title: Sepsis caused by Listeria monocytogenes during chemotherapy for small cell carcinoma of the thymus.
abstract: BACKGROUND
  Listeria monocytogenes is a facultative intracellular parasitic bacterium that is Gram positive, catalase positive, oxidase negative, and a facultative anaerobe. It is known to infect humans through food. It is a bacillus with low virulence, but can cause meningitis and sepsis in infants and immunocompromised patients.
  
  
  METHODS
  A case of 75-year-old Japanese female with small cell carcinoma of the thymus and pleural dissemination is described. She was treated with carboplatin and etoposide and showed a partial response. However, the tumor recurred 6 months later. Therefore, we again administered carboplatin and etoposide. Though peritoneal dissemination was suspected based on abdominal computed tomography findings after two courses, the assessment was stable disease. She was occasionally treated for constipation. She developed chills, rigor, and diarrhea, necessitating admission on the 7th day of the third course of chemotherapy. We suspected intestinal infection, and cefepime was thus administered. However, her blood pressure dropped and neutropenia manifested on the 4th day of admission. We therefore switched the antibiotic from cefepime to meropenem and also administered granulocyte-colony stimulating factor. Listeria monocytogenes was detected by two blood cultures, and the antimicrobial medication was thus switched to ampicillin, in consideration of sensitivity. Her general condition improved and she was able to leave the hospital on the 19th day after admission.
  
  
  CONCLUSIONS
  During chemotherapy, factors such as impaired bowel movements, malnutrition, and myeloablation can contribute to the development of severe infections. It is necessary to comprehensively assess a patient's state and treat all aspects of illness.
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. gacchi88@hotmail.com.|Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. gacchi88@hotmail.com.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Itoga
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. y-asari@cc.hirosaki-u.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Asari
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. moritaka@cc.hirosaki-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. taima0305@hotmail.com.
authors.forename: Kageaki
authors.initials: K
authors.lastname: Taima
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. kuni19780502@yahoo.co.jp.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. lapin2105@gmail.com.|Department of Cardiology Medicine, Mutsu General Hospital, 1-2-8 Ogawa-cho, Mutsu, 035-8601, Japan. lapin2105@gmail.com.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. xyghx335@gmail.com.|Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. xyghx335@gmail.com.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. t-shingo@cc.hirosaki-u.ac.jp.|Health Administration Center, Hirosaki University, 1 Bunkyo, Hirosaki, 036-8562, Japan. t-shingo@cc.hirosaki-u.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. kayaba@cc.hirosaki-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kayaba
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. okumura@cc.hirosaki-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000473:pathology; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008089:Listeria monocytogenes / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology; D008088:Listeriosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D000077731:Meropenem; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D013845:Thienamycins / Q000627:therapeutic use; D013950:Thymus Gland / Q000187:drug effects / Q000473:pathology; D013953:Thymus Neoplasms / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002511:Cephalosporins; D013845:Thienamycins; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D000667:Ampicillin; D000077723:Cefepime; D016190:Carboplatin; D000077731:Meropenem