Listeria monocytogenes Meningitis in an Intensive Care Unit

TL;DR

This study examines Listeria monocytogenes meningitis cases in an ICU, focusing on clinical features, risk factors, and outcomes.

Contribution

The study provides a detailed analysis of ICU-specific data and outcomes for L. monocytogenes meningitis cases.

Findings

Six patients with L. monocytogenes meningitis were admitted to the ICU over nine years.

All patients survived, but two had neurological sequelae despite timely antibiotic treatment.

Classic meningitis symptoms were present in only 33.3% of patients.

Abstract

Community-acquired bacterial meningitis remains one of the most serious and life-threatening infectious diseases, with Listeria monocytogenes representing the third most common causative agent. Listeria meningitis occurs more frequently in immunocompromised and older adults and often requires intensive care unit (ICU) admission, depending on disease severity. We conducted a descriptive, retrospective study in an ICU that included adult patients admitted with community-acquired L. monocytogenes meningitis. Clinical features, risk factors, and management of these patients were analyzed. Over nine years, six patients were admitted to the ICU. The mean ICU stay was 5.8±4.7 days, and the mean hospital stay was 27.8±22.4 days. ICU severity scores at admission were as follows: Acute Physiology and Chronic Health Evaluation II (APACHE II) 19±5.1, Simplified Acute Physiology Score II (SAPS II) 44.3±11.8, SAPS III 53.3±11.6, and Sequential Organ Failure Assessment (SOFA) 6±3.2. The classic triad of meningitis (fever, neck stiffness, and altered mental status) was present in only two patients (33.3%). Lumbar puncture and blood cultures were performed in all patients. The most relevant risk factors identified were advanced age and alcohol consumption. All patients received the first dose of antibiotics in the emergency department before ICU admission. Despite the associated morbidity, all patients survived, although two experienced neurological sequelae.