The treatment of Listeria monocytogenes infections in the central nervous system.
Fifty-four cases of Listeria monocytogenes meningitis and meningoencephalitis occurred in Denmark between 1981 and 1986. The aim of the present study was to consider the antibiotic treatment of these patients, 33 males and 21 females aged from 16 months to 91 years: average (AV) 54 years. One or more predisposing factors (PF) were found in 30 patients (55%): steroid treatment (15), cancer (12), alcoholism and/or cirrhosis (10), diabetes mellitus (5), and renal allograft (2). Follow-up varied from 3 months to 5 years. Ampicillin (AMP) was used as the only antibiotic in 14 patients, and with an aminoglycoside (AMI) in 38 but AMI was withdrawn within 24-48 h in 14. High doses of AMP were used (AV 16 g/day) generally for two weeks (AV 11 days), but AMI was usually withdrawn in the first week (AV 5 days). The mortality rate (MR) was 39% and varied greatly between previously healthy patients (PHP) and those with one or more PF: only 2 out of 24 PHP died, both admitted to hospital with respiratory insufficiency and shock. No significant differences between survivors and non-survivors were observed either in the doses, duration and administration of AMP, or use of AMI, although a higher number of PF was found in the non-survivors. Relapse occurred in at least 3 immuno-compromised patients. Sequelae were reported in 9 patients. Death occurred in 6 within 24-48 h of admission. Delayed diagnosis and treatment together with the underlying disease seemed responsible for the high MR. More effective treatments in immunocompromised patients should be tried.
Carvajal
A
A
State Serum Institute, Copenhagen, Denmark.
Samuelsson
S
S
Rothgardt
N P
NP
Frederiksen
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000617:Aminoglycosides; D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015984:Causality; D002493:Central Nervous System Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D008088:Listeriosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000667:Ampicillin