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Conn Med. Author manuscript; available in PMC 2015 May 07. Published in final edited form as: Conn Med. 2015 January ; 79(1): 31–36.
Are Nectarines to Blame? A Case Report and Literature Review of Spontaneous Bacterial Peritonitis Due to Listeria monocytogenes Joan How, BA, MS4, Yale School of Medicine, New Haven
Author Manuscript
Marwan M. Azar, MD, and Clinical Fellow in Infectious Diseases, Section of Infectious Diseases, Yale School of Medicine, New Haven Jaimie P. Meyer, MD, MS Assistant Professor of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven
Abstract
Author Manuscript
Spontaneous bacterial peritonitis (SBP) is a frequent and potentially deadly complication of ascites in patients with end-stage liver disease. Unlike other pathogens more commonly implicated in SBP, Listeria monocytogenes is a nonenteric organism that may be acquired either sporadically or in the setting of foodborne outbreaks. Listeria is an unusual cause of SBP that presents particular management challenges because of the organism’s intrinsic resistance to first-line and empiric SBP treatment that would otherwise include third-generation cephalosporins. We present here a case of Listeria SBP in a 68-year-old man with previously unidentified cirrhosis. His infection occurred in the context of a nationwide fruit recall for Listeria contamination, prompting an epidemiologic investigation. After describing the case, we then review the extant literature on Listeria peritonitis. To date, no case studies on Listeria SBP have systematically described risk factors for Listeria acquisition. As incidence of Listeria SBP is increasing, however, knowledge of patient risk factors, especially foodborne exposure risks, may be important in preventing future episodes of Listeria SBP, and in accurately monitoring foodborne outbreaks.
Introduction Author Manuscript
Spontaneous bacterial peritonitis (SBP) is a frequent complication of end-stage liver disease (ESLD) associated with significant morbidity and mortality. In the United States, SBP affects an estimated 10–30% of hospitalized cirrhotic patients, and is associated with a 10– 50% in-hospital mortality rate.1 The guideline-recommended empiric treatment of SBP is a third-generation cephalosporin, which has activity against the most common causative
Corresponding author: Joan How, BA, MS4, [email protected]. Author Contributions: Joan How, BA collected and analyzed the data with guidance from Marwan M. Azar, MD and Jaimie P. Meyer. MD, MS, and drafted the first versions of the manuscript. Dr. Azar and Dr. Meyer edited and revised the manuscript. All authors have seen and approved the final version for submission.
How et al.
Page 2
Author Manuscript
pathogens, including E. coli, Klebsiella pneumoniae, Streptococci spp., and Enterobacteriaceae spp.2 In a minority of cases (
Conn Med. Author manuscript; available in PMC 2015 May 07. Published in final edited form as: Conn Med. 2015 January ; 79(1): 31–36.
Are Nectarines to Blame? A Case Report and Literature Review of Spontaneous Bacterial Peritonitis Due to Listeria monocytogenes Joan How, BA, MS4, Yale School of Medicine, New Haven
Author Manuscript
Marwan M. Azar, MD, and Clinical Fellow in Infectious Diseases, Section of Infectious Diseases, Yale School of Medicine, New Haven Jaimie P. Meyer, MD, MS Assistant Professor of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven
Abstract
Author Manuscript
Spontaneous bacterial peritonitis (SBP) is a frequent and potentially deadly complication of ascites in patients with end-stage liver disease. Unlike other pathogens more commonly implicated in SBP, Listeria monocytogenes is a nonenteric organism that may be acquired either sporadically or in the setting of foodborne outbreaks. Listeria is an unusual cause of SBP that presents particular management challenges because of the organism’s intrinsic resistance to first-line and empiric SBP treatment that would otherwise include third-generation cephalosporins. We present here a case of Listeria SBP in a 68-year-old man with previously unidentified cirrhosis. His infection occurred in the context of a nationwide fruit recall for Listeria contamination, prompting an epidemiologic investigation. After describing the case, we then review the extant literature on Listeria peritonitis. To date, no case studies on Listeria SBP have systematically described risk factors for Listeria acquisition. As incidence of Listeria SBP is increasing, however, knowledge of patient risk factors, especially foodborne exposure risks, may be important in preventing future episodes of Listeria SBP, and in accurately monitoring foodborne outbreaks.
Introduction Author Manuscript
Spontaneous bacterial peritonitis (SBP) is a frequent complication of end-stage liver disease (ESLD) associated with significant morbidity and mortality. In the United States, SBP affects an estimated 10–30% of hospitalized cirrhotic patients, and is associated with a 10– 50% in-hospital mortality rate.1 The guideline-recommended empiric treatment of SBP is a third-generation cephalosporin, which has activity against the most common causative
Corresponding author: Joan How, BA, MS4, [email protected]. Author Contributions: Joan How, BA collected and analyzed the data with guidance from Marwan M. Azar, MD and Jaimie P. Meyer. MD, MS, and drafted the first versions of the manuscript. Dr. Azar and Dr. Meyer edited and revised the manuscript. All authors have seen and approved the final version for submission.
How et al.
Page 2
Author Manuscript
pathogens, including E. coli, Klebsiella pneumoniae, Streptococci spp., and Enterobacteriaceae spp.2 In a minority of cases (
