Early invasiveListeria monocytogenes infection after orthotopic liver transplantation: Case report and review of the literature

Abstract

Infection with Listeria monocytogenes is rare, with a reported annual incidence of 4.4 cases per million individuals. It is caused by a gram-positive rod-shaped bacterium (Listeria monocytogenes) that can be found in soil, vegetation, water, sewage, and silage and in feces of humans and animals. It is a facultative intracellular pathogen with the ability to survive and multiply in phagocytic host cells, even in adverse environmental circumstances. Listeriosis has rarely been reported after orthotopic liver transplantation, and transplant physicians are often unfamiliar with the clinical presentation of this rare but virulent infection, which accounts for 20%-30% mortality in affected individuals. We present a case of invasive Listeria infection causing bacteremia and peritonitis in the early postoperative period after cadaveric liver transplantation in a previously asymptomatic patient. Liver Transpl 14: [88][89][90][91] 2008 Infections due to Listeria in immunocompromised individuals after orthotopic liver transplantation (OLT) usually occur months to years after surgery. Sepsis is the most common clinical presentation, and it is associated with high fatality rate. We encountered a case of a recipient who developed Listeria monocytogenes peritonitis during the early postoperative period after undergoing a second liver transplant for recurrent primary sclerosing cholangitis. CASE REPORTWe report the case of a 29-year-old man diagnosed with autoimmune hepatitis at the age of 11. He underwent his first OLT at age 19. At the age of 24, he was diagnosed with ulcerative colitis with multiple flares despite maintenance doses of corticosteroids. In 2004, he had esophageal variceal bleeding; results of a percutaneous liver biopsy revealed cirrhosis of his liver graft. Over the next 2 years, he developed liver failure, and he was listed for a second OLT. His immunosuppression included tacrolimus (2 mg a day), mycophenolate mofetil (750 mg a day), and prednisone (7.5 mg a day). At admission for the second OLT, his physical examination was unremarkable except for the presence of ascites, sclerocutaneous jaundice, and muscle wasting. He denied any fever, night sweats, diarrhea, or other symptoms suggestive of colitis flare-up or recent infection within the last months. His serology was negative for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus and positive for anti-Epstein-Barr nuclear antigen and anti-cytomegalovirus antibodies.He received 1 g of cefotaxime as antibiotic prophylaxis before surgery and for the first day after OLT.His immunosuppression regimen was tacrolimus based (2 mg a day) with prednisone tapering dose and anti-interleukin-2 receptor antibody therapy (basiliximab) administered during induction and on day 4 after surgery.On day 4 after surgery, he had a low-grade fever (38.2°C). Blood, urine, and peritoneal drainage fluid samples were obtained and cultured, and gram-positive rods were found in blood samples. Empirical treatment with parenteral piperacillin-tazobactam was initiated...

Listeria monocytogenesperitonitis: presentation, clinical features, treatment, and outcome

“…The remaining twenty-five patients [16,18,[58][59][60][61][62][63][64][65][66][67][68], that could not be included in either of the first two subgroups, were encountered in subgroup III. Their mean age was 50.6 years, with male predominance (Table IVa).…”

Risk Factors, Clinical Features, and Outcomes of Listeriosis in Solid‐Organ Transplant Recipients: A Matched Case‐Control Study

“…Solid-organ transplant (SOT) recipients are typically considered to be at increased risk for acquiring listeriosis because of immunosuppressive therapy-related deficiencies in cellular immune function [2,3]. Nevertheless, although cases of listeriosis occurring in SOT recipients have been sporadically reported [4][5][6][7][8][9], comprehensive information on this infection in this pop-at Universidad de Cantabria on January 11, 2013 http://cid.oxfordjournals.org/ Downloaded from ulation is particularly scarce. Significantly, risk factors for listeriosis in SOT recipients have not been formally assessed.…”

Liver biopsy-related infection in liver transplant recipients: A current matter of concern?

“…The second was a patient who presented with signs of meningoencephalitis 2 days after LB; Listeria monocytogenes was isolated from both cerebrospinal fluid and blood cultures. This case was not considered a biopsy‐related complication because of the absence of LB‐related Listeria sepsis cases reported in the literature, although cases have been described in relation to early after liver transplantation …”