Multiple cerebral abscesses because of Listeria monocytogenes: three case reports and a literature review of supratentorial listerial brain abscess(es).
BACKGROUND
Central nervous system involvement often follows bacteremia because of Listeria monocytogenes. Meningitis is clinically the most common manifestation, while brain abscess occurs in about 1% of patients. Brain abscess is usually solitary but in recent years, probably in part because of the availability of computerized tomography and magnetic resonance imaging, several reports have described two or more separate supratentorial abscesses.


METHODS
We have described three patients with listerial brain abscesses and reviewed the North American and European literature of brain abscess(es) because of L. monocytogenes through December 2001. We have evaluated the role of underlying diseases and therapeutic immunosuppression on the development of solitary or greater than one brain abscess.


RESULTS
In contrast to meningitis, where immunosuppression does not predispose either to disease incidence or to higher mortality, patients with solitary and particularly those with more than one supratentorial abscess usually are immunosuppressed either by disease or by therapy. Corticosteroids in particular are significant predisposing factors, especially in those patients with two or more brain abscesses. Mortality resulting from listerial brain abscess, whether solitary or multiple, is nearly three times higher than nonlisterial brain abscess, probably in part because of both underlying diseases and immunosuppressive therapy.


CONCLUSIONS
Therapy with high-dose ampicillin in combination with gentamicin appear to be the drugs of choice, followed by trimethoprim/sufamethoxazole and vancomycin. In general, antimicrobial therapy appears to be satisfactory treatment without surgical intervention.
Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
Lawrence A
LA
Cone
Millie M
MM
Leung
Richard G
RG
Byrd
Gary M
GM
Annunziata
Richard Y
RY
Lam
Brian K
BK
Herman
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D008089:Listeria monocytogenes / Q000472:pathogenicity*; D008088:Listeriosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination