Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage: A case report and review of the literature

Abstract

BACKGROUND Listeria monocytogenes ( L. monocytogenes ), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L. monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage, which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few. CASE SUMMARY We herein report a case of rhombencephalitis caused by L . monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance. His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L . monocytogenes . Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus. Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage. Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions. CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.

Listeria monocytogenes meningitis in elderly patient

“…Con el cambio del estilo de vida de los consumidores, hay menos tiempo disponible para la preparación de alimentos y se consumen más alimentos prepreparados y listos para llevar (8) . Los alimentos se producen con mayor vida útil lo que los convierte en 'alimentos con riesgo de Listeria' , por el mayor tiempo para multiplicarse que esta bacteria puede disponer.…”

Expression of Acute Phase Protein, Glial Fibrillary Acidic Protein, Epithelial Cadherin, and S100 Protein in Brain Tissues from Natural Cases of Ovine Encephalitic Listeriosis

“…The encephalitic form is thought to be caused by unilateral ascending injury of the trigeminal nerve following infection of teeth cavities, or invasion of injured buccal mucosa by L. monocytogenes. The incidence rate of encephalitic listeriosis is approximately 10-12%, while the mortality rate may be as high as 7.08% in sheep (Kumar et al, 2007) and 10% in human (Liang et al, 2019). The main manifestation of encephalitic listeriosis is unilateral facial and pharyngeal paralysis (Nightingale et al, 2004;Wei et al, 2020).…”

A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage: A review of treatment options and outcomes

“…CNS manifestations can range from a mild febrile illness with mental status changes to more severe manifestations including coma and death. Meningoencephalitis is the most common CNS Listeria infection, with less common complications including ventriculitis, rhomboencephalitis, hemorrhage, and hydrocephalus [2].…”

“…Hydrocephalus has been a recognized complication of Listeria monocytogenes meningoencephalitis (LMME) leading to significant morbidity and mortality. The etiology of hydrocephalus is likely multifactorial and related to factors such as a high level of CSF protein and impaired CSF absorption due to the obliteration of the subarachnoid space by meningeal exudates or defective CSF reabsorption through arachnoid granulations because of severe inflammatory reaction [2,4]. After S. pneumoniae, L. monocytogenes is the second most common pathogen causing hydrocephalus [3].…”

“…However it has been reported in adults, where it has been found to be an independent marker of unfavorable outcomes [5]. The underlying pathophysiology of intraventricular hemorrhage in L. monocytogenes infection is hypothesized to be related to dysregulation of both the coagulation and fibrinolytic pathways and to vascular endothelial cell swelling and activation [2,5].…”