Increased Risk of Meningitis and Bacteremia Due to Listeria monocytogenes in Patients with Human Immunodeficiency Virus Infection

Reis

Rev. Soc. Bras. Med. Trop.

2006

A análise fenotípica de 255 amostras do gênero Listeria isoladas de material clínico humano, tanto de indivíduos doentes (220-86,3%), como de aparentemente normais (35-13,7%) de várias regiões do país e colecionadas no período de 1969 a 2000, permitiu caracterizar a distribuição de sorovares de Listeria monocytogenes. Nas faixas etárias de 0 a 10 e de 41 a 60 anos, predominaram os isolamentos de líquido cefalorraquidiano sobre os de sangue, incluindo dos transplantados renais. Somente dos hemocultivos foi possível detectar os sete sorovares de Listeria monocytogenes. No cômputo geral, o sorovar 4b foi o mais incidente (154-60,3%) secundado por ¹/2 a (74-29%) nos três decênios considerados, além de ocorrerem em quase todas as regiões do país. Os dados deste estudo evidenciaram a circulação de L. monocytogenes na espécie humana, provocando quadros graves de meningite e septicemia, bem como, revelando a figura do portador assintomático, razão pela qual são recomendadas novas investigações bacteriológicas, subsidiadas por análises clínico-patológicas e epidemiológicas.

Section: Discussionunclassified

Sorovares de Listeria monocytogenes e espécies relacionadas, isoladas de material clínico humano

Reis

Rev. Soc. Bras. Med. Trop.

2006

“…However, in patients with compromised T cell-dependent immunity, the life-time risk of listeric infections is estimated to be 100-to 300-fold higher than in the general population. 22,23 Routine broad-spectrum antimicrobial prophylaxis with trimethoprim-sulfamethoxazole and ciprofloxacin may confer protection in individuals at risk, including those undergoing Bone Marrow Transplantation transplantation. [2][3][4]21,[24][25][26] Alternatively, the pre-activated macrophages during the early phase following transplantation may provide effective containment of these opportunistic intracellular pathogens 27,28 and play a critical role in the paucity of infection due to L. monocytogenes, Legionella pneumophila, Nocardia asteroids and Salmonella spp, in this setting.…”

Section: Discussionmentioning

confidence: 99%

Listeriosis in recipients of allogeneic blood and marrow transplantation: thirteen year review of disease characteristics, treatment outcomes and a new association with human cytomegalovirus infection

Safdar

Papadopoulous

Armstrong

2002

Bone Marrow Transplant

Summary:Listeriosis is uncommon in recipients of allogeneic blood, marrow and organ transplantation. Six patients with systemic Listeria monocytogenes infection during 1985-1997 at Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center are described. In two male and four female patients, the median duration from transplantation to isolation of L. monocytogenes was 62.5 (range 29 to 821) days. Among five allogeneic marrow transplant recipients, four (80%) received HLA antigen matched, T cell-depleted grafts from three unrelated and a single related donor. One patient underwent mismatched-related marrow graft transplant. Cord stem cell transplantation was performed in a single patient. Two required therapy for graftversus-host disease (GVHD). The 13 year incidence of systemic Listeria infections was 0.47 percent. All six presented with fever (Ͼ39؇C), and L. monocytogenes bloodstream invasion. Mental status changes and meningioencephalitis were observed in two (33.3%). A concurrent primary opportunistic infection was present in five individuals (83.3%), and four (80%) were being treated for acute human cytomegalovirus (HCMV) viremia. Sixty-six percent responded to therapy and two died from unrelated, non-listeric causes. Systemic listeriosis was uncommon in our high-risk allogeneic blood and marrow transplantation population, and response to therapy with parenteral ampicillin and gentamicin was excellent. The association between primary HCMV reactivation and subsequent listeric infection emphasizes the significance of HCMV-related dysfunction in

“…[11][12][13] In patients with compromised T cell function, the lifetime risk of listeria infections is estimated to be 100-300-fold higher than in general population. [14][15][16] There are multiple reports of listeriosis after kidney transplantation, 17 but only 15 cases of listeriosis after liver transplantation have been reported to date ( Table 1).…”

Section: 10mentioning

confidence: 99%

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

et al. 2007

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...