Listeria monocytogenes multifocal cerebritis in an immunocompetent adult

Branko Milosevic, Aleksandar Urosevic, Natasa Nikolic, Ivana Milosevic, Jasmina Poluga, Tanja Tosic, Milica Jovanovic
2018 Vojnosanitetski Pregled  
Kratak naslov rada: Listeria monocytogenes cerebritis Pojedinačan doprinos koautora u pisanju i objavljivanju rada: Branko Milošević-lečenje bolesnika, osmišljavanje i pisanje rada Aleksandar Urošević-lečenje bolesnika, pronalaženje literature Nataša Popović-pisanje apstrakta, saradnja pri pisanju rada Ivana Milošević-korekcije jezika, saradnja pri pisanju rada Jasmina Poluga-tehničko uređivanje rada, korekcije jezika Tanja Tošić-dijagnostika mikroorganizma, pronalaženje literature Milica
more » ... rature Milica Jovanović-dijagnostika mikroorganizma, pisanje rada 3 Listeria monocytogenes multifocal cerebritis in an immunocompetent adult Abstract Introduction: Multifocal cerebritis is a rare and severe disease and so far, only few cases caused by Listeria monocytogenes were described in the literature. Case report:A 64 year old man was admitted to the hospital with consciounsness impairment (GlasgowComaScale: 9) after being febrile for 16 days with history of headache and middle ear pain. The patient was allergic to penicillin. He did not have any comorbidities and was not immunocompromised. Neurological exam revealed no positive meningeal or focal neurologic signs but computed tomography of the brain with contrast injection showed three hypodense zones in the occipital and one in the right temporal lobe. Laboratory findings in blood and cerebrospinal fluid (CSF) were indicative of the infectious aetiology of changes in the endocranium (multifocal cerebritis). Initial therapy was the combination of cefotaxime, amikacin and metronidazole, but after the isolation of L.monocytogenes from CSF and blood culture therapy was switched to co-trimoxazole. Recovery of consciousness with establishment of alert state has occurred after 6 days of cotrimoxazole administration. The total duration of therapy was 36 days, during which the patient recovered and all laboratory parameters normalized. The patient was discharged recovered, with sequelas such as amnesia and slurred speech. Conclusion: In the treatment of multifocal cerebritis caused by L.monocytogenes, adequate and prolonged antibiotic therapy is essential. The drug of choice is amoxicillin but in the case of penicillin allergy co-trimoxazole is a good replacement. Listeria monocytogenes multifokalni cerebritis kod imunokompetentnog bolesnika Apstrakt Uvod. Multifokalni cerebritis koji uzrokuje Listeria monocytogenes je retko i teško oboljenje koje je u literaturi opisano samo u nekoliko slučajeva. Prikaz bolesnika. Pacijent star 64 godine primljen je u bolnicu poremećene svesti (Glasgow Coma Scale: 9) nakon 16 dana prethodne febrilnosti, glavobolje i bola u desnom uvu. Nije imao drugih prethodnih bolesti, nije bio imunokompromitovan. Dobijen je podatak o alergiji na penicilin. Pri neurološkom pregledu nisu evidentirani meningealni 4 znaci i fokalni neurološki poremećaji, a snimak endokranijuma kompjuterizovanom tomografijom sa kontrastom je pokazao 3 hipodenzne zone u okcipitalnom i jednu u desnom temporalnom lobusu. Laboratorijski nalazi u krvi i cerebrospinalnoj tečnosti su upućivali na infektivnu prirodu promena u endokranijumu (multifokalni cerebritis). Incijalna terapija je bila kombinacija cefotaxima, amikacina i metronidazola, a nakon izolacije Listeria monocytogenes u kulturi cerebrospinalne tečnosti i hemokulturi, terapija je zamenjena ko-trimoksazolom. Ukupno trajanje terapije je bilo 36 dana. Oporavak stanja svesti sa uspostavljanjem budno-svesnog stanja je nastupio nakon 6 dana od primene kotrimoksazola. Ukupno trajanje terapije ko-trimoksazolom je bilo 36 dana, za koje vreme su se normalizovali klinički i laboratorijski parametri. Pacijent je otpušten kao oporavljen,sa sekvelama amnezije i usporenog govora. Zaključak. U lečenju multifokalnog cerebritisa uzrokovanog L.monocytogenes neophodni su adekvatan izbor i dugotrajna primena antibiotske terapije. Lek izbora je ampicilin ali u slučaju alergije ko-trimoksazol je dobra zamena.
doi:10.2298/vsp180619146m fatcat:ryhta2svqjaanin5ikzvqj6ixm