Infection

, Volume 42, Issue 5, pp 817–827

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

  • I. Pelegrín
  • M. Moragas
  • C. Suárez
  • A. Ribera
  • R. Verdaguer
  • S. Martínez-Yelamos
  • F. Rubio-Borrego
  • J. Ariza
  • P. F. Viladrich
  • C. Cabellos
Clinical and Epidemiological Study

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 

References

  1. 1.
    Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364:2016–25.PubMedCrossRefGoogle Scholar
  2. 2.
    Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, et al. Bacterial meningitis in the United States in 1995. N Engl J Med. 1997;337:970–6.PubMedCrossRefGoogle Scholar
  3. 3.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–59.PubMedCrossRefGoogle Scholar
  4. 4.
    Guevara RE, Mascola L, Sorvillo F. Risk factors for mortality among patients with nonperinatal listeriosis in Los Angeles County, 1992–2004. Clin Infect Dis. 2009;48:1507–15.PubMedCrossRefGoogle Scholar
  5. 5.
    Lorber B. Listeriosis. Clin Infect Dis. 1997;24:1–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Fernàndez-Sabé N, Cervera C, López-Medrano F, Llano M, Sáez E, Len O, et al. Risk factors, clinical features, and outcomes of listeriosis in solid-organ transplant recipients: a matched case-control study. Clin Infect Dis. 2009;49:1153–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Muñoz P, Rojas L, Bunsow E, Saez E, Sánchez-Cambronero L, Alcalá L, et al. Listeriosis: an emerging public health problem especially among the elderly. J Infect. 2012;64:19–33. doi:10.1016/j.jinf.2011.10.006 Epub 2011 Oct 21.PubMedCrossRefGoogle Scholar
  8. 8.
    Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-acquired Lm meningitis in adults. Clin Infect Dis. 2006;43:1233–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Amaya-Villar R, García-Cabrera E, Sulleiro-Igual E, Fernández-Viladrich P, Fontanals-Aymerich D, Catalán-Alonso P, et al. Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults. BMC Infect Dis. 2010;10:324.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Koopmans MM, Brouwer MC, Bijlsma MW, Bovenkerk S, Keijzers W, van der Ende A, et al. Listeria monocytogenes sequence type 6 and increased rate of unfavorable outcome in meningitis: epidemiologic cohort study. Clin Infect Dis. 2013;57:247–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Mitjà O, Pigrau C, Ruiz I, Vidal X, Almirante B, Planes AM, et al. Predictors of mortality and impact of aminoglycosides on outcome in listeriosis in a retrospective cohort study. J Antimicrob Chemother. 2009;64:416–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Kasanmoentalib ES, Brouwer MC, van der Ende A, van de Beek D. Hydrocephalus in adults with community-acquired bacterial meningitis. Neurology. 2010;75:918–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Bille J. Listeria an Erysipelotrix. In: Murray PR, Baron EJ, Pfaller MA, Jorgensen JH, Yolken RH, editors. Manual of clinical microbiology. 9th ed. Washington, DC: American Society for Microbiology; 2007. p. 474.Google Scholar
  14. 14.
    Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Sixteenth Informational Supplement. CLSI document M100-S16 [ISBN 1-56238-588-7]. Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087–1898 USA, 2006.Google Scholar
  15. 15.
    Evans W. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry. 1942;47:931–7.CrossRefGoogle Scholar
  16. 16.
    Gawler J, Du Boulay GH, Bull JW, Marshall J. Computerized tomography (the EMI Scanner): a comparison with pneumoencephalography and ventriculography. J Neurol Neurosurg Psychiatry. 1976;39:203–11.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    de Gans J, van de Beek D. European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Allerberger F, Wagner M. Listeriosis: a resurgent foodborne infection. Clin Microbiol Infect. 2010;16:16–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, et al. Acute bacterial meningitis in adults: a review of 493 episodes. N Engl J Med. 1993;328:21–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Moellering RC Jr, Medoff G, Leech I, Wennersten C, Kunz LJ. Antibiotic synergism against Lm. Antimicrob Agents Chemother. 1972;1:30–4.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Scheld WM, Dacey RG, Winn HR, Welsh JE, Jane JA, Sande MA. Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alterations with penicillin and methylprednisolone. J Clin Invest. 1980;66:243–53.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Lm. 33 years’ experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore). 1998;77:313–36.CrossRefGoogle Scholar
  24. 24.
    Zoons E, Weisfelt M, de Gans J, Spanjaard L, Koelman JH, Reitsma JB, et al. Seizures in adults with bacterial meningitis. Neurology. 2008;70:2109–15.PubMedCrossRefGoogle Scholar
  25. 25.
    Pfister HW, Feiden W, Einhäupl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol. 1993;50:575–81.PubMedCrossRefGoogle Scholar
  26. 26.
    Østergaard C, Konradsen HB, Samuelsson S. Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect Dis. 2005;27:93.CrossRefGoogle Scholar
  27. 27.
    Pelegrín I, Verdaguer R, Ariza J, Viladrich PF, Cabellos C. Effect of Adjuvant Therapy in pneumococcal meningitis: seizures and mortality. In on line library 22th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) London, March 31–April 3 2012.Google Scholar
  28. 28.
    Armstrong RW, Fung PC. Brainstem encephalitis (Rhombencephalitis) due to Lm: case report and review. Clin Infect Dis. 1993;16:689–702.PubMedCrossRefGoogle Scholar
  29. 29.
    Uldry PA, Kuntzer T, Bogousslavsky J, Regli F, Miklossy J, Bille J, Francioli P, Janzer R. Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases. J Neurol. 1993;240:235–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Lavetter A, Leedom JM, Mathies AW Jr, Ivler D, Wehrle PF. Meningitis due to Listeria monocytogenes. A review of 25 cases. N Engl J Med. 1971;285:598–603.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • I. Pelegrín
    • 1
  • M. Moragas
    • 2
  • C. Suárez
    • 1
  • A. Ribera
    • 1
  • R. Verdaguer
    • 3
  • S. Martínez-Yelamos
    • 2
  • F. Rubio-Borrego
    • 2
  • J. Ariza
    • 1
  • P. F. Viladrich
    • 1
  • C. Cabellos
    • 1
  1. 1.Infectious Diseases ServicesIDIBELL-Hospital Universitari de BellvitgeL’Hospitalet de LlobregatSpain
  2. 2.Neurology DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Microbiology DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain

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