Listeria monocytogenes Meningitis

L. monocytogenes is an intracellular gram-positive bacillus that has been reported to contaminate certain foods, such as soft cheese, unpasteurized milk, raw meats and fish, processed meats, and raw vegetables. Bacteria from contaminated foods colonize the GI tract, pass into the bloodstream, and overcome natural cellular immune responses to cause infection. L. monocytogenes meningitis, usually observed in patients at extremes of age and in immunocompromised patients with depressed cellular immunity (including patients with leukemia, solid-organ transplants, and HIV/AIDS), has an overall mortality rate of up to 30%.34,35

Only a limited number of antibiotics show bactericidal activity against Listeria. The combination of high-dose ampicillin or penicillin G and an aminoglycoside is synergistic and bactericidal against Listeria. A total treatment course of at least 3 weeks is required. Because of concerns about the risk of nephrotoxicity with an extended treatment course of aminoglycosides, patients are treated with combination therapy for 10 days and may finish out the remainder of their treatment with ampicillin or penicillin alone.34 In penicillin-allergic patients, trimethoprim-sulfamethoxazole is the agent of choice due to documented in vitro bactericidal activity against Listeria, as well as good CNS penetration. Vancomycin and cephalosporins are not effective treatments for Listeria meningitis. Prophylaxis is not needed for close contacts, nor is suppressive therapy indicated. Patients with severe depression of cell-mediated immunity should be advised to avoid foods that may be contaminated with Listeria.

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