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Listeria monocytogenes peritonitis during postpartum
Although
Listeria monocytogenes
has been isolated from the gastrointestinal tract, it is an infrequent cause of bacterial peritonitis. Since 1963 only 23 cases of peritonitis caused by listeria have been reported. This report describes another case in a patient with cirrhosis and chronic renal failure and presents a review of the literature. Most (16) of the previous cases were cirrhotic while six were undergoing chronic ambulatory peritoneal dialysis. Eight patients were on immunosuppressive therapy. Blood cultures were positive in fewer than half (42%) of the cases and Gram stain of peritoneal fluid was positive only twice. The peritoneal fluid protein concentration was relatively high compared with other causes of bacterial peritonitis. Ampicillin was the drug most commonly used for treatment, and the majority of patients survived the acute infection.
Background:
Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients. Gram (-) (E. coli, Klebsiella pneumoniae), and Gram (+) (Streptococci, Staphylococci) bacteria are most frequently cultured from patients'ascites. Listeria monocytogenes (Lm) is scarcely reported as a causative agent.
Objective:
Our objective is to describe Lm peritonitis as a clinical entity, including its presentation, clinical features, treatment, and the potential factors that might affect survival outcome.
Material and methods:
Data sources:
MEDLINE, Scholar.Google, Scopus databases, including English, Spanish, French, and German language papers published between 1966 and June 2011, and reference lists.
Data extraction:
investigators abstracted details about medical history, disease presentation, laboratory data, treatment and outcome.
Data synthesis:
One-hundred and twenty-eight cases with known survival outcome--eighty-six cirrhotics, seventeen individuals undergoing continuous ambulatory peritoneal dialysis and another twenty-five with other or no underline condition were reviewed. An additional number of twenty-five cases with unknown outcome were searched in Listeria studies published from 1990 to 2009 and were only used for calculating worldwide distribution.
Conclusion:
Cirrhotics, mostly alcoholics, presented with fever and abdominal pain. Those who succumbed had significantly higher peripheral WBC count (15622 vs. 8155 cells/mm(3), p = 0.01) and (%) polymorphonuclear cells in differential count (83.3 vs. 71%, p = 0.001). Higher mortality was experienced in those with comorbidities, and those who presented with encephalopathy. Lower mortality was experienced in patients on continuous ambulatory peritoneal dialysis. Ascites was neutrocytic in 86% of the samples. In the sum of the cases mortality was 27.3%, with significantly highest rates in the elderly, in patients with bacteremia, immunosuppression, hematological malignancies, and lowest rates in those who presented with abdominal pain and in diabetics (type I or II). The latter observation was surprising and could be considered a single fortuitous fact. Initial appropriate treatment was associated with significantly better outcome (p = 0.002) than inappropriate; combination therapy with an aminoglycoside was superior to monotherapy (p = 0.038).
Listeria monocytogenes peritonitis in a patient with cirrhosis and simultaneous soft tissue infection is reported. Six previously documented cases are reviewed. All seven patients were bacteremic, suggesting hematogenous seeding to the peritoneum as the pathogenic mechanism. Clinical and laboratory characteristics of L. monocytogenes peritonitis are compared with peritonitis of other bacterial etiologies.
LISTERIA monocytogenes has been recognized as a human pathogen for more than 50 years; it causes illness mainly in pregnant women, newborns, elderly persons, and immunocompromised persons. The organism is found in multiple ecological sites and throughout the food chain, and anecdotal reports have linked human illness with the ingestion of foods contaminated with Listeria.1 More recently, it has been shown to cause outbreaks of illness that were associated with commercial food products.2-5 The Food and Drug Administration has recommended product recalls when L monocytogenes has been identified in commercial foods that are available for consumption without further cooking. Although recalls have generated widespread public concern, information about the magnitude of risk and the clinical presentations of disease has not been widely available to the medical community. This article reviews the history, microbiology, ecology, pathogenesis, epidemiology, and clinical spectrum of human illnesses caused by L monocytogenes and highlights
Two new cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes are reported. Listeria monocytogenes was recovered from the ascitic fluid but not from the blood cultures of two adult diabetic inpatients with hepatic cirrhosis and SBP that had been treated empirically with cefotaxime. These two cases add to the 17 cases of Listeria monocytogenes SBP reported previously, stressing the relevance of this microorganism to this clinical condition. The recovery of Listeria monocytogenes from blood has been achieved in only half of the cases reported, suggesting the possibility of a direct translocation mechanism. Combinations of amino- or ureidopenicillins with beta-lactamase inhibitors or carbapenems might be more effective as empiric therapy of SBP in cirrhotic patients.
Listeria monocytogenes peritonitis in a patient with cirrhosis and simultaneous soft tissue infection is reported. Six previously documented cases are reviewed. All seven patients were bacteremic, suggesting hematogenous seeding to the peritoneum as the pathogenic mechanism. Clinical and laboratory characteristics of L. monocytogenes peritonitis are compared with peritonitis of other bacterial etiologies.
Infection d'ascite à Listeria monocytogenes au cours d'une carcinose peritoneale
- Chetrit
Listeria Monocytogenes peritonitis complicating CAPD
- Korzels
Listeria monocytogenes: une étiologie rare d'infection du liquide d'ascite pouvant être asymptomatique
- Kitmacher
Tratado de pediatria
- Jiménez