A Retrospective Study of Rare Listeria Meningoencephalitis in Immunocompetent Children in China

Abstract

ObjectivesListeria meningoencephalitis (LMM) is very rare in healthy children. We aimed to assess the clinical features, differential diagnosis, treatment options, and outcomes of LMM in immunocompetent children through a retrospective study.MethodsThe clinical symptoms, laboratory findings, imaging features, antibiotic use, and metagenomic next-generation sequencing (mNGS) results of the cerebrospinal fluid (CSF) were obtained from immunocompetent children who were diagnosed with LMM and admitted to the Xi'an Children's Hospital from May 2018 to July 2020.ResultsThe data from 8 immunocompetent children were retrospectively analyzed in this study. The cohort included data from 5 males and 3 females who were aged from 1 year and 7 months to 16 years and 6 months. A total of 4 patients had chilled food before onset. The complications included hyponatremia (3/8), hydrocephalus (2/8), and hemophagocytic syndrome (1/8). In total, 8 patients were diagnosed with Listeria monocytogenes by positive CSF culture or mNGS results. The positive rate of CSF culture was 62.5% (5/8). A total of 5 patients conducted CSF mNGS, and the results of the mNGS were positive in 4 patients (80%, 4/5) and suspected in 1 patient. A total of 7 patients changed their therapeutic regimen to combined antibacterial therapies that included linezolid and meropenem (5/8), or ampicillin and meropenem (2/8). A total of 5 patients had favorable outcomes (Glasgow Outcome Scale, GOSE = 5) while two patients had unfavorable outcomes (GOSE = 1) and were complicated with hyponatremia and hydrocephalus.ConclusionsListeria meningoencephalitis (LMM) can occur in children with normal immune function and is commonly mistaken for other central nervous system infections. L. monocytogenes can be quickly and accurately detected by mNGS. Hyponatremia and hydrocephalus may indicate unfavorable outcomes.

Clinical Characteristics and Treatment of Listeria monocytogenes Infections in the Central Nervous System

“…When patients exhibit with prodrome characterized by gastrointestinal symptoms and a monocyte percentage increase, followed by manifestations of meningitis or meningoencephalitis, such as headache, fever, and altered consciousness, L. monocytogenes infection should be considered. 17 Monitoring the proportion of monocytes in blood and improving mNGS of CSF contribute to early and rapid diagnosis.…”

“…There is currently no consensus concerning the regimen and duration of therapy for L. monocytogenes infection in the CNS. 17 , 34 The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guideline recommends penicillin G, amoxicillin, or ampicillin as the standard treatment for listeria meningitis. Adding an aminoglycoside can be considered, and trimethoprim–sulfamethoxazole (SMZ-TMP), meropenem or linezolid would be effective alternatives.…”

“…This bacterium is highly neurophilic and can result in CNS invasion in immunocompromised patients, causing meningitis, meningoencephalitis, rhombencephalitis, or brain abscess. 10,12,14,15 However, CNS listeriosis can also occur in immunocompetent patients, [16][17][18] and our study has three previously healthy patients. The listeriosis incidence rates have increased in developed countries yearly during the 21st century, and epidemiological investigation of listeriosis is lacking in China.…”

Resolution of the expert council «The role of multiplex PCR diagnostics in optimizing treatment tactics for neuroinfections in children»

“…Участники круглого стола подчеркнули, что в последние годы наблюдается регистрация листериозных менингитов не только у детей первых месяцев жизни, но и у им-* Список экспертов представлен в алфавитном порядке [5][6][7][8][9]; верификация «нетипичной» для возраста этиологии ГБМ часто запаздывает, что неблагоприятно влияет на течение и исходы заболевания.…”