Journal Article

Community-Acquired <i>Listeria monocytogenes</i> Meningitis in Adults

Matthijs C. Brouwer, Diederik van de Beek, Sebastiaan G. B. Heckenberg, Lodewijk Spanjaard and Jan de Gans

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 43, issue 10, pages 1233-1238
Published in print November 2006 | ISSN: 1058-4838
Published online November 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/508462
Community-Acquired Listeria monocytogenes Meningitis in Adults

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Background. Listeria monocytogenes is the third most common cause of bacterial meningitis.

Methods. We prospectively evaluated 30 episodes of community-acquired L. monocytogenes meningitis, confirmed by culture of cerebrospinal fluid specimens, in a nationwide study in The Netherlands. Outcome was graded using the Glasgow outcome score; an unfavorable outcome was defined as a score of 1–4.

Results. We found 30 episodes of L. monocytogenes meningitis. All patients were immunocompromised or >50 years old. In 19 (63%) of 30 patients, symptoms were present for >24 h; in 8 patients (27%), symptoms were present for ⩾4 days. The classic triad of fever, neck stiffness, and change in mental status was present in 13 (43%) of 30 patients. An individual cerebrospinal fluid indicator of bacterial meningitis was present in 23 (77%) of 30 cases. Gram staining of cerebrospinal fluid samples revealed the causative organism in 7 (28%) of 25 cases. The initial antimicrobial therapy was amoxicillin based for 21 (70%) of 30 patients. The coverage of initial antimicrobial therapy was microbiologically inadequate for 9 (30%) of the patients. The mortality rate was 17% (5 of 30), and 8 (27%) of 30 patients experienced an unfavorable outcome. Inadequate initial antimicrobial therapy was not related to outcome.

Conclusions. In contrast with previous reports, we found that patients with meningitis due to L. monocytogenes do not present with atypical clinical features; however, typical cerebrospinal fluid findings predictive for bacterial meningitis might be absent. A high proportion of patients received initial antimicrobial therapy that did not cover L. monocytogenes.

Journal Article.  3546 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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