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Listerial Meningitis
⚠️ Consider Listeria in any patient over 50, immunosuppressed, diabetic, alcoholic, or pregnant. In these cases, always add Ampicillin to standard meningitis therapy.
📖 About
- 🛑 Must not be missed – identify at-risk groups early.
- Caused by Listeria monocytogenes, an intracellular Gram-positive bacillus.
- Can cause meningitis and rhombencephalitis (brainstem infection).
🧬 Aetiology
- Gram-positive bacillus, transmitted via contaminated food (e.g., soft cheeses, deli meats, unpasteurised milk).
- Causes CNS infections: meningitis, brain abscess, and brainstem encephalitis.
⚠️ Risk Groups
- Immunosuppressed patients (transplants, chemotherapy, HIV).
- Diabetes mellitus.
- Chronic alcohol misuse.
- Pregnant females 🤰 (risk of miscarriage, stillbirth, neonatal sepsis/meningitis).
- Neonates 👶 (via vertical transmission).
🩺 Clinical Features
- Brainstem signs ➝ cranial nerve palsies, ataxia, dysarthria.
- Confusion, headache, reduced GCS.
- Pyrexia, meningism (nuchal rigidity, photophobia).
- Seizures possible.
🔎 Investigations
- CT head 🖥️ ➝ exclude raised ICP, hydrocephalus, or mass lesions before LP.
- CSF (LP) 💉 ➝ low glucose, high protein, raised WCC, Gram-positive bacilli (not cocci – correction).
- Blood cultures ➝ may grow Listeria.
- MRI brain ➝ brainstem lesions if rhombencephalitis suspected.
💊 Management
- Stabilise ➝ ABC, oxygen, IV fluids, HDU/ITU support as required.
- Empirical therapy for meningitis:
- Cefotaxime 2 g IV q6h OR Ceftriaxone 2 g IV q12h.
- PLUS Ampicillin 2 g IV q4h (to cover Listeria).
- Alternative if allergic: IV Co-trimoxazole (5 mg/kg daily in 2 doses).
- Add Dexamethasone in suspected bacterial meningitis unless contraindicated.
- Consider longer treatment course (≥3 weeks) for Listeria meningitis.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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