|Year : 2014 | Volume
| Issue : 3 | Page : 197-198
Listeria monocytogenes meningitis in an elderly, alcoholic male
Meena Dias, TK Sukumar, Damodharan Tina
Department of Microbiology, Fr Muller Medical College, Mangalore, Karnataka, India
|Date of Web Publication||13-Aug-2014|
S-3, Casa Leila, S.L. Mathias Road, Falnir, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
Listeriosis is a zoonotic infection seen normally in herd animals. Humans can be infected by consumption of raw meat, fish, milk, vegetables or canned refrigerated foods. There are many reports of listeriosis in pregnant females, neonates and immune-compromised individuals. However, due to limited clinical suspicion in India, only a few cases has been reported, most of them in neonates. We report here a case of Listeria meningitis in an elderly alcoholic male who was treated successfully with ampicillin and vancomycin.
Keywords: Alcoholic, elderly, Listeria monocytogenes
|How to cite this article:|
Dias M, Sukumar T K, Tina D. Listeria monocytogenes meningitis in an elderly, alcoholic male. Int J Health Allied Sci 2014;3:197-8
|How to cite this URL:|
Dias M, Sukumar T K, Tina D. Listeria monocytogenes meningitis in an elderly, alcoholic male. Int J Health Allied Sci [serial online] 2014 [cited 2018 Apr 26];3:197-8. Available from: http://www.ijhas.in/text.asp?2014/3/3/197/138607
| Introduction|| |
Listeria monocytogenes , a cause of listeriosis, is a worldwide zoonotic pathogen. All members of the genus Listeria are widely distributed in nature and have been isolated from soil, vegetation, sewage, water, animal feed, fresh, and frozen meat, slaughterhouse wastes and the feces of healthy animals. Thus, farm animals and their environment may present an important source of food contamination and infections for humans.  Majority of patients with listeriosis do have an underlying condition which predisposes to infection by interfering with T cell-mediated immunity  like pregnant women, neonates, alcoholics, drug abusers, diabetics, patients receiving treatments which alter their natural immunity, AIDS patients, patients with malignancy and the elderly. Due to globalization, improved international trade in food and its products and increased tourism listeriosis is an emerging infection in India, though the exact magnitude of the problem is lacking due to limited information in the absence of disease surveillance system. Of late, there are increase reports of sporadic cases on the incidence of L. monocytogenes in clinical and food samples. ,,, Most of them are reported from mothers and neonates except for one in young adult.  We report a rare case of Listeria meningitis caused by L. monocytogenes, isolated from cerebrospinal fluid (CSF) of the elderly, alcoholic male patient.
| Case report|| |
A 70-year-old, chronic alcoholic male patient who presented with altered sensorium for 2 days. Signs of meningitis were positive. There was no history of diabetes mellitus, hypertension or any other chronic debilitating disorders. His liver function tests and kidney function tests were within normal limits. CSF was sent for biochemical, pathological and microbiological analysis. On gross examination CSF was turbid, white blood cell count was 2860 cells/mm 3 , CSF glucose was 148 mg/dl and protein was increased to 914.7 mg/dl. Gram's-stain of the CSF showed numerous mononuclear cells with occasional Gram-positive, short nonsporing bacillus. The CSF was inoculated onto blood agar (BA), Chocolate agar (CA) and MacConkey agar (MA). A small amount of CSF was inoculated into BACTEC™ Peds Plus™/F vials. After 24 h of incubation, there was no growth on BA, CA and MA but BACTEC flagged positive in 12 h which showed Gram-positive, short, nonsporing bacilli with a diptheroid like arrangement. It was sub cultured on BA, CA, and MA. BA showed translucent colonies with minimal β hemolysis. No growth was seen on MA. The bacterium was catalase positive, oxidase negative, showed turbidity in peptone water and grew at 4°C. It showed tumbling motility at 25°C but was nonmotile at 37°C. Umbrella shaped motility pattern was observed in mannitol motility medium. CAMP test using ATCC strain 25923 of Staphylococcus aureus was positive and negative with Rhodococcus. Hydrolyzed esculin, methyl red and Voges-Proskaeur test positive. It fermented glucose and rhamnose but not xylose. Based on these tests, the isolate was identified as L. monocytogenes.  The isolate was sensitive to ampicillin, cotrimoxazole, vancomycin, gentamicin and resistant to cephalosporin. The patient was empirically treated with ceftriaxone 1 g bd and ampicillin 1 g tid but after the sensitivity report, the treatment was continued with ampicillin 1 g tid and vancomycin 500 mg bd. After an uneventful hospital stay the patient stabilized and discharged.
| Discussion|| |
Listeriosis may account for 10% of community acquired meningitis, however majority of these cases occur in newborn, pregnant women and elderly patients with compromised immune status.  Our patient is immunocompromised as he was old and also a chronic alcoholic. The characteristic feature of this bacterium is its ability to survive for long periods of time in the environment (soil, plants, and water), on foods, and in food processing plants, and its ability to grow at very low temperature (2°C to 4°C) and to survive in or on food for prolonged periods under adverse conditions.  A study from Mangalore reported the highest incidence of isolation from seafood, especially the raw fish.  Mangalore being a coastal city and fish being a staple food, and it is stored under refrigeration can pose a major risk factor for transmission. We conclude our patient must have acquired infection from the fish and being alcoholic and elderly was prone to infection. We could not carryout surveillance in the affected area due to limited resources.
For treating L. monocytogenes infection, combination therapy of ampicillin and gentamicin is recommended. One should remember that it is always resistant to cephalosporins which are frequently used in the empirical treatment of bacterial meningitis of unknown etiology. 
Because of morphological resemblance of diptheroid species, L. monocytogenes could be regarded as a contaminant unless it is suspected. We faced the same challenge when it was sent on 1 st day, CSF showed gram variable short bacilli and growth was positive in BACTEC that showed Gram-positive short bacilli with diptheroid arrangement, this was discarded as it was mistaken for contamination. After alerted by the treating physician on the 5 th day, the second sample of CSF was processed, and Listeria was isolated. Hence, the importance of detailed history with good communication between the treating physicians cannot be over emphasized for microbiologists. In our case, sensitivity of BACTEC proved better than routine conventional culture for CSF. High degree of alert is essential among clinicians and microbiologists whenever gram variable or Gram-positive bacteria are noticed on Gram-stain.
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