Listeria monocytogenes multifokalni cerebritis kod imunokompetentnog bolesnika
Sažetak
Uvod. Multifokalni cerebritis koji uzrokuje Listeria monocytogenes je retko i teško oboljenje koje je u literaturi opisano samo u nekoliko slučajeva. Prikaz bolesnika. Bolesnik star 64 godine primljen je u bolnicu poremećene svesti (Glasgow Coma Scale skor: 9) nakon 16 dana prethodne febrilnosti, glavobolje i bola u desnom uvu. Nije imao drugih prethodnih bolesti, niti je bio imunokompromitovan. Dobijen je podatak o alergiji na penicilin. Pri neurološkom pregledu nisu evidentirani meningealni znaci i fokalni neurološki poremećaji, a snimak endokranijuma kompjuterizovanom tomografijom sa kontrastom pokazao je tri hipodenzne zone u okcipitalnom i jednu u desnom temporalnom lobusu. Laboratorijski nalazi u krvi i cerebrospinalnoj tečnosti upućivali su na infektivnu prirodu promena u endokranijumu (multifokalni cerebritis). Incijalna terapija bila je kombinacija cefotaksima, amikacina i metronidazola, a nakon izolacije L. monocytogenes u kulturi cerebrospinalne tečnosti i hemokulturi, terapija je zamenjena ko-trimoksazolom. Oporavak stanja svesti sa uspostavljanjem budno-svesnog stanja nastupio je nakon šest dana od primene ko-trimoksazola. Ukupno trajanje terapije ko-trimoksazolom iznosilo je 36 dana. U tom periodu normalizovali su se svi klinički i laboratorijski parametri. Bolesnik je otpušten kao oporavljen, sa sekvelama amnezije i usporenog govora. Zaključak. U lečenju multifokalnog cerebritisa uzrokovanog L. monocytogenes neophodan je adekvatan izbor i dugotrajna primena antibiotske terapije. Lek izbora je ampicilin, ali u slučaju alergije na njega, ko-trimoksazol predstavlja dobru zamenu.
Reference
Cone LA, Leung MM, Byrd RG, Annunziata GM, Lam RY, Herman BK. Multiple cerebral abscesses because of Listeria monocytogenes: three case reports and a literature review of supratentorial listerial brain abscess(es). Surg Neurol 2003; 59(4): 320–8.
Watson GW, Fuller TJ, Elms J, Kluge RM. Listeria cerebritis: re-lapse of infection in renal transplant patients. Arch Intern Med 1978; 138(1): 83–7.
Haykal H, Zamani A, Wang A, Barsotti J. CT features of early Listeria monocytogenes cerebritis. AJNR Am J Neuroradiol 1987; 8(2): 279–82.
Salata RA, King RE, Gose F, Pearson RD. Listeria monocyto-genes cerebritis, bacteremia, and cutaneous lesions complicat-ing hairy cell leukemia. Am J Med 1986; 81(6): 1068–72.
Aladro Y, Ponce P, Santullano V, Angel-Moreno A, Santana MA. Cerebritis due to Listeria monocytogenes: CT and MR find-ings. Eur Radiol 1996; 6(2): 188.
Mylonakis E, Hohmann EL, Calderwood SB. Central nervous sys-tem infection with Listeria monocytogenes 33 years' experi-ence at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77(5): 313–36.
Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis 2017; 17(5): 510–9.
Seeliger H. Listeriose. In: Habs H, Kathe J. Beiträge zur Hygiene und Epidemiologie. Leipzig: Barth JA Verlag; 1955.
Duncan JM. Listeria and psychiatric syndromes. Br J Psychiatry 1989; 154: 887.
Kellner M, Sonntag A, Strian F. Psychiatric sequelae of listerio-sis. Br J Psychiatry 1990; 157: 299.
Nielsen H, Gyldensted C, Harmsen A. Cerebral abscess: aetiolo-gy and pathogenesis, symptoms, iagnosis and treatment. A re-view of 200 cases from 1935-1976. Acta Neurol Scand 1982; 65(6): 609–22.
Dee RR, Lorber B. Brain abscess due to Listeria monocyto-genes: case report and literature review. Rev Infect Dis 1986; 8(6): 968–77.
Antal EA, Loberg EM, Bracht P, Melby KK, Maehlen J. Evidence for intraaxonal spread of Listeria monocytogenes from the pe-riphery to the central nervous system. Brain Pathol 2001; 11(4): 432–8.
Michelet C, Leib SL, Bentue-Ferrer D, Täuber MG. Comparative efficacies of antibiotics in a rat model of meningoencephalitis due to Listeria monocytogenes. Antimicrob Agents Chemoth-er 1999; 43(7): 1651–6.
Patel K, Clifford DB. Bacterial brain abscess. The Neurohospi-talist 2014; 4(4): 196–204.
Rouquette C, Berche P. The pathogenesis of infection by Listeria monocytogenes. Microbiologia 1996; 12(2): 245–58.
Reynaud L, Graf M, Gentile I, Cerini R, Ciampi R, Noce S, et al. A rare case of brainstem encephalitis by Listeria monocyto-genes with isolated mesencephalic localization. Case report and review. Diagn Microbiol Infect Dis 2007; 58: 121–3.
Join-Lambert OF, Ezine S, Le Monnier A, Jaubert F, Okabe M, Berche P, et al. Listeria monocytogenes-infected bone marrow myeloid cells promote bacterial invasion of the central nerv-ous system. Cell Microbiol 2005; 7(2): 167–80.
Marget W, Seeliger HP. Listeria monocytogenes infections: therapeutic possibilities and problems. Infection 1988; 16(Suppl 2): S175–7.
Lorber B. Listeriosis. Clin Infect Dis 1997; 24(1): 1–9; quiz 10–1.
Temple ME, Nahata MC. Treatment of Listeriosis. Ann Phar-macother 2000; 34(5): 656–61.
Spitzer PG, Hammer SM, Karchmer AW. Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev Infect Dis 1986; 8(3): 427–30.
Wacker P, Ozsahin H, Groll AH, Gervaix A, Reinhard L, Hum-bert J. Trimethoprim-sulfamethoxazole salvage for refractory listeriosis during maintenance chemotherapy for acute lym-phoblastic leukemia. J Pediatr Hematol Oncol 2000; 22(4): 340–3.
Al-Khatti AA, Al-Tawfiq JA. Listeria monocytogenes brain ab-scess in a patient with multiple myeloma. J Infect Dev Ctries 2010; 4(12): 849–51.
Polat M, Kara SS, Tapısız A, Derinöz O, Çağlar K, Tezer H. Suc-cessful treatment of refractory listeria meningitis and bactere-mia with trimethoprim-sulfamethoxazole in an immunocom-petent child. Turkish J Pediatr 2016; 58(2): 220–2.
Merle-Melet M, Dossou-Gbete L, Maurer P, Meyer P, Lozniewski A, Kuntzburger O, et al. Is amoxicillin-cotrimoxazole the most appropriate antibiotic regimen for listeria meningoencephali-tis? Review of 22 cases and the literature. J Infect 1996; 33(2): 79–85.
Beach JE, Perrott J, Turgeon RD, Ensom MH. Penetration of vancomycin into the cerebrospinal fluid: a systematic review. Clin Pharmacokinet 2017; 56(12): 1479–90.
Pagliano P, Arslan F, Ascione T. Epidemiology and treatment of the commonest form of listeriosis: meningitis and bacteraemia. Infez Med 2017; 25(3): 210–6.