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15 November 2006

Volume 43, Number 10
Clinical Infectious Diseases 2006;43:1233–1238
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4310-0001$15.00
DOI: 10.1086/508462
MAJOR ARTICLE

Community‐Acquired Listeria monocytogenes Meningitis in Adults

Matthijs C. Brouwer,1

Diederik van de Beek,1

Sebastiaan G. B. Heckenberg,1

Lodewijk Spanjaard,2 and

Jan de Gans1

Departments of 1Neurology and 2Medical Microbiology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Background.Listeria monocytogenes is the third most common cause of bacterial meningitis.

Methods.We prospectively evaluated 30 episodes of community‐acquired L. monocytogenes meningitis, confirmed by culture of cerebrospinal fluid specimens, in a nationwide study in The Netherlands. Outcome was graded using the Glasgow outcome score; an unfavorable outcome was defined as a score of 1–4.

Results.We found 30 episodes of L. monocytogenes meningitis. All patients were immunocompromised or >50 years old. In 19 (63%) of 30 patients, symptoms were present for >24 h; in 8 patients (27%), symptoms were present for 4 days. The classic triad of fever, neck stiffness, and change in mental status was present in 13 (43%) of 30 patients. An individual cerebrospinal fluid indicator of bacterial meningitis was present in 23 (77%) of 30 cases. Gram staining of cerebrospinal fluid samples revealed the causative organism in 7 (28%) of 25 cases. The initial antimicrobial therapy was amoxicillin based for 21 (70%) of 30 patients. The coverage of initial antimicrobial therapy was microbiologically inadequate for 9 (30%) of the patients. The mortality rate was 17% (5 of 30), and 8 (27%) of 30 patients experienced an unfavorable outcome. Inadequate initial antimicrobial therapy was not related to outcome.

Conclusions.In contrast with previous reports, we found that patients with meningitis due to L. monocytogenes do not present with atypical clinical features; however, typical cerebrospinal fluid findings predictive for bacterial meningitis might be absent. A high proportion of patients received initial antimicrobial therapy that did not cover L. monocytogenes.

Received 8 May 2006; accepted 14 June 2006; electronically published 10 October 2006.

Reprints or correspondence: Dr. Matthijs C. Brouwer, Academic Medical Center, University of Amsterdam, Dept. of Neurology H2, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands ().

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