A 66-year-old Man With Fever and Altered Mental Status: A Case Report
DOI:
https://doi.org/10.7175/cmi.v12i1.1350Keywords:
Altered Mental Status, Fever, Meningitis, Listeria monocytogenesAbstract
We describe the case of a 66-year-old man who was admitted to the Emergency Department with high fever, urinary incontinence, asthenia, and altered mental status characterized by drowsiness and lethargy from the previous night. The head CT scan was negative, while the chest X-ray showed a right basal reduced transparency and solitary pulmonary nodules already known and considered as expression of asbestosis. No acute neurological signs were observed by the consultant neurologist. A diagnosis of right basal pneumonia complicated by delirium was made and an empiric antibiotic therapy with ceftriaxone plus azithromycin was started. As patient’s conditions did not improve in the following 48 hours, a lumbar puncture was performed, with the microbiological isolation of L. monocytogenes. According to the indications of the infectious disease consultant, a new antibiotic regimen with ampicillin/sulbactam plus gentamicin was introduced. The chest CT scan performed as further examination revealed right pleural thickening highly suspicious for mesothelioma. The patient was discharged after 4 weeks with no neurological deficits.
References
Guillet C, Join-Lambert O, Le Monnier A, et al. Human listeriosis caused by Listeria ivanovii. Emerg Infect Dis 2010; 16: 136-8; https://doi.org/10.3201/eid1601.091155
Vázquez-Boland JA, Kuhn M, Berche P, et al. Listeria pathogenesis and molecular virulence determinants. Clin Microbiol Rev 2001; 14: 584-640; https://doi.org/10.1128/CMR.14.3.584-640.2001
Arslan F, Meynet E, Sunbul M, et al. The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study. Eur J Clin Microbiol Infect Dis 2015; 34: 1213-21; https://doi.org/10.1007/s10096-015-2346-5
Ooi ST, Lorber B. Gastroenteritis due to Listeria monocytogenes. Clin Infect Dis 2005; 40: 1327-32; https://doi.org/10.1086/429324
Barton Behravesh C, Jones TF, Vugia DJ, et al; FoodNet Working Group. Deaths associated with bacterial pathogens transmitted commonly through food: foodborne diseases active surveillance network (FoodNet), 1996-2005. J Infect Dis 2011; 204: 263-7; https://doi.org/10.1093/infdis/jir263
Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther 2011; 34: 1269-81; https://doi.org/10.1111/j.1365-2036.2011.04874.x
Zolin A, Amato E, D’Auria M, et al. Estimating the real incidence of invasive listeriosis through an integrated surveillance model in use in Lombardy (Italy, 2006-2014). Epidemiol Infect 2017; 145: 2072-80; https://doi.org/10.1017/S0950268817000711
de Noordhout CM, Devleesschauwer B, Angulo FJ, et al. The global burden of listeriosis: a systematic review and meta-analysis. Lancet Infect Dis 2014; 14: 1073-82; https://doi.org/10.1016/S1473-3099(14)70870-9
Doganay M. Listeriosis: clinical presentation. FEMS Immunol Med Microbiol 2003; 35: 173-5; https://doi.org/10.1016/S0928-8244(02)00467-4
Bartt R. Listeria and atypical presentations of Listeria in the central nervous system. Semin Neurol 2000; 20: 361-73; https://doi.org/10.1055/s-2000-9398
Thigpen MC, Whitney CG, Messonnier NE, et al; Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011; 364: 2016-25; https://doi.org/10.1056/NEJMoa1005384
van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351: 1849-59. Erratum in: N Engl J Med 2005; 352: 950. https://doi.org/10.1056/NEJMoa040845
Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years’ experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77: 313-36; https://doi.org/10.1097/00005792-199809000-00002
Pagliano P, Attanasio V, Rossi M, et al. Listeria monocytogenes meningitis in the elderly: distintive characteristics of the clinical and laboratory presentation. J Infect 2015; 71: 134-6; https://doi.org/10.1016/j.jinf.2015.02.003
High KP, Bradley SF, Gravenstein S, et al; Infectious Diseases Society of America. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009; 57: 375-94; https://doi.org/10.1111/j.1532-5415.2009.02175.x
Magazzini S, Nazerian P, Vanni S, et al. Clinical picture of meningitis in the adult patient and its relationship with age. Intern Emerg Med 2012; 7: 359-64; https://doi.org/10.1007/s11739-012-0765-1
Pagliano P, Ascione T, Boccia G, et al. Listeria monocytogenes meningitis in the elderly: epidemiological, clinical and therapeutic findings. Infez Med 2016; 24: 105-11
Jaton K, Sahli R, Bille J. Development of polymerase chain reaction assays for detection of Listeria monocytogenes in clinical cerebrospinal fluid samples. J Clin Microbiol 1992; 30: 1931-6
Hof H, Nichterlein T, Kretschmar M. Management of listeriosis. Clin Microbiol Rev 1997; 10: 345-57
Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39: 1267-84; https://doi.org/10.1086/425368
Merle-Melet M, Dossou-Gbete L, Maurer P, et al. Is amoxicillin-cotrimoxazole the most appropriate antibiotic regimen for listeria meningoencephalitis? Review of 22 cases and the literature. J Infect 1996; 33: 79-85; https://doi.org/10.1016/S0163-4453(96)92929-1
van de Velde S, Nguyen HA, van Bambeke F, et al. Contrasting effects of human THP-1 cell differentiation on levofloxacin and moxifloxacin intracellular accumulation and activity against Staphylococcus aureus and Listeria monocytogenes. J Antimicrob Chemother 2008; 62: 518-21; https://doi.org/10.1093/jac/dkn232
Callapina M, Kretschmar M, Dietz A, et al. Systemic and intracerebral infections of mice with Listeria monocytogenes successfully treated with linezolid. J Chemother 2001; 13: 265-9; https://doi.org/10.1179/joc.2001.13.3.265
Thønnings S, Knudsen JD, Schønheyder HC, et al. Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia. Clin Microbiol Infect 2016; 22: 725-30; https://doi.org/10.1016/j.cmi.2016.06.006
Arsene O, Linassier C, Quentin R, et al. Development of listeriosis during vancomycin therapy in a neutropenic patient. Scand J Infect Dis 1996; 28: 415-6; https://doi.org/10.3109/00365549609037930
Heyderman RS; British Infection Society. Early management of suspected bacterial meningitis and meningococcal septicaemia in immunocompetent adults--second edition. J Infect 2005; 50: 373-4; https://doi.org/10.1016/j.jinf.2005.04.002
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