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Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973–1982
72 Infectious Diseases Newsletter 6(9) September 1987 were over 50 years of age. There were no deaths; both definite and probable cases were treated with erythromycin. Comparing the six definite cases with 21 patient controls revealed significantly longer hospitalization and occupancy of rooms closer to a shower facility in the six cases. Of 61 environmental specimens, 38 were from the hot water system; 13 yielded L. pneumophila from shower heads, and hot water tank (both from water and sludge). The hot water system was cured of legionellosis by cleaning and superchlorination treatment.
Comment Although it is reasonable to postulate aerosols generated in showering as the vehicle of transmission, the authors were unable to isolate L. pneumophila by exposing culture media near operating showers and by plating air filtration samples. Yet, in other outbreaks, aerosol transmission of L. pneumophila has been documented (Am Rev Resp Dis 128:657-661, 1983). Moreover, the patients who became ill had higher exposure to shower generated aerosols, the outbreak ceased with closure of the showers, and no cases followed restitution of showering after cleaning-sanitizing the water system. Possibly, showers should be regarded as sources of aerosols capable of communicating L. pneumophila, along with proved sources of infectious aerosols, ie, cooling towers and whirlpool baths. PDH []
Hansen PB, Jensen TH, Lykkegaard S, et al: Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973-1982. Scand J Infect Dis 19:55-60, 1987.
Over a decade, 16 cases of listerial meningitis were seen at the Rigshospitalet in Copenhagen. The age range was 23 to 79 years of age, with 12 males. Predisposing diseases included malignancies (three patients, yielding two deaths), collagen-vascular diseases (three patients, yielding one death), and alcoholism (five patients, yielding three deaths. The remaining fatality occurred in a 70-year-old man with atherosclerotic heart disease. There was no unique or distinguishing clinical or laboratory findings, except isolation of L. monocytogenes. Although the concentration of glucose was always abnormally low in the cerebrospinal fluid, in no patient was it zero. All of the isolates of L. monocytogenes were susceptible to ampicillin and the aminocyclitols.
that were compatible with bacterial meningitis. Ninety-six patients had received antibacterial therapy before admission to hospital, ie, in 49 patients, bacteria were recovered from the CSF despite prior treatment. Blood cultures yielded growth in 51% of the untreated patients, as contrasted with a 25% yield from those who were treated with antimicrobics before entry. The lack of adverse effect on etiologic diagnosis of bacterial meningitis by culture of the CSF of outpatient treatment with antimicrobic(s) was ascribed by the author to poor penetration into the CSF in view of the agents, doses, and the PO route of administration; the necessarily short duration of treatment; and the frequency of resistance, eg, penicillin V for Haemophilus influenzae.
Comment The authors' experience reiterates the lack of clinical and general laboratory singularity in listerial meningitis. Only the isolation and identification of L. monocytogenes surely differentiates this form of listeriosis. PDH []
Comment The author's conclusions are reasonable. So long as outpatient treatment does not delay hospitalization and the commencement of proper therapy, it appears that pretreatment poses no hazard to etiologic diagnosis by culture of the CSF. There was, however, an apparent decreased success in culture of the causative bacteria from the blood. PDH []
Ferguson A: The effect of antibiotic therapy before admission to hospital on recognition of the causative organism in acute bacterial meningitis. J Infection 13:241-244, 1986. Of 245 patients with acute bacterial meningitis, etiological diagnosis was made in 198 by isolation of the causative bacteria from the cerebrospinal fluid (CSF). The 47 patients without proof of cause by isolation of bacteria had clinical findings and changes in their CSF
© 1987ElsevierScience Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
3orup-Ronstrom C: Epidemiologi-
cai, bacteriological, and complicating features of erysipelas. Scand J Infect dis 18:519-524, 1986. During a 2-year-period, 19811983, 233 patients with erysipelas were studied. There were 103 females (mean age, 59 years), and there was no seasonality of occurrence. The involved regions were
Comment Although it is reasonable to postulate aerosols generated in showering as the vehicle of transmission, the authors were unable to isolate L. pneumophila by exposing culture media near operating showers and by plating air filtration samples. Yet, in other outbreaks, aerosol transmission of L. pneumophila has been documented (Am Rev Resp Dis 128:657-661, 1983). Moreover, the patients who became ill had higher exposure to shower generated aerosols, the outbreak ceased with closure of the showers, and no cases followed restitution of showering after cleaning-sanitizing the water system. Possibly, showers should be regarded as sources of aerosols capable of communicating L. pneumophila, along with proved sources of infectious aerosols, ie, cooling towers and whirlpool baths. PDH []
Hansen PB, Jensen TH, Lykkegaard S, et al: Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973-1982. Scand J Infect Dis 19:55-60, 1987.
Over a decade, 16 cases of listerial meningitis were seen at the Rigshospitalet in Copenhagen. The age range was 23 to 79 years of age, with 12 males. Predisposing diseases included malignancies (three patients, yielding two deaths), collagen-vascular diseases (three patients, yielding one death), and alcoholism (five patients, yielding three deaths. The remaining fatality occurred in a 70-year-old man with atherosclerotic heart disease. There was no unique or distinguishing clinical or laboratory findings, except isolation of L. monocytogenes. Although the concentration of glucose was always abnormally low in the cerebrospinal fluid, in no patient was it zero. All of the isolates of L. monocytogenes were susceptible to ampicillin and the aminocyclitols.
that were compatible with bacterial meningitis. Ninety-six patients had received antibacterial therapy before admission to hospital, ie, in 49 patients, bacteria were recovered from the CSF despite prior treatment. Blood cultures yielded growth in 51% of the untreated patients, as contrasted with a 25% yield from those who were treated with antimicrobics before entry. The lack of adverse effect on etiologic diagnosis of bacterial meningitis by culture of the CSF of outpatient treatment with antimicrobic(s) was ascribed by the author to poor penetration into the CSF in view of the agents, doses, and the PO route of administration; the necessarily short duration of treatment; and the frequency of resistance, eg, penicillin V for Haemophilus influenzae.
Comment The authors' experience reiterates the lack of clinical and general laboratory singularity in listerial meningitis. Only the isolation and identification of L. monocytogenes surely differentiates this form of listeriosis. PDH []
Comment The author's conclusions are reasonable. So long as outpatient treatment does not delay hospitalization and the commencement of proper therapy, it appears that pretreatment poses no hazard to etiologic diagnosis by culture of the CSF. There was, however, an apparent decreased success in culture of the causative bacteria from the blood. PDH []
Ferguson A: The effect of antibiotic therapy before admission to hospital on recognition of the causative organism in acute bacterial meningitis. J Infection 13:241-244, 1986. Of 245 patients with acute bacterial meningitis, etiological diagnosis was made in 198 by isolation of the causative bacteria from the cerebrospinal fluid (CSF). The 47 patients without proof of cause by isolation of bacteria had clinical findings and changes in their CSF
© 1987ElsevierScience Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
3orup-Ronstrom C: Epidemiologi-
cai, bacteriological, and complicating features of erysipelas. Scand J Infect dis 18:519-524, 1986. During a 2-year-period, 19811983, 233 patients with erysipelas were studied. There were 103 females (mean age, 59 years), and there was no seasonality of occurrence. The involved regions were