Community-Acquired Listeria monocytogenes Meningitis Literature: Commentary by Dr. John G. Bartlett -- April 2007

John G. Bartlett, MD


May 02, 2007

Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-Acquired Listeria monocytogenes Meningitis in Adults. Clin Infect Dis. 2006;43:1233-1238. The purpose of this study was to review the experience with bacterial meningitis caused by Listeria monocytogenes. This experience was based on subset analysis of 696 episodes of community-acquired acute bacterial meningitis, which showed 352 (51%) caused by Streptococcus pneumoniae, M meningitidis in 257 (37%), other bacteria in 57 (8%), and L monocytogenes in 30 (4%). All patients with Listeria were older than 50 years of age or immunocompromised. Other common features are summarized in the Table .

The authors emphasize the fact that their patients with Listeria meningitis presented with clinical features that are common with other forms of pyogenic meningitis except that the findings in the cerebrospinal fluid may be somewhat unique. There were a total of 5 (17%) deaths and all occurred within 3 days of admission and all patients were older than 55 years of age. The Gram stain was positive in only 24%. Many patients did not receive proper therapy initially, and the authors emphasize the need for ampicillin with empiric treatment in patients older than 50 years of age who have pyogenic meningitis.