From the Yale School of Medicine (C.W.Z.), New Haven, CT; Department of Internal Medicine (C.W.Z.), St. Vincent's Medical Center, Bridgeport, CT; and Department of Neurology (S.D., Q.W.), Kunming Medical University, Yunnan, China.
Neurology. 2022 Jul 19;99(3):123-126. doi: 10.1212/WNL.0000000000200732. Epub 2022 May 4.
is a Gram-positive food-borne pathogen that causes gastrointestinal symptoms and CNS infection in susceptible hosts. Two lineages of cause the majority of neurolisteriosis in humans. In this report, we discuss a case of a 23-year-old previously healthy woman who presented with acute-onset rapidly progressive altered mental status after eating undercooked meats at a local restaurant. Given her age and lack of comorbidities, bacterial meningitis was suspected, and she was treated with ceftriaxone, vancomycin, and steroids. MRI of the brain was consistent with meningitis and ventriculitis; CSF analysis also suggested bacterial meningitis. Despite mechanical ventilation, pressors, and ventricular drain placement, she quickly decompensated and died 12 hours after arrival. CSF culture later returned positive for We used whole-genome sequencing and near-source comparison to identify the subtype that led to her unexpected presentation. The results suggest that her CSF isolate was consistent with a lineage II serotype, which is known to exhibit greater genetic variation than the more commonly isolated lineage I serotypes. We conclude the discussion with diagnostic and treatment approaches to neurolisteriosis. In susceptible hosts, namely immunocompromised, pregnant, neonatal, or elderly patients, infection may result in CNS invasion, causing meningoencephalitis and, rarely, ventriculitis and rhombencephalitis. Although neurolisteriosis most commonly affects individuals with known risk factors, CNS infection is nevertheless possible in otherwise healthy young patients. Suspicion should be raised in patients with an exposure history who do not improve with empiric antibiotics.
李斯特菌是一种革兰氏阳性食源性病原体，可导致易感宿主出现胃肠道症状和中枢神经系统感染。两种谱系的李斯特菌导致了人类大多数的李斯特菌病。在本报告中，我们讨论了一例 23 岁的既往健康女性，在当地一家餐馆食用未煮熟的肉类后出现急性发作的迅速进展性意识改变。鉴于她的年龄和无合并症，细菌性脑膜炎被怀疑，她接受了头孢曲松、万古霉素和类固醇治疗。脑部 MRI 与脑膜炎和脑室炎一致；CSF 分析也提示细菌性脑膜炎。尽管进行了机械通气、升压药和脑室引流，但她在入院后 12 小时迅速恶化并死亡。CSF 培养后来对李斯特菌呈阳性。我们使用全基因组测序和近源比较来确定导致她意外表现的李斯特菌血清型。结果表明，她的 CSF 分离株与谱系 II 血清型一致，该血清型已知比更常见的分离谱系 I 血清型具有更大的遗传变异。我们以李斯特菌病的诊断和治疗方法结束讨论。在易感宿主中，即免疫功能低下、孕妇、新生儿或老年患者中，李斯特菌感染可能导致中枢神经系统侵袭，引起脑膜脑炎，很少引起脑室炎和脑桥脑炎。尽管李斯特菌病最常影响有已知危险因素的个体，但中枢神经系统感染在其他健康的年轻患者中也是可能的。对于没有因经验性抗生素而改善的有暴露史的患者，应提高警惕。
