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

Abstract

Purpose

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

Data Sharing Statement

The datasets are available from the corresponding author on reasonable request.

Ethical Approval

This study was conducted with the approval of the ethics committee of Chinese PLA General Hospital and followed the relevant provisions of the Helsinki Declaration of the World Medical Congress. The research only uses the previous medical record information and has removed the relevant personal information of the subject, which will not cause risks to the subject and will not have adverse effects on the rights and health of the subject, and the application for exemption of informed consent is approved at the same time. We will make every effort to protect the privacy and personal information of the subject’s personal medical data within the scope permitted by law.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.