Immunosuppression of any kind is a known risk factor for infection with
We report the case of a 57-year old man diagnosed with liver cirrhosis Child-Turcotte-Pugh C resulting from chronichepatitis C. He underwent liver transplantation in June 2007, at a transplantation center in Germany. The operation itself was uneventful and no complications were reported after surgery. Furthermore the preexistent hepato-renal syndrome resolved after transplantation. His immunosuppressive medication included tacrolimus (2
In August 2007 the patient was admitted to our hospital because of impaired consciousness since the previous day. In our emergency ward elevated body temperature was noticed and shortly after admittance the patient suffered a focal epileptic seizure accompanied by worsening of the mental status and the respiratory situation. He became unconscious and had to be transferred to our intensive care unit. For further evaluation a lumbar puncture was performed. The laboratory-chemical analysis indicated bacterial meningitis (see Table
Cerebrospinal fluid analysis.
Reference range, adults | On admission | Hospital day 6 | |
---|---|---|---|
Total cell count (per | 0–5 | 1220 | 724 |
Proteine (mg/dl) | 5–55 | 519 | 311 |
Glucose (mg/dl) | 50–57 | 36 | 101 |
Lactate (mmol/l) | 16.6 | 4.7 |
After the introduction of the Haemophilus influenzae type b conjugate vaccine in the USA, meningitis caused by
Most of the systemic invasive infections with Listeria are in individuals with one or more predisposing conditions. The risk factors are mainly pregnancy, corticosteroid therapy, other immunosuppressive therapy, and age. In a study from Finland seventy four cases of systemic listeriosis were analysed. Of these patients, 66% had an underlying disease, most commonly malignancy, diabetes mellitus, or renal transplantation, and 43% had received immunosuppressive therapy within one week before onset of listeriosis. Bacteremia and central nervous system infections were the most common clinical entities; both accounted for 43% of cases [
According to a Spanish study bacterial meningitis in cirrhotic patients was associated with a high mortality and a large number of complications; a case fatality rate of 53.1% was observed. Of the classic pathogens,
Even though there are still no satisfactory data regarding the incidence of Listeria infection following liver transplantation it seems that patients after transplantation suffer a greater risk to develop an aggravated course of infection with this pathogen. Including this case there are 16 reported cases of listeriosis after liver transplantation (see Table
Cases of listeria infection following liver transplantation.
Age (yr) | Sex | Time post LTX | Clinical presentation | Treatment | Outcome | Ref |
---|---|---|---|---|---|---|
53 | M | 5 d | Meningitis with headache, mental decline | Ampicillin | Survived | [ |
66 | F | 32 mo | Fever, hypotension, bacteremia | Ampicillin | Survived | [ |
39 | F | 7 d | Fever, abdominal pain, bacteremia | Ampicillin | Survived | [ |
66 | F | 32 mo | Fever, right flank pain, anorexia, bacteremia | Ampicillin | Survived | [ |
39 | F | 7 d | Fever, abdominal pain, bacteremia | Ampicillin | Survived | [ |
55 | F | 4 mo | Fever, abdominal pain, bacteremia | TMP-SMX | Survived | [ |
57 | F | 20 mo | Bacteremia, hepatitis | Ampicillin | Survived | [ |
56 | F | 8 mo | Bacteremia, hepatitis | Ampicillin, Gentamicin | Survived | [ |
41 | F | 10 mo | Endocarditis, bacteremia, hepatitis, pulmonary emboli | Ampicillin, Gentamicin | Survived | [ |
47 | F | NR | Peritonitis, bacteremia | Ampicillin, Amikacin | Survived | [ |
11 mo | M | 7 d | Meningitis, epididymitis, orchitis | Ampicillin | Survived | [ |
NR | NR | 14 d | Meningitis | NR | Survived | [ |
67 | F | 21 d | Meningitis | Ampicillin | Died | [ |
13 | F | 4 mo | Meningitis | Ampicllin, Tetracycline | Died | [ |
29 | M | 4 d | Fever, abdominal pain, cholestasis | Ampicillin | Survived | [ |
Abbreviations: TMP-SMX: trimethoprim-sulfamethoxazole; NR: not reported.
The clinical signs of meningitis caused by Listeria include fever, headache and altered mental status and the signs of Listeria meningitis do not for the most part differ from those found in patients with community-acquired non-listerial bacterial meningitis [
We present a case of Listeria meningitis shortly after orthotopic liver transplantation. Because of the low incidence and the high mortality rate of Listeria infection, physicians must be aware of this pathogen most notably in immunocompromised patients, particularly because the therapy of Listeria meningitis diverges from the “normal” regime used for other bacterial pathogens causing meningitis. Third-generation cephalosporins are the beta-lactams of choice in the empiric treatment of meningitis. These drugs have potent activity against all the major pathogens of bacterial meningitis with the notable exception of
S. Schmiedel and A. W. Lohse contributed to the discussion of the case report.