Kraus A, Cabral A R, Sifuentes-Osornio J, Alarcón-Segovia D
Department of Immunology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
J Rheumatol. 1994 Apr;21(4):635-8.
Patients with connective tissue diseases (CTD) are prone to infections, either from the disease itself or secondary to treatment. The incidence of listeriosis in immunosuppressed patients is increasing. We therefore evaluated the frequency of listeriosis, an otherwise rarely reported infection in the rheumatologic literature, in patients with CTD.
Retrospective analysis of listeria positive cultures in patients with CTD between 1982 and 1992 at a tertiary care center in Mexico City.
We identified 8 patients: 7 with systemic lupus erythematosus and one with dermatomyositis. At the time of the infection, 5 had active disease, 6 were receiving prednisone and/or other immunosuppressive drugs and 2 were receiving hemodialysis. L. monocytogenes was isolated from cerebrospinal fluid (5 patients), from blood (one patient) and from both sites (2 patients). Patients had bacteremia without a known focus of infection or meningitis as the 2 most common clinical forms of listeriosis. In spite of appropriate antibiotic therapy, 4 patients died.
As in other immunosuppressed individuals, listeriosis is an aggressive infection in patients with CTD. Although rare, listeriosis should be included in the differential diagnosis of meningitis in patients with CTD and appropriate aggressive therapy rapidly instituted. To determine its frequency in rheumatic patients, multicentric prospective studies are required.
结缔组织病（CTD）患者易于发生感染，这或是源于疾病本身，或是继发于治疗。免疫抑制患者中李斯特菌病的发病率正在上升。因此，我们评估了CTD患者中李斯特菌病（一种在风湿病学文献中鲜有报道的感染）的发生频率。
对1982年至1992年间墨西哥城一家三级护理中心的CTD患者中李斯特菌阳性培养物进行回顾性分析。
我们确定了8例患者：7例患有系统性红斑狼疮，1例患有皮肌炎。在感染时，5例患者疾病处于活动期，6例正在接受泼尼松和/或其他免疫抑制药物治疗，2例正在接受血液透析。从脑脊液中分离出单核细胞增生李斯特菌（5例患者），从血液中分离出（1例患者），从这两个部位均分离出（2例患者）。患者以无已知感染灶的菌血症或脑膜炎作为李斯特菌病最常见的两种临床形式。尽管进行了适当的抗生素治疗，仍有4例患者死亡。
与其他免疫抑制个体一样，李斯特菌病在CTD患者中是一种侵袭性感染。尽管罕见，但在CTD患者脑膜炎的鉴别诊断中应考虑李斯特菌病，并应迅速开始适当的积极治疗。为确定其在风湿病患者中的发生频率，需要进行多中心前瞻性研究。
