1/18. trimethoprim-sulfamethoxazole salvage for refractory listeriosis during maintenance chemotherapy for acute lymphoblastic leukemia.A 5-year-old boy with acute lymphoblastic leukemia (ALL) and intolerance to oral trimethoprim-sulfamethoxazole (TMP/SMX) had listeria monocytogenes bacteremia and meningitis develop during maintenance chemotherapy. Despite prompt administration of IV amoxicillin/gentamicin and microbiologic clearance of the bloodstream, the patient had no response to therapy after a course of 7 days. Intravenous TMP/SMX (10 mg/kg per day of TMP) was added to the antibiotic regimen after desensitization. fever and meningeal signs rapidly resolved, and the patient was ultimately cured. amoxicillin and gentamicin, although highly active and synergistic in vitro against L. monocytogenes, have limited intracellular penetration and activity. In contrast, TMP/SMX has bactericidal extracellular and intracellular activity against Listeria and excellent central nervous system penetration, and thus may be effective for the treatment of refractory listeriosis.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/18. Listeria spinal cord abscess responsive to trimethoprim-sulfamethoxazole monotherapy.OBJECTIVE: To describe an alternative antibiotic regimen for the treatment of central nervous system listeria monocytogenes infection. BACKGROUND: Classical treatment of listeria infections of the brain and spinal cord has included ampicillin in combination with gentamicin and chloramphenicol. Antibiotic resistance to L. monocytogenes is extraordinarily low, and the combined risks of nephrotoxicity, ototoxicity, and agranulocytosis in an already critically ill patient make the potential use of trimethoprim-sulfamethoxazole monotherapy for coverage or treatment of listeria an important alternative. methods: Case report. RESULTS: A 58-year-old woman presented with a two-week history of progressive quadriplegia. gadolinium enhanced MRI showed diffuse edema of the cervical and thoracic spine with ring-enhancing lesions. cerebrospinal fluid and blood cultures both grew L. monocytogenes. spinal cord biopsy of the lesion revealed inflammation with necrosis and also grew listeria. Intravenous trimethoprim-sulfamethoxazole (8 mg/kg in four divided doses) was administered for six weeks with resultant arrest of neurological symptoms and stabilization of the clinical course. Although the patient was quadraparetic she was able to be discharged to a rehabilitation facility. CONCLUSIONS: trimethoprim-sulfamethoxazole monotherapy may be a potential alternative option for critically ill patients with central nervous system L. monocytogenes infection.- - - - - - - - - - ranking = 2.0660619074288keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
3/18. Listeria meningoencephalitis: two cases and a review of the literature.INTRODUCTION: Although presently uncommon locally, Listeria is increasing an important cause of central nervous system (CNS) infection worldwide. It differs from the common meningitis pathogens in its clinical features and treatment. CLINICAL PICTURE: We present 2 recently encountered cases of Listeria meningoencephalitis. In case 1, a previously healthy 42-year-old man presented with clinical features of meningoencephalitis. In case 2, a 64-year-old woman had clinical features of pneumonia and meningoencephalitis. Both had a predominantly lymphocytic picture in their cerebrospinal fluid (CSF) samples. Listeria grew in blood cultures of both patients and the CSF culture of the first. TREATMENT: In both cases, Listeria was resistant to the empirical antibiotics used. Intravenous ampicillin was eventually used in both patients, with gentamicin, added for synergistic action in the first. OUTCOME: The first patient developed complications of hydrocephalus, subdural collection and extensive cerebritis and ventriculitis. The second patient had focal seizures and a pontine infarct. Both did not survive. CONCLUSION: These 2 recent cases with different presentations of intracranial listerosis highlight the increasing importance of listerial infections in singapore. Clinicians need to be familiar with the features of this lethal disease in order to recognize and manage it successfully.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/18. A case report of sporadic ovine listerial menigoencephalitis in iowa with an overview of livestock and human cases.A case of ovine listeriosis was examined in a flock of sheep. The index case was a male lamb, which was part of a flock of 85 sheep located in central iowa. Because the sheep were raised on a premise where soybean sprouts were also cultivated for the organic foods market, the potential of a public health concern was addressed. To identify the source of contaminations, clinical and environmental samples were cultured for listeria monocytogenes. Isolates were serotyped and analyzed using pulsed-field gel electrophoresis (PFGE). listeria monocytogenes (serotype 1) was recovered from the brain of a male lamb with clinical signs of listerial encephalitis. Isolates of serotypes 1 and 4 were also cultured from feces of clinically healthy lambs, compost piles, and soybean cleanings. By PFGE, the clinical isolate was distinctly different from the other isolates. Environmental isolates were identified as L. monocytogenes serotypes 1 and 4. However, by PFGE, none matched the profile of the single clinical isolate. Thus, the ultimate source of contamination is unknown.- - - - - - - - - - ranking = 0.066061907428788keywords = brain (Clic here for more details about this article) |
