Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report

<p>Abstract</p> <p>Introduction</p> <p>The mortality of listerial rhombo-encephalitis exceeds 26% and may involve otherwise healthy patients. A case is presented of a man with fatal listerial infection of the central nervous system that was monitored in an intensive car...

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Main Authors: Karakitsos Dimitrios, Samonis George, Georgountzos Vasilios, Karabinis Andreas
Format: Article
Language:English
Published: BMC 2009-06-01
Series:Journal of Medical Case Reports
Online Access:http://www.jmedicalcasereports.com/content/3/1/7383
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spelling doaj-dc767ab4f3144f2f8f72cbde5242d5b82020-11-24T22:16:23ZengBMCJournal of Medical Case Reports1752-19472009-06-0131738310.4076/1752-1947-3-7383Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case reportKarakitsos DimitriosSamonis GeorgeGeorgountzos VasiliosKarabinis Andreas<p>Abstract</p> <p>Introduction</p> <p>The mortality of listerial rhombo-encephalitis exceeds 26% and may involve otherwise healthy patients. A case is presented of a man with fatal listerial infection of the central nervous system that was monitored in an intensive care unit.</p> <p>Case presentation</p> <p>A 42-year-old, previously healthy man was admitted with fever of 39°C, blurred vision, confusion and headache. He had right-sided central facial paresis, bilateral absent gag reflex and bilateral cerebellar ataxia. After a few hours, he became septic and developed bilateral vocal cord paralysis and airway obstruction. He was intubated and put on mechanical ventilation. Computed tomography brain scans revealed multiple frontal hypodense areas and slight hydrocephalus. Cerebrospinal fluid findings included pleocytosis of 4200 cells/μL (77% neutrophils), protein of 114 mg/dL and normal glucose levels. Listerial infection was suspected; therefore ampicillin was added to his initial therapeutic regimen, already including ceftriaxone and gentamicin. All cultures were negative, and no immunologic abnormality could be documented, but the patient's clinical condition deteriorated rapidly. Continuous neuromonitoring by means of transcranial Doppler and optic nerve sonography along with follow-up computed tomography brain scans confirmed the severity of the brain damage; hence, dexamethasone and mannitol were also administered. The patient was clinically documented as 'brain dead' 7 days after his admission to the intensive care unit; thereafter, blood- and post-mortem brain tissue cultures grew <it>Listeria monocytogenes</it>.</p> <p>Conclusion</p> <p>This case report illustrates the importance of neuromonitoring in patients with severe brain damage. We also show that, despite prompt antibiotic treatment and dexamethasone administration, listerial infection of the central nervous system can be lethal.</p> http://www.jmedicalcasereports.com/content/3/1/7383
collection DOAJ
language English
format Article
sources DOAJ
author Karakitsos Dimitrios
Samonis George
Georgountzos Vasilios
Karabinis Andreas
spellingShingle Karakitsos Dimitrios
Samonis George
Georgountzos Vasilios
Karabinis Andreas
Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
Journal of Medical Case Reports
author_facet Karakitsos Dimitrios
Samonis George
Georgountzos Vasilios
Karabinis Andreas
author_sort Karakitsos Dimitrios
title Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
title_short Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
title_full Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
title_fullStr Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
title_full_unstemmed Fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
title_sort fulminant listerial infection of the central nervous system in an otherwise healthy patient: a case report
publisher BMC
series Journal of Medical Case Reports
issn 1752-1947
publishDate 2009-06-01
description <p>Abstract</p> <p>Introduction</p> <p>The mortality of listerial rhombo-encephalitis exceeds 26% and may involve otherwise healthy patients. A case is presented of a man with fatal listerial infection of the central nervous system that was monitored in an intensive care unit.</p> <p>Case presentation</p> <p>A 42-year-old, previously healthy man was admitted with fever of 39°C, blurred vision, confusion and headache. He had right-sided central facial paresis, bilateral absent gag reflex and bilateral cerebellar ataxia. After a few hours, he became septic and developed bilateral vocal cord paralysis and airway obstruction. He was intubated and put on mechanical ventilation. Computed tomography brain scans revealed multiple frontal hypodense areas and slight hydrocephalus. Cerebrospinal fluid findings included pleocytosis of 4200 cells/μL (77% neutrophils), protein of 114 mg/dL and normal glucose levels. Listerial infection was suspected; therefore ampicillin was added to his initial therapeutic regimen, already including ceftriaxone and gentamicin. All cultures were negative, and no immunologic abnormality could be documented, but the patient's clinical condition deteriorated rapidly. Continuous neuromonitoring by means of transcranial Doppler and optic nerve sonography along with follow-up computed tomography brain scans confirmed the severity of the brain damage; hence, dexamethasone and mannitol were also administered. The patient was clinically documented as 'brain dead' 7 days after his admission to the intensive care unit; thereafter, blood- and post-mortem brain tissue cultures grew <it>Listeria monocytogenes</it>.</p> <p>Conclusion</p> <p>This case report illustrates the importance of neuromonitoring in patients with severe brain damage. We also show that, despite prompt antibiotic treatment and dexamethasone administration, listerial infection of the central nervous system can be lethal.</p>
url http://www.jmedicalcasereports.com/content/3/1/7383
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