CNS listeriosis

Stephen F Overcash (Mr. Overcash of Indiana School of Medicine has no relevant financial relationships to disclose.)
Karen L Roos MD FAAN, editor. (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)
Originally released September 21, 1998; last updated January 24, 2017; expires January 24, 2020

This article includes discussion of CNS listeriosis, listerial meningitis, listerial encephalitis, listerial rhombencephalitis, listerial cerebritis, and listerial brain abscess. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Meningitis is the most common CNS infection caused by Listeria monocytogenes, but it can also cause encephalitis, cerebritis, and abscess formation. In this updated article, the author discusses the epidemiology, clinical manifestations, diagnosis, and treatment of CNS listeriosis. This update includes a review of epidemiological data and a discussion of data indicating that the rate of Listeria infection appears to be decreasing. Also included are new data regarding pathogenesis, prognosis, complications, and recommendations for management of pregnant patients with suspected listeriosis. High-risk foods are highlighted along with recommendations on the prevention of this infection in at-risk groups, such as neonates, the elderly, pregnant women, and immunocompromised patients.

Key points

 

• The most common CNS infection caused by Listeria monocytogenes is meningitis, though rhombencephalitis, encephalitis, cerebritis, and abscess also occur.

 

• Neonates, the elderly, pregnant women, and immunocompromised patients are at highest risk of developing listerial meningitis, though a notable minority of patients is without risk factors.

 

• In contrast to other forms of listerial infection, rhombencephalitis typically affects healthy adults, and CSF cell count can sometimes be normal.

 

• Clinical manifestations of CNS listeriosis depend on the involved neuroanatomy but commonly include fever, headache, altered sensorium, nuchal rigidity, hemiplegia, cranial nerve palsies, and seizure.

 

• The standard treatment for CNS listeriosis in adults is ampicillin 2 g IV every 4 hours with or without gentamicin for synergy.

Historical note and terminology

Listeria monocytogenes has long been recognized as a veterinary pathogen causing basilar meningitis and stillbirth in sheep and cattle. It was first described as human pathogen in a patient with a mononucleosis-like syndrome in 1929 (Nyfeldt 1929).

Meningitis due to L monocytogenes was described in 1936, but the first authentic isolation came from a World War I soldier in 1918. His meningitis was attributed to a diphtheroid species. However, the original culture was preserved at the Pasteur Institute in Paris and was identified 20 years later as L monocytogenes. This historical note provides an important reminder that L monocytogenes is sometimes confused and dismissed as a diphtheroid contaminant because of morphological, colonial, and biochemical similarities. A 1949 German epidemic of “granulomatosis infantisepticum” led to the discovery that L monocytogenes caused this severe neonatal infection (Hof 2003). Brainstem encephalitis due to Listeria was first described in 1957 (Eck 1957). The first foodborne outbreak of listeriosis was attributed to infected vegetables in a Boston Hospital in 1979 (Gellin and Broome 1989).

This gram-positive bacterium has been known by many names, including Listerella hepatolytica, Corynebacterium infantisepticum, Corynebacterium parvulum, and Erysipelothrix monocytogenes. In 1940 taxonomists reached a general agreement to call the species Listeria monocytogenes in honor of the father of antisepsis, Lord Lister (Seeliger 1961).

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