title: Listeria monocytogenes meningoencephalitis in adults: analysis of factors related to unfavourable outcome.
abstract: OBJECTIVE
  To analyse the short-term outcome in patients with Listeria monocytogenes meningoencephalitis (LMME) to improve management and outcome.
  
  
  METHODS
  Observational study with adult patients with LMME between 1977 and 2009 at a tertiary hospital in Barcelona, Spain. Parameters that predicted outcome were assessed with univariate and logistic regression analysis.
  
  
  RESULTS
  Of 59 cases of LMME, 28 occurred in the last decade. Since 1987, a new protocol has been used and 29/45 patients (64%) treated since then received adjuvant dexamethasone. In patients who received this treatment there was a trend towards fewer neurological sequelae (5 vs 33%; p = 0.052). Antiseizure prophylaxis with phenytoin was administered in 13/45 (28%) patients. Seizures occurred in 7/45 (16%) patients, all in the group who did not receive phenytoin. Hydrocephalus presented in 8/59 (14%). It was never present at admission and five patients needed neurosurgical procedures. Sequelae after 3 months were present in 8/45 (18%), mostly cranial nerve palsy. Rhombencephalitis (RE) was related to the presence of neurologic sequelae (OR: 20.4, 95% CI: 1.76-236). Overall mortality was 14/59 (24%), 9/59 (15%) due to neurological causes related to hydrocephalus or seizures. Mortality was defined as early in 36% and late in 64%. In the multivariate analysis, independent risk factors for mortality were presence of hydrocephalus (OR: 17.8, 95% CI: 2.753-114) and inappropriate empirical antibiotic therapy (OR: 6.5, 95% CI: 1.201-35).
  
  
  CONCLUSIONS
  Outcome of LMME may be improved by appropriate empirical antibiotic therapy, suspicion and careful management of hydrocephalus. Use of adjuvant dexamethasone or phenytoin in a subgroup of these patients might have a benefit.
authors.affiliation: Infectious Diseases Services, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain, ivan_pelegrin@hotmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Pelegrín
authors.forename: M
authors.initials: M
authors.lastname: Moragas
authors.forename: C
authors.initials: C
authors.lastname: Suárez
authors.forename: A
authors.initials: A
authors.lastname: Ribera
authors.forename: R
authors.initials: R
authors.lastname: Verdaguer
authors.forename: S
authors.initials: S
authors.lastname: Martínez-Yelamos
authors.forename: F
authors.initials: F
authors.lastname: Rubio-Borrego
authors.forename: J
authors.initials: J
authors.lastname: Ariza
authors.forename: P F
authors.initials: PF
authors.lastname: Viladrich
authors.forename: C
authors.initials: C
authors.lastname: Cabellos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000927:Anticonvulsants / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008089:Listeria monocytogenes / Q000502:physiology; D008297:Male; D008584:Meningitis, Listeria / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D013030:Spain / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D003907:Dexamethasone