    • 21
  • B. Ceylan
    • 22
  • M. Yılmaz
    • 22
  • A. Mert
    • 1
    • 23
    Email author
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyIstanbul Medipol University HospitalIstanbulTurkey
  2. 2.Pôle thorax et vaisseaux, Unité d’oncologie thoraciqueCHU GrenobleGrenoble cedex 9France
  3. 3.Infectious Diseases and Clinical MicrobiologyOndokuz Mayis University Medical SchoolSamsunTurkey
  4. 4.Department of Infectious Diseases and Clinical MicrobiologyEge University Faculty of MedicineIzmirTurkey
  5. 5.Department of Infectious Diseases, Faculty of MedicineCukurova UniversityAdanaTurkey
  6. 6.Department of Infectious Diseases and Clinical MicrobiologyKaradeniz Technical University Faculty of MedicineTrabzonTurkey
  7. 7.Department of Infectious Diseases, School of MedicineHacettepe UniversityAnkaraTurkey
  8. 8.Department of Infectious DiseasesD. Cotugno Hospital, AORN Dei ColliNaplesItaly
  9. 9.Infectious Diseases and Clinical MicrobiologyHaseki Training and Research HospitalIstanbulTurkey
  10. 10.Infectious Diseases and Clinical MicrobiologyDr. Lutfi Kirdar Kartal Education and Research HospitalIstanbulTurkey
  11. 11.Clinic of Infectious Diseases and Clinical MicrobiologyAnkara Numune Education and Research HospitalAnkaraTurkey
  12. 12.Department of Infectious Diseases, School of MedicineErciyes UniversityKayseriTurkey
  13. 13.Infectious Diseases and Clinical Microbiology ClinicAtaturk Training and Research HospitalAnkaraTurkey
  14. 14.Department of Infectious Diseasesİzmir Katip Çelebi University Atatürk Research and Education HospitalIzmirTurkey
  15. 15.Department of NeurologyMarmara University HospitalIstanbulTurkey
  16. 16.Department of Infectious Diseases and Clinical Microbiology, Faculty of MedicineAtatürk UniversityErzurumTurkey
  17. 17.Izmir Bozyaka Research and Education HospitalIzmirTurkey
  18. 18.Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Education and Training HospitalIstanbulTurkey
  19. 19.Department of Infectious Diseases and Clinical Microbiology, School of MedicineKaraelmas UniversityZonguldakTurkey
  20. 20.Department of Infectious Diseases and Clinical Microbiology, School of Cerrahpasa Medicine FacultyIstanbul UniversityIstanbulTurkey
  21. 21.Infectious Diseases and Clinical MicrobiologyGebze State HospitalGebzeTurkey
  22. 22.Infectious Diseases and Clinical MicrobiologyIstanbul Medipol UniversityIstanbulTurkey
  23. 23.Internal MedicineIstanbul Medipol UniversityIstanbulTurkey

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