Buyck Griet, Devriendt Veronique, Van den Abeele Anne-Marie, Bachmann Christian
a Department of Geriatric Medicine , University Hospital Ghent , Ghent , Belgium.
b Department of Emergency Medicine , AZ Sint-Lucas Hospital Ghent , Ghent , Belgium.
Acta Clin Belg. 2018 Dec;73(6):418-422. doi: 10.1080/17843286.2017.1421846. Epub 2018 Jan 9.
Listeria monocytogenes is a rare foodborne pathogen, causing both outbreaks and sporadic infections. Severe, systemic infections are more prevalent in at-risk populations, such as pregnant women, but occur mostly in older people and immunocompromised individuals. In this case report, we describe the presentation, diagnosis, and treatment of Listeria monocytogenes sepsis in an older patient, and we briefly review the literature about listeriosis and the importance of safe food practices.
We report the case of a nursing home resident with multiple co-morbidities who presented with abdominal complaints and fever. We found diffuse tenderness on abdominal examination without guarding or rebound pain. No other neurologic symptoms were reported and neurologic evaluation showed a normal mental status, no movement disorders, no neck stiffness, and no focal neurologic deficit. Intervention (& Technique): Blood results revealed moderate inflammation, but a CT scan of the abdomen showed no abdominal focus of infection. Hemocultures became positive with Listeria monocytogenes the day after admission, indicating a diagnosis of Listeria sepsis. The patient was admitted to the hospital for intravenous rehydratation with a tentative diagnosis of viral gastroenteritis. After receipt of the positive hemocultures, treatment was initiated with aminopenicillin (amoxicillin 4 × 1 g per day) with good clinical result.
Listeriosis occurs more frequently in older patients than in pregnant women and still has a high mortality despite adequate treatment. Physicians, in particular geriatricians, should be aware of this potentially severe foodborne infection. In older adult consumers and long-term care facilities, recommendations for safe food handling and storage should be emphasized.
单核细胞增生李斯特菌是一种罕见的食源性病原体，可引发暴发和散发性感染。严重的全身性感染在高危人群（如孕妇）中更为普遍，但大多发生在老年人和免疫功能低下者身上。在本病例报告中，我们描述了一名老年患者单核细胞增生李斯特菌败血症的临床表现、诊断和治疗情况，并简要回顾了关于李斯特菌病的文献以及安全食品操作的重要性。
我们报告了一名患有多种合并症的养老院居民的病例，该患者出现腹部不适和发热症状。腹部检查发现弥漫性压痛，但无肌紧张或反跳痛。未报告其他神经系统症状，神经系统评估显示精神状态正常，无运动障碍，无颈部僵硬，无局灶性神经功能缺损。干预措施（&技术）：血液检查结果显示有中度炎症，但腹部CT扫描未发现腹部感染病灶。入院第二天血培养结果显示单核细胞增生李斯特菌阳性，提示诊断为李斯特菌败血症。患者因初步诊断为病毒性肠胃炎入院接受静脉补液治疗。收到血培养阳性结果后，开始使用氨基青霉素（阿莫西林，每天4次，每次1克）进行治疗，临床效果良好。
李斯特菌病在老年患者中比在孕妇中更常见，尽管治疗充分，但其死亡率仍然很高。医生，尤其是老年病医生，应意识到这种潜在的严重食源性感染。对于老年消费者和长期护理机构，应强调安全食品处理和储存的建议。
