Brainstem Encephalitis Caused by Listeria monocytogenes

Abstract

International outbreaks of listerial infections have become more frequent in recent years. Listeria monocytogenes, which usually contaminates food, can cause potentially fatal infections. Listerial cerebritis is a rare disease that is encountered mostly in immunocompromised or elderly patients. However, listerial brainstem encephalitis (mesenrhombencephalitis or rhombencephalitis) is found in persons who were formerly in good health, and recognizing this disease, particularly at its early stages, is challenging. Listerial brainstem encephalitis has high mortality, and serious sequelae are frequently reported in survivors. Early recognition and correct diagnosis, as well as the timely use of appropriate antibiotics, can reduce the severity of listerial infections. The trigeminal nerve is proposed as a pathway through which L. monocytogenes reaches the brainstem after entering damaged oropharyngeal mucosa or periodontal tissues. This review introduces the clinical manifestations, pathology, magnetic resonance imaging (MRI) findings, diagnosis, and treatment of listerial brainstem encephalitis. Moreover, it proposes that L. monocytogenes may also invade the brainstem along the vagus nerve after it infects enteric neurons in the walls of the gastrointestinal tract.

Expression of Acute Phase Protein, Glial Fibrillary Acidic Protein, Epithelial Cadherin, and S100 Protein in Brain Tissues from Natural Cases of Ovine Encephalitic Listeriosis

“…The unilateral signs of CNS deficits in listeriosis are attributable to an ascending infection along one trigeminal nerve and the inflammation of the adjacent nuclei. Additionally, the reduced or absent palpebral reflexes are due to impairment of the sensitivity component of the trigeminal nerve and the motor component of the facial nerve (Disson & Lecuit, 2012;Wei et al, 2020). In our study, the gross lesions were in the form of cerebro-menengial hemorrhage and gray color liquefied spots; these findings are in agreement with those of previous reports (Maxie & Youssef, 2007; Engelen- Lee et al, 2018).…”

“…The histopathologic lesions of listerial encephalitis are mainly restricted to the brainstem (Maxie & Youssef, 2007;Zachary, 2012;Wei et al, 2020). However, in the current study, lesions were also noted in the cerebellum of two cases; this finding is consistent with that described by Rissi et al (2006) in southern Brazil.…”

“…The incidence rate of encephalitic listeriosis is approximately 10-12%, while the mortality rate may be as high as 7.08% in sheep (Kumar et al, 2007) and 10% in human (Liang et al, 2019). The main manifestation of encephalitic listeriosis is unilateral facial and pharyngeal paralysis (Nightingale et al, 2004;Wei et al, 2020). Histopathologic diagnosis of ovine listeriosis is based on the identification of the characteristic microabscesses and extensive perivascular mononuclear cuffing in different anatomical locations of the central nervous system, particularly at the brainstem (Maxie & Youssef, 2007;Zachary, 2012;Headley et al, 2013).…”

“…Diagnosis of encephalitic listeriosis can be confirmed via bacterial isolation (Johnson et al, 1995;Le Monnier et al, 2011), molecular biology and serological tests (Bundrant et al, 2011;Wei et al, 2020), and immunohistochemical evaluation (Rissi et al, 2006;Özyıldız et al, 2018). Glial fibrillary acidic protein (GFAP) is a structural protein that is produced mainly by astrocytes and is essential for cell communication and regulation of the blood-brain barrier (Yang & Wang, 2015;Özyıldız et al, 2018).…”

Phagocytosis by Peripheral Glia: Importance for Nervous System Functions and Implications in Injury and Disease

“…However, a few pathogenic bacteria, viruses and protozoans can directly infect SCs, which can result in peripheral nerve damage (Neal and Gasque, 2016) or invasion of the CNS via cranial nerves in which SCs are found, in particular the trigeminal nerve (St John et al, 2016;Duarte et al, 2019;Nazareth et al, 2021). The intranasal branches of this nerve can serve as a direct path to CNS infection by several infectious agents, including Streptococcus pneumoniae, Burkholderia pseudomallei, Chlamydia muridarum, Herpes simplex virus, and Listeria monocytogenes (Shimeld et al, 2001;van Ginkel et al, 2003;St John et al, 2014Wei et al, 2020;Nazareth et al, 2021). Thus, understanding SC phagocytosis of "non-self " is important and may lead to novel therapies, as mentioned earlier.…”