Halfman Camille, Slate Luke, Yamamoto Julienne, Jones Samantha
SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York.
Clin Pract Cases Emerg Med. 2020 Nov;4(4):530-532. doi: 10.5811/cpcem.2020.7.48053.
Patients with naturally occurring, impaired cell-mediated immunity secondary to age and pregnancy are known to be at risk of developing severe and invasive Listeria monocytogenes infections. Immunosuppressant medications, particularly infliximab, are also known to increase this risk.
We present the case of a seven-year-old female on infliximab who was diagnosed with culture positive L. monocytogenes meningitis after a negative cerebral spinal fluid polymerase chain reaction (PCR).
Patients receiving infliximab who display signs of central nervous system infection should be suspected to have L. monocytogenes as an infecting agent, and empiric addition of ampicillin to their antibiotic regimen should be considered, with substitution of trimethoprim-sulfamethoxazole in cases of penicillin allergy, regardless of initial PCR results.
已知因年龄和妊娠导致细胞介导免疫自然受损的患者有发生严重侵袭性单核细胞增生李斯特菌感染的风险。免疫抑制药物，尤其是英夫利昔单抗，也会增加这种风险。
我们报告一例七岁女性患者，该患者正在接受英夫利昔单抗治疗，在脑脊液聚合酶链反应（PCR）结果为阴性后，被诊断为培养阳性的单核细胞增生李斯特菌脑膜炎。
接受英夫利昔单抗治疗且出现中枢神经系统感染迹象的患者应怀疑感染了单核细胞增生李斯特菌，应考虑在其抗生素治疗方案中经验性添加氨苄西林，对于青霉素过敏的患者，可用甲氧苄啶 - 磺胺甲恶唑替代，无论初始PCR结果如何。
