Tiri Beatrice, Priante Giulia, Saraca Lavinia Maria, Martella Lucia Assunta, Cappanera Stefano, Francisci Daniela
Infectious Diseases Clinic, Department of Medicine, University of Perugia, Perugia, Italy.
Infectious Diseases Clinic, Department of Medicine, "S. Maria" Hospital, Terni, Italy.
Case Rep Infect Dis. 2018 Jul 24;2018:6549496. doi: 10.1155/2018/6549496. eCollection 2018.
(LM) is an opportunistic pathogen, and the most common central nervous system manifestation is meningitis while listerial brain abscesses are rare. We describe 2 cases of brain abscess due to LM and a literature review. Only 73 cases were reported in the literature from 1968 to 2017. The mean age was 51.9, and the mortality rate was 27.3%. In 19% of cases, no risk factors for neurolisteriosis were identified. Blood cultures were positive in 79.5% while CSF or brain abscess biopsy material was positive in 50.8%. In 40% was started a monotherapy regimen while in 60% a combination therapy without substantial differences in mortality. Fifty-two percent underwent neurosurgery while 45.3% has been treated only with medical therapy. The mortality rates were, respectively, 13% and 38.2%. Only 25% of patients who were treated for ≤6 weeks underwent neurosurgery, while 80% of those who were treated for ≥8 weeks were operated. The mortality rates were, respectively, 12.5% and 0%, suggesting that a combined approach of surgery and prolonged medical therapy would have an impact on mortality. We believe that it is essential to carry out this review as brain abscesses are rare, and there are no definitive indications on the optimal management, type, and duration of therapy.
单核细胞增生李斯特菌（LM）是一种机会致病菌，最常见的中枢神经系统表现是脑膜炎，而李斯特菌脑脓肿较为罕见。我们描述了2例由LM引起的脑脓肿病例并进行文献综述。1968年至2017年的文献中仅报道了73例。平均年龄为51.9岁，死亡率为27.3%。在19%的病例中，未发现神经李斯特菌病的危险因素。血培养阳性率为79.5%，而脑脊液或脑脓肿活检材料阳性率为50.8%。40%的患者开始采用单一疗法，60%采用联合疗法，死亡率无显著差异。52%的患者接受了神经外科手术，45.3%仅接受药物治疗。死亡率分别为13%和38.2%。治疗≤6周的患者中只有25%接受了神经外科手术，而治疗≥8周的患者中有80%接受了手术。死亡率分别为12.5%和0%，这表明手术和延长药物治疗的联合方法会对死亡率产生影响。我们认为进行这项综述很有必要，因为脑脓肿很罕见，而且在最佳治疗管理、治疗类型和持续时间方面没有明确的指征。
