Delić Snežana, Brkić Snežana, Delić Aleksandar, Ćirković Ivana B
Med Pregl. 2014 Nov-Dec;67(11-12):407-9. doi: 10.2298/mpns1412407c.
Listeria monocytogenes is one of the most common causes of bacterial central nervous system infections in adults. It often affects immunicompromised and elderly patients. Even with appropriate antimicrobial treatment, mortality due to Listeria monocytogenes meningoencephalitis is among the highest of all causes of bacterial central nervous system infections.
We presented a previously healthy, 79-year-old farmer with typical clinical features of meningoencephalitis. The initial treatment with vancomycin and meropenem did not produce any clinical effect. On day six, Listeria monocytogenes was isolated from the cerebrospinal fluid and blood culture and identified by using conventional and automated microbiology methods. Antimicrobial susceptibility testing was performed by E test method. After bacterial isolation and identification, the administration of ampicillin and gentamicin was followed by the complete recovery of our patient.
This case is presented to emphasize the negative outcome of empirical treatment when Listeria monocytogenes is not taken into consideration. Furthermore, the administration of ampicillin and gentamicin combination for treatment should be considered as the best therapeutic option in Listeria monocytogenes meningoencephalitis.
单核细胞增生李斯特菌是成人细菌性中枢神经系统感染最常见的病因之一。它常影响免疫功能低下和老年患者。即使进行适当的抗菌治疗,单核细胞增生李斯特菌性脑膜脑炎导致的死亡率在所有细菌性中枢神经系统感染病因中也位居前列。
我们报告了一位既往健康的79岁农民,他具有脑膜脑炎的典型临床特征。最初使用万古霉素和美罗培南治疗未产生任何临床效果。在第6天,从脑脊液和血培养中分离出单核细胞增生李斯特菌,并通过传统和自动化微生物学方法进行鉴定。采用E试验法进行药敏试验。细菌分离鉴定后,给予氨苄西林和庆大霉素治疗,患者完全康复。
本病例旨在强调未考虑单核细胞增生李斯特菌时经验性治疗的不良后果。此外,氨苄西林和庆大霉素联合给药应被视为单核细胞增生李斯特菌性脑膜脑炎的最佳治疗选择。