Pearls & Oy-sters: Diagnosis and Subtyping of Listeria Ventriculitis in an Immunocompetent Host

Abstract

Listeria monocytogenes is a gram-positive food-borne pathogen that causes gastrointestinal symptoms and central nervous system (CNS) infection in susceptible hosts.. Two lineages of Listeria cause the majority of neurolisteriosis in humans. In this report, we discuss a case of a 23-year-old previously healthy female who presented with acute-onset rapidly progressive altered mental status after eating undercooked meats at a local restaurant. Given her age and lack of comorbidities, bacterial meningitis was suspected, and she was treated with ceftriaxone, vancomycin, and steroids. Magnetic resonance imaging of the brain was consistent with meningitis and ventriculitis; Cerebrospinal fluid (CSF) analysis also suggested bacterial meningitis. Despite mechanical ventilation, pressors, and ventricular drain placement, she quickly decompensated and died 12 hours after arrival. CSF culture later returned positive for Listeria monocytogenes. We used whole genome sequencing and near-source comparison to identify the Listeria subtype that led to her unexpected presentation. The results suggest that her CSF isolate was consistent with a lineage II Listeria serotype, which is known to exhibit greater genetic variation than the more commonly isolated lineage I serotypes. We conclude the discussion with diagnostic and treatment approaches to neurolisteriosis. In susceptible hosts, namely immunocompromised, pregnant, neonatal or elderly patients, Listeria infection may result in CNS invasion, causing meningoencephalitis and, rarely, ventriculitis and rhombencephalitis. Although neurolisteriosis most commonly affects individuals with known risk factors, CNS infection is nevertheless possible in otherwise healthy young patients. Suspicion should be raised in patients with an exposure history and do not improve with empiric antibiotics.

Meningoencephalitis due to <i>Listeria monocytogenes</i> in a Young Immunocompetent Patient: Case Report with Literature Review

“…The patient died 3 weeks after admission (Mohan 2023) [9]. Zhao et al reported the case of a 23-year-old female with no previous history of immunocompromise or other chronic diseases, only with a history of ingesting poorly cooked meats, who developed meningitis complicated with ventriculitis and obstructive hydrocephalus, who died 12 hours after her income [10]. Cao et al reported the case of a previously healthy 50-year-old man, with no comorbidities or history of immunocompromise, who was misdiagnosed with facial neuritis, treated unsuccessfully with dexamethasone.…”

Clinical Characteristics and Treatment of Listeria monocytogenes Infections in the Central Nervous System

“…Like other forms of bacterial infections in the CNS, the most common signs and symptoms of CNS listeriosis are headache, fever, neck stiffness and disturbance of consciousness. 7 , 22 However, some patients can present seizures and focal neurological deficits, such as cranial nerve palsies. 23 Previous studies have demonstrated that only 41–51% of the patients presented the classic triad of fever, neck stiffness and altered mental status, 22 which consistent with our research, 50% of the patients displayed a typical triad in this study.…”

“…9,27 L. monocytogenes isolation from blood or CSF combined with a compatible clinical manifestation is the gold standard for diagnosing neurolisteriosis. 5,7,30 L. monocytogenes detection using the mNGS of CSF can also be used as evidence for diagnosing CNS listeriosis, and it appears to be more sensitive than traditional detection methods. [31][32][33] The blood and CSF culture positive rates were 40% and 28.57%, respectively, while the mNGS positive rate was 100% in our cases.…”

“… 5 Moreover, CNS listeriosis primarily affects specific population segments, including neonates, pregnant women, and elderly and immunocompromised hosts, such as those taking medications that suppress cell-mediated immunity. 2 , 6 , 7 Recent trends in organ transplantation and the use of immunosuppressants have led to a rise in the number of patients clinically diagnosed with listeriosis. 8 , 9 However, there is currently no consensus concerning its diagnosis and therapy resulting in high disability and mortality.…”