Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: The differential diagnostic importance of cerebrospinal fluid lactic acid levels

Cunha, Burke A.; Fatehpuria, Ritu; Eisenstein, Lawrence

doi:10.1016/j.hrtlng.2007.01.001

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…Previous studies show that CSF LA exhibited the highest sensitivity (89%–100%) and specificity (96%–100%) at values ≥3.5 mmol/L to discriminate between acute untreated bacterial meningitis and viral meningitis (11, 12). This limit proved to be also relevant for tuberculosis (8), Listeria monocytogenes (13) and fungal meningitis (14). The CSF LA test fulfills the criteria of an optimum test; higher discrimination limits at >5.0 mmol/L reduce diagnostic sensitivity, and a lower limit, such as 2.8 mmol/L decreases diagnostic specificity and does not allow differentiation of viral meningitis from controls (15).…”

Section: Discussionmentioning

confidence: 99%

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Almeida

Boritza²,

Cogo³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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Background Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV. Methods CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n = 17); 2) HIV positive with normal CSF (n = 20); 3) enterovirus meningitis (n = 33); 4) Herpesviridae meningoencephalitis (n = 30); 5) fungal meningitis (n = 25); 6) tuberculosis (TB) meningitis (n = 17); 7) toxoplasmosis (n = 18); 8) neurosyphilis (n = 6); 9) control group (n = 57). Results CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9–7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7–5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4–1.9 mmol/L) and other groups (p≤0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity. Conclusions CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.

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Section: Discussionmentioning

confidence: 99%

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Almeida

Boritza²,

Cogo³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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“…Spinal fl uid cultures and blood cultures are positive in about one-half of cases. Case reports indicate that encephalitis caused by L. monocytogenes may mimic herpes simplex encephalitis, particularly because-like herpes simplex virus-L. monocytogenes is one of the few causes of encephalitis associated with red blood cells in CSF without a CNS bleed or a traumatic lumbar puncture [ 36 ].…”

Section: Encephalitis (Cerebritis)mentioning

confidence: 99%

Central nervous system infection with Listeria monocytogenes

Clauss¹,

Lorber

2008

Curr Infect Dis Rep

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The foodborne pathogen Listeria monocytogenes has a particular tropism for the central nervous system and can produce infection in the meninges and brain substance. Well-recognized clinical syndromes include meningitis, brain abscess, rhombencephalitis, and spinal cord abscess; simultaneous infection of the meninges and brain is common. Although it is an uncommon cause of infection in the population at large, L. monocytogenes is an important cause of central nervous system infection in those with impaired cell-mediated immunity, whether due to underlying disease or treatment with immunosuppressive therapeutic agents; it is the etiology in 20% of bacterial meningitis cases in neonates and in 20% of cases in those older than 50 years. Ampicillin is considered the treatment of choice, and trimethoprim-sulfamethoxazole is recommended for those allergic to penicillin. At-risk patients should be advised to avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products.

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“…14 In meningoencephalitis, among patients with no red blood cells in the CSF, L. monocytogenes may mimic hepatic encephalopathy, Legionnaire's disease, or West Nile encephalitis. [15][16][17][18] Levels of lactic acid in the CSF provide a key diagnostic test for the early differentiation of ABM from nonbacterial meningitis. Patients with ABM manifest levels of lactic acid in the CSF at greater than or equal to 6 mmol/L, whereas those with aseptic or viral meningitis manifest levels of lactic acid in the CSF at less than 3 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

Systemic lupus erythematosus (SLE) cerebritis versus Listeria monocytogenes meningoencephalitis in a patient with systemic lupus erythematosus on chronic corticosteroid therapy: The diagnostic importance of cerebrospinal fluid (CSF) of lactic acid levels

McCaffrey¹,

Petelin²,

Cunha³

2012

Heart & Lung

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Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: The differential diagnostic importance of cerebrospinal fluid lactic acid levels

Cited by 26 publications

References 17 publications

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Central nervous system infection with Listeria monocytogenes

Systemic lupus erythematosus (SLE) cerebritis versus Listeria monocytogenes meningoencephalitis in a patient with systemic lupus erythematosus on chronic corticosteroid therapy: The diagnostic importance of cerebrospinal fluid (CSF) of lactic acid levels

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