Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient

Abstract

A 54-year-old male, five months postorthotopic heart transplantation, presented with intermittent fevers, headaches, and “soupy” stools. Prior to presentation, he had low-level cytomegalovirus (CMV) viremia for two straight weeks. Given his immunosuppression, diarrhea, and low-level CMV viremia, he was presumed to have cytomegalovirus and/or C. difficile colitis and treated empirically for both on hospital day one. However, he developed neck pain/stiffness, diaphoresis, and worsening fevers on hospital day three. Blood cultures eventually grew Listeria monocytogenes; MRI of the brain with gadolinium showed left brain meningoencephalitis with early cerebral abscess formation. Lumbar puncture revealed elevated opening pressure, CSF neutrophilic pleocytosis, and elevated CSF protein and lactate but negative gram stain and cultures. First-line agent for Listeria meningoencephalitis is ampicillin. However, he reported amoxicillin allergy. Desensitization to ampicillin failed because ampicillin was too unstable per the allergist. He was therefore treated with penicillin monotherapy for eight weeks with complete resolution of his brain lesions and without any residual neurologic deficits.

<i>Listeria monocytogenes</i> Bacteremia During Isatuximab Therapy in a Patient with Multiple Myeloma

“…Second, TMP-SMX, which has been reported as an independent protective factor against L. monocytogenes infection, should be used prophylactically as part of the treatment regimen ( 11 ). L. monocytogenes meningoencephalitis and cerebral abscesses have been reported after switching from TMP-SMX to atovaquone for preventing PCP ( 12 ). In the present case, L. monocytogenes bacteremia developed after TMP-SMX treatment was switched to atovaquone and did not recur after the administration of TMP-SMX was re-started, suggesting the effectiveness of TMP-SMX in preventing the infection.…”

Prevalence and Antimicrobial Resistance of Listeria monocytogenes in Different Raw Food from Reynosa, Tamaulipas, Mexico

“…The strains isolated in this study were tested with a panel of 12 antibiotics, showing resistance to only 4 of these: sulfamethoxazole/trimethoprim, at 78.9%; streptomycin, at 26.3%; meropenem, at 21.1%; and gentamycin, at 2.6%. Most of the strains were resistant to sulfamethoxazole/trimethoprim (78.9%), which serves as a critical warning, as sulfamethoxazole/trimethoprim is an alternative or secondary treatment for listeriosis in meningoencephalitis caused by L. monocytogenes [ 83 , 84 ]. Except for the sulfamethoxazole/trimethoprim combination (78.9%), which showed high resistance against L. monocytogenes isolates, the strains showed high susceptibility to most of the antibiotics tested, coinciding with the susceptibility pattern commonly reported in other studies.…”