Infection and Drug Resistance (Sep 2023)

Clinical Characteristics and Treatment of Listeria monocytogenes Infections in the Central Nervous System

  • Xu X,
  • Shan Y,
  • Cen Y,
  • Zhao J,
  • Yang X,
  • Liu R,
  • Tan Q,
  • Ma Y,
  • He M,
  • Zhang J,
  • Yang F,
  • Yu S

Journal volume & issue
Vol. Volume 16
pp. 5899 – 5909

Abstract

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Xiaojiao Xu,1,2 Yuheng Shan,3 Yuying Cen,2,4 Jiahua Zhao,2,4 Xiaosa Yang,2,4 Rui Liu,1,2 Qingche Tan,2 Yubao Ma,2 Mianwang He,2 Jiatang Zhang,1,2,4 Fei Yang,2 Shengyuan Yu2 1School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China; 2Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 3Department of Neurology, Characteristic Medical Centre of People’s Armed Police Force, Tianjin, 300162, People’s Republic of China; 4Medical School of Chinese PLA, Beijing, 100853, People’s Republic of ChinaCorrespondence: Jiatang Zhang; Fei Yang, Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People’s Republic of China, Tel +86 13601380322 ; Tel +86 13910973120, Email [email protected]; [email protected]: Listeria monocytogenes infections are rare in the central nervous system (CNS) and frequently difficult-to-diagnose. Our goal is to assess CNS listeriosis patients’ clinical characteristics, diagnosis, treatment, and prognosis.Patients and Methods: Patients with CNS listeriosis admitted to the Department of neurology, the first medical center of the Chinese PLA general hospital, were enrolled in this study from March 2018 to August 2022.Results: This study analyzed eight adults, including five males and three females. The average age of onset was (50.25 ± 11.52) years. The clinical manifestations included fever, headache, altered mental status, vomiting, seizures, neck rigidity, hemiplegia and cranial nerve palsies. Cerebrospinal fluid (CSF) tests revealed intracranial hypertension, elevated cell count and protein concentration, and decreased glucose levels. The positive rates of blood and CSF culture were 40% and 28.57%, respectively. All patients underwent CSF metagenomic next-generation sequencing (mNGS), with a 100% positive rate and the specific read number 12– 20394. Magnetic resonance imaging (MRI) exhibited leptomeningitis, meningoencephalitis, and brain abscess, and no specific changes were discovered in two patients. All patients received antibiotic treatment, seven were cured, and one died.Conclusion: Monitoring the proportion of monocytes in blood and mNGS results of CSF can play a crucial role in diagnosing pathogens. Early and sufficient application of two to three sensitive antibiotics with a BBB permeability of 20– 30% for at least 2– 3 months can significantly improve CNS listeriosis prognosis.Keywords: Listeria monocytogenes, central nervous system, CNS, clinical characteristics, treatment, metagenomic next-generation sequencing, mNGS

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