Listeria monocytogenes meningitis in an immunocompetent 18-year old patient as a possible diagnostic and therapeutical problem

Abstract

Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.Uvod. Listeria monocytogenes je treci najcesci uzrocnik bakterijskih meningitisa kod odraslih. Obicno pogadja osobe sa poremecajem celijski posredovanog imuniteta ili u odmaklom zivotnom dobu. Opisano je samo nekoliko bolesnika bez postojece predispozicije. Prikaz bolesnika. U radu je prikazan osamnaestogodisnji, prethodno zdrav bolesnik, sa tipicnom klinickom slikom meningitisa. Na osnovu ambulantnog lecenja ceftriaksonom i nalaza u cerebrospinalnoj tecnosti postavljena je pretpostavka o parcijalno lecenom bakterijskom meningitisu. Terapija, zapoceta vankomicinom i ceftriaksonom, koji je 4. dana zamenjen meropenemom, nije dala klinicko poboljsanje. Sestog dana od prijema iz cerebrospinalne tecnosti izolovana je Listeria monocytogenes, a primena ampicilina, mada odlozena, dovela je do potpunog oporavka bolesnika. Zakljucak. Kod mladih, imunokompetentnih osoba, uprkos prisutnim dijagnostickim i terapijskim problemima, subakutni tok meningitisa prouzrokovanog bakterijom Listeria monocytogenes omogucava adekvatno lecenje i povoljan ishod bolesti.