5/18. syringomyelia following Listeria meningoencephalitis: report of a case.A case of symptomatic syringomyelia which appeared six years after Listeria meningoencephalitis is described. Chronic spinal arachnoiditis, as shown by standard MRI and dynamic phase contrast (PC) cine-MRI, may occur after spinal infection and is likely the cause of syringomyelia. To our knowledge, there are no previous reports of delayed spinal complications following listeria monocytogenes infection. The possibility of developing syringomyelia should be always considered in any patient with a history of central nervous system infection.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/18. Fulminant listeria monocytogenes meningitis complicated with acute hydrocephalus in healthy children beyond the newborn period.We describe 3 previously healthy Costa Rican children who had listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.- - - - - - - - - - ranking = 0.066061907428788keywords = brain (Clic here for more details about this article) |
7/18. Fatal meningitis due to listeria monocytogenes in elderly patients with underlying malignancy.adult patients with malignancies are considered to be at a high risk for listeria monocytogenes meningitis. The microbiology Laboratory's database of the University Hospital of Ioannina, greece, was searched for cases of L. monocytogenes during the period from January 1990 to December 2002. Listerial meningitis occurred in three patients: one with brain tumour, one with chronic lymphocytic leukaemia, and one with non-Hodgkin's lymphoma. All the patients were older than 70 and they were actively receiving therapy for their malignancy. L. monocytogenes type 4b was isolated from blood and cerebrospinal fluid. All were treated with ampicillin and gentamicin, but they died shortly after the initiation of the treatment. Experience with the three present cases indicated the high mortality rate due to listerial meningitis in this immunosuppressed population. So, listeriosis should be suspected in patients with meningitis and underlying malignancy. Since meningitis due to L. monocytogenes is not distinguishable clinically from other types of bacterial meningitis, it is recommended to cover Listeria in the initial empirical therapy of bacterial meningitis in immunosuppressed patients.- - - - - - - - - - ranking = 0.066061907428788keywords = brain (Clic here for more details about this article) |
8/18. Successful treatment of disseminated cerebritis complicating methicillin-resistant staphylococcus aureus endocarditis unresponsive to vancomycin therapy with linezolid.A unique case of community acquired methicillin resistant Staphylococcus aureus (MRSA) sepsis, with endocardial and cerebral metastatic seeding, caused by a strain representative of the Italian clone, is described. The patient was a 47-y-old man without apparent risk factors for endocarditis and for MRSA infection who developed coma with multiple cerebritis lesions under vancomycin plus amikacin therapy. He was eventually cured with the addition of linezolid to the initial antimicrobial regimen. This observation seems to confirm previous reports of the efficacy of linezolid for the treatment of central nervous system infections caused by multidrug resistant gram-positive bacteria. To our knowledge, this is the first report of MRSA disseminated cerebritis, a nearly always fatal disease, cured with this oxazolidinone drug. The increase in community acquired MRSA may have some impact on empirical treatment of serious infections caused by this organism.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/18. Neurolisteriosis causing hydrocephalus, trapped fourth ventricle, hindbrain herniation and syringomyelia.central nervous system infection by listeria monocytogenes is relatively uncommon, but is known to be highly morbid and fatal. We describe a case of listeria meningoencephalitis, wherein the acute episode was followed by a hitherto unreported conglomeration of severe and progressive neurological sequelae, in the form of supratentorial hydrocephalus, aqueduct block, trapped fourth ventricle, hindbrain herniation and syringomyelia. Pertinent literature is reviewed and the pathogenesis of the observed sequelae is explored.- - - - - - - - - - ranking = 0.54916304862617keywords = nervous system, brain (Clic here for more details about this article) |
10/18. listeriosis in patients infected with human immunodeficiency virus.Although resistance to listeria monocytogenes infection requires intact T cell-mediated immunity, only 20 patients with human immunodeficiency virus (hiv) infection and listeriosis (including one patient described herein) have been reported to date. listeriosis developed before AIDS in five cases. Syndromes included meningitis in nine cases, bacteremia in nine, brain abscess in one, and endocarditis in one. Eighteen patients were treated with ampicillin, penicillin, or amoxicillin with or without aminoglycosides. Clinical and microbiologic responses were obtained in one patient with bacteremia treated with vancomycin and in one patient with meningitis treated with trimethoprim-sulfamethoxazole. Three of the nine patients with meningitis died, as did the patient with brain abscess. All nine patients with bacteremia and the patient with endocarditis survived. No case of relapse was documented. L. monocytogenes, although uncommon, should be considered in the differential diagnosis of febrile illness, meningitis, and brain abscess in patients with hiv infection.- - - - - - - - - - ranking = 0.19818572228636keywords = brain (Clic here for more details about this article) |
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