title: Listeria monocytogenes peritonitis: presentation, clinical features, treatment, and outcome.
abstract: 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.
  
  
  METHODS
  
  
  
  METHODS
  MEDLINE, Scholar.Google, Scopus databases, including English, Spanish, French, and German language papers published between 1966 and June 2011, and reference lists.
  
  
  METHODS
  investigators abstracted details about medical history, disease presentation, laboratory data, treatment and outcome.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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).
authors: 2nd Department of Internal Medicine, General Hospital of Athens G. Gennimatas, Athens, Greece. geoliatsos@yahoo.gr
authors: George D
authors: GD
authors: Liatsos
authors: Spyridon
authors: S
authors: Thanellas
authors: Maria
authors: M
authors: Pirounaki
authors: Ioannis
authors: I
authors: Ketikoglou
authors: Antonios
authors: A
authors: Moulakakis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications; D006801:Humans; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods / Q000706:statistics & numerical data; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents