Journal of Infection (I99I) z3, 287-29I
CASE REPORT Fatal listeria m e n i n g i t i s in an i m m u n o c o m p r o m i s e d infant: therapeutic implications Laurene Mascola,* Frank Sorvillo,* Nancy Lashleyt and Evan Steinberg~ * Los Angeles County Department of Health Services, Acute Communicable Disease Control, 313 N. Figueroa St, Los Angeles, CA 9ooIe and Departments of afEpidemiology and ~ Pediatrics, Kaiser Permanente, Southern California Permanente Medical Group, 4867 Sunset Blvd., Los Angeles, CA 90027, U.S.A. Accepted for publication 28 March I99I
Summary Infection with Listeria monocytogenes is rare in infants and children. Listeriosis has been made a notifiable condition in the State of California since I985. From January I985 to December I99O, only seven cases of listeriosis have been reported in children ~< I3 years of age. This brief report summarises the features of a fatal case of listeria meningitis in an immunocompromised 4-month-old infant, discusses diagnostic and therapeutic implications, and describes the other six cases.
Introduction Infection with Listeria monocytogenes, a Gram-positive rod, is relatively uncommon in children and healthy adults. A review of the literature therefore reveals only a few cases of listeriosis in both immunocompetent and immunocompromised children. 1-7 Listeria species are ubiquitous in the environment, especially in the food chain. Infants and children therefore are likely to be continually exposed to this organism, which causes illness in iatrogenically immunocompromised patients, the elderly, pregnant women, and newborn babies. Nearly all paediatric infections occur perinatally (designated as early-onset cases) or in infants at I - 4 weeks of age (designated as late-onset cases). A foodborne outbreak of listeriosis involving at least 66 cases associated with Mexican-style cheese in Los Angeles County in I985 led to the State of California Department of Health Services making listeriosis notifiable for clinical laboratories. F r o m January I985 to December I99o over 564 cases of listeria infection were reported in Los Angeles County. Of those cases, 48 (n = 270) were in pregnant women and/or their neonates. Although Los Angeles County has the highest rate of perinatal listeriosis nationwide, s three times that of other recently studied states, only seven cases of listeriosis (both of sepsis and meningitis) have been reported to date in children > 4 weeks and ~< I3 years of age. Five children had listeria sepsis or meningitis, two, aged IO and I2 years, with cancer, and three aged 6 weeks, 7 weeks and 8 weeks. One oi63-4453/9I/O6OZ87+o5 $03.00/0
© I99I The British Society for the Study of Infection
288
L. M A S C O L A E T A L .
case of listeriosis arose in a healthy 7-year-old child. A more recent case of the disease, reported from Los Angeles County, was in a 4-month-old infant receiving adrenocorticotropic h o r m o n e ( A C T H ) for an epileptic disorder. This case report summarises the hospital course of this i m m u n o c o m p r o m i s e d infant with listeria meningitis. Diagnostic and therapeutic aspects of the illness will be discussed. Six other cases will also be briefly described. Case report
This was the second hospital admission for this 4-month-old black girl, who presented to the emergency room with fever to 4 r °C and nasal congestion of 2 days' duration. On the day of admission her m o t h e r reported that the child had decreased appetite and activity as well as four episodes of bilious vomiting. T h e r e was no history of diarrhoea or cough. All other family members, including a 3-year-old sibling, were well. Travel history was negative. T h e m o t h e r had had an uneventful pregnancy. T h e child was born by normal vaginal delivery, with a birth weight of 3.430 kg. Epileptic fits, which had begun at I week of age, were diagnosed as infantile spasms. She was first admitted to hospital at 2 months of age, when a full neurological evaluation confirmed the presence of Aicardi's syndrome, i.e. a left-sided detached retina, a cavernous haemangioma under the right eye, agenesis of the corpus callosum and cystic encephalomalacia. T h e child had been receiving A C T H at a dose of I2o units per square metre of body surface from 2 m o n t h s of age. Other medicines administered in the m o n t h before her admission to hospital included oral nystatin and an 'over-the-counter' cold and cough medicine. On admission the child's temperature was 39'2 °C rectally, pulse rate I 4 4 / p m , respiration rate 4 8 / p m , blood pressure IO4/72 m m H g and weight 4"52 kg (25th percentile). She was lethargic, with intermittent spasms of the arms and legs, and was unresponsive to verbal or painful stimuli. Additional physical findings included an open metopic suture with swelling of the sagittal suture, a right-sided orbital haemangioma, left-sided nystagmus, patchy thrush lesions on the buccal mucosa and oral pharynx together with abdominal distension without enlargement of the abdominal organs. Laboratory investigations showed a WBC count of 3"7 × IO9/1 with 55 % segmented neutrophils, 6 % band forms, and 3 9 % lymphocytes. T h e cerebrospinal fluid (CSF) cell count showed 3"2 × Io9/1 RBC, 5"7 × Io8/1 WBC of which 85 % were polymorphonuclear and I5 % were mononuclear cells. C S F protein was r'98 g/1 and C S F sugar was 2.I mmol/1. A Gram-stained preparation demonstrated a few Gram-negative organisms and occasional Gram-positive rods with a moderate n u m b e r of WBC. T h e child was treated with intravenous cefotaxime 225 mg rv (5o m g / k g body weight) every 6 h, phenobarbitone I I m g IM (2"5 m g / k g body weight) every 12 h, and A C T H 40 units I M daily. T h e infant's neurological and general clinical condition rapidly deteriorated. On her second day in hospital, dexamethasone at a daily dose of o-6 m g / k g body weight, given in equally divided doses every 6 h, was added to the therapeutic regimen. A computerised tomographic scan was not performed. On her third day in h o ~- "*al a blood culture done on admission was reported
Listeriosis in an immunocompromised infant
289
as positive for L. monocytogenes. T h e CSF culture was similarly positive. Ampicillin at a dose of 225 mg IV (5o m g / k g body weight) every 6 h was then added to the therapeutic regimen. On her fourth day in hospital, the child developed bradycardia that was unresponsive to cardiopulmonary resuscitation. At autopsy the child was found to have right-sided micro-ophthalmia with an intraorbital cyst, left-sided micro-ophthalmia with agenesis of the corpus callosum and intracerebral cysts, meningitis (most severe in the posterior fossa, brain and spinal cord), ascites, hepatomegaly and adrenal hyperplasia. Post-mortem cultures were not performed. Other cases of paediatric listeriosis
T h e other six cases of listeriosis in infants and children reported to our surveillance system fell into three categories: older late-onset cases, cancer cases and a normal category. T h r e e infants (two boys and one girl) were between I month and 2 months of age at the time of their infection. T h e y had not had any previous illnesses and presented with signs of sepsis and meningitis very similar clinically, to late-onset listeriosis. T w o other cases were in older Hispanic children with cancer, one being a boy and the other a girl. Both children had recent histories of intensive chemotherapy. One child had listeria sepsis and meningitis, the other had listeria sepsis only. T h e last case of listeriosis was in a 7-year-old black boy, who had blood for culture taken in the emergency room due to high fever, sore throat and a high WBC count. He was treated with a single intramuscular dose of ceftriaxone and sent home. He remained well I year after diagnosis and has not had any sequelae due to what might be presumed inadequate therapy of listeria infection. Discussion
Our case illustrates a weakness in the prevailing treatment of bacterial meningitis in children. In a recent poll of paediatric infectious disease programme directors reporting on therapy of presumed bacterial meningitis in infants 5 months to children I2 years of age, over 62 0/0 recommended cefotaxime, ceftriaxone or cefuroxime only2 For therapy of presumed bacterial sepsis of children in the same age-range, over 76% recommended a cephalosporin only. 9 Although L. monocytogenes is relatively sensitive in vitro to cephalothin, TM cephalosporins are not usually listed in treatment regimens for this organism. T M Reports have described resistance of the organism to cefotaxime. 6 We have noted other clinical failures, especially in febrile pregnant women with listeria infection, and who were treated with a cephalosporin, and in whom perinatal transmission of the organism was not prevented. In light of the decreasing use of ampicillin for empirical therapy of meningitis, this case highlights the importance of the CSF Gram-stain. T h e CSF Gram-stain on admission of the child to hospital revealed a mixed flora which included Gram-positive rods. Any time that Gram-positive bacilli are seen in the CSF, regardless of the patient's age or underlying condition, therapy for L. monocytogenes, e.g. ampicillin and gentamicin, must be included.
290
L. MASCOLA E T ,4L.
Review of both the paediatric and adult clinical literature, 1-7'13-15 however, reveals that nearly all patients with listeria meningitis have negative C S F Gram-stains on admission. In one series alone, of 25 patients with listeria meningitis, organisms were not seen in the C S F on their admission to hospital in I9 ( 7 6 % ) patients. ~3 F u r t h e r m o r e , bacterial antigen tests are not commercially available for L. monocytogenes. Therefore, empirical treatment of purulent meningitis with a negative C S F G r a m - s t a i n and negative bacterial antigen tests should also include ampicillin. T h e low incidence of listeria infection n o t e d in infants and children in our surveillance system is consistent with the findings of past studies. 3'~5 It is surprising that this ubiquitous organism does not m o r e often cause infection in i m m u n o s u p p r e s s e d children. In our case, regular A C T H therapy for an epileptic disorder m a y have p u t the child at risk of acquiring listeriosis. Several observations m a y explain the low rate of listeriosis in infants and children. Although estimates suggest that I - 5 % persons in the general population harbor L. monoeytogenes in their gastro-intestinal tracts, 16 i m m u n o competent and i m m u n o s u p p r e s s e d infants and children often receive multiple courses of antibiotics in their first years of life and which m a y alter their gastro-intestinal flora or even eradicate L. monocytogenes. Both amoxicillin and co-trimoxazole appear to be effective in cases o f listeriosis. 17'~8 Less exposure m a y also play a role since the diet of children m a y not include high-risk foods, especially raw vegetables. Unfortunately, accurate denominator data for children at risk of listeria infection are not readily available. Therefore, the exact rate of infection in children is difficult to calculate. Paediatricians should advise parents of highrisk patients not to give t h e m foods such as raw dairy products, u n d e r c o o k e d poultry, raw meats (especially uncooked hot dogs), and raw fish; also thoroughly to wash raw vegetables and salads before consumption. 19 Despite the rarity of listeriosis in children, clinicians treating undiagnosed meningitis or sepsis in infants and children (especially those with underlying i m m u n o c o m p r o m i s i n g conditions or w h o are receiving corticosteroids) should always consider L. monocytogenes as a possible aetiological agent. (We thank Mr Alan Wald, Dr Francine Kaufman, Dr Stephen Waterman and Dr Gary Overturf for reviewing this case report and Ms Juanita Orta for her secretarial support.) References
I. Maguire BJ, Riley HD Jr. Infections due to Listeria monocytogenes in infants and children. Am J Med Sci I967; 254: 421-428. 2. Colagiuri PM, Leslie CJ. Listeria monocytogenes infection in children. N Y State J Med x96I; 6I: 2ii0-2ii2. 3. Tim MW, Jackson MA, Shannon K, Cohen B, McCracken GH Jr. Non-neonatal infection due to Listeria monocytogenes. Pediatr Infect Dis i984; 3:213-217 • 4. Nichols W Jr, Woolley PV Jr. Listeria monocytogenes meningitis. J Pediatr I962; 6x: 337-350. 5. Trang TTH, Joly JB, Odi~vre M. Infection fi Listeira monocytogenes chez le grand enfant. Arch Fr Pediatr I987; 44: 449-45I. 6. Hervas JA, Fiol M, Cuesta M. Non-neonatal relapsing meningitis caused by Listeria monocytogenes (Letter). Pediatr Infect Dis I986; 6: 72I.
Listeriosis in an immunocompromised infant
291
7. Visintine A M , Oleske JM, Nahmias AJ. Listeria monocytogenes infection in infants and children. Am J Dis Child I977; I3x: 393-397. 8. Gellin BG, Broome CV. Listeriosis. J A M A I989; 26x: I313-I32o. 9. W o r d BM, Klein JO. Therapy of bacterial sepsis and meningitis in infants and children: i989 poll of directors of programs in pediatric infectious diseases. Pediatr Infect Dis I989; 8 : 635-637. Io. van Keulen PHJ, Limburg M, de Gans J. Treatment of Listeria meningitis with cephalothin combined with trimethoprim (Letter). J Infect I986; I3: 303-305. I I. Bortolussi R, Hawkins A, Evans J, Albritton W L . Listeriosis. In: Feigin RD, Cherry JD, Eds. Textbook of pediatric infectious diseases. Philadelphia: WB Sannders, I987 : I 2 o 6 - I 2 i I. I2. Armstrong D. Listeria monocytogenes. In: Mandell G L , Douglas R G Jr, Bennett JE, Eds. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, I99o : I587-I593. I3. Lavetter A, Leedom JM, Mathies A W Jr, Ivler D, Wehrle PF. Meningitis due to Listeria monocytogenes. A review of 25 cases. N Engl ff Med I97I ; 285: 598-6o:~. I4. Nieman RE, Lorber B. Listeriosis in adults : a changing pattern. Report of eight cases and review of the literature, I968-I978. Rev Infect Dis I98o; 2: 2o7-zz7. 15. Kessler SL, Dajani AS. Listeria meningitis in infants and children. Pediatr Infect Dis I99O; 9: 61-63. I6. Jacobs JL, Murray I-IW. Why is Listeria monocytogenes not a pathogen in the acquired immunodeficiency syndrome? (Editorial.) Arch lntern A4ed I986; x46: I299--I3oo. 17. Spitzer PG, H a m m e r SM, Karchmer A W . Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev lnfect Dis 1986; 8 : 427-430. I8. Gunther G, Philipson A. Oral trimethoprim as follow-up treatment of meningitis caused by Listeria monocytogenes. Rev Infect Dis 1988; IO: 53-55. 19. Schwartz B, Broome CV, Brown G R et al. Association of sporadic listeriosis with consumption of uncooked hot dogs and undercooked chicken. Lancet I988; ii: 779--782.
12
JIN23
CASE REPORT Fatal listeria m e n i n g i t i s in an i m m u n o c o m p r o m i s e d infant: therapeutic implications Laurene Mascola,* Frank Sorvillo,* Nancy Lashleyt and Evan Steinberg~ * Los Angeles County Department of Health Services, Acute Communicable Disease Control, 313 N. Figueroa St, Los Angeles, CA 9ooIe and Departments of afEpidemiology and ~ Pediatrics, Kaiser Permanente, Southern California Permanente Medical Group, 4867 Sunset Blvd., Los Angeles, CA 90027, U.S.A. Accepted for publication 28 March I99I
Summary Infection with Listeria monocytogenes is rare in infants and children. Listeriosis has been made a notifiable condition in the State of California since I985. From January I985 to December I99O, only seven cases of listeriosis have been reported in children ~< I3 years of age. This brief report summarises the features of a fatal case of listeria meningitis in an immunocompromised 4-month-old infant, discusses diagnostic and therapeutic implications, and describes the other six cases.
Introduction Infection with Listeria monocytogenes, a Gram-positive rod, is relatively uncommon in children and healthy adults. A review of the literature therefore reveals only a few cases of listeriosis in both immunocompetent and immunocompromised children. 1-7 Listeria species are ubiquitous in the environment, especially in the food chain. Infants and children therefore are likely to be continually exposed to this organism, which causes illness in iatrogenically immunocompromised patients, the elderly, pregnant women, and newborn babies. Nearly all paediatric infections occur perinatally (designated as early-onset cases) or in infants at I - 4 weeks of age (designated as late-onset cases). A foodborne outbreak of listeriosis involving at least 66 cases associated with Mexican-style cheese in Los Angeles County in I985 led to the State of California Department of Health Services making listeriosis notifiable for clinical laboratories. F r o m January I985 to December I99o over 564 cases of listeria infection were reported in Los Angeles County. Of those cases, 48 (n = 270) were in pregnant women and/or their neonates. Although Los Angeles County has the highest rate of perinatal listeriosis nationwide, s three times that of other recently studied states, only seven cases of listeriosis (both of sepsis and meningitis) have been reported to date in children > 4 weeks and ~< I3 years of age. Five children had listeria sepsis or meningitis, two, aged IO and I2 years, with cancer, and three aged 6 weeks, 7 weeks and 8 weeks. One oi63-4453/9I/O6OZ87+o5 $03.00/0
© I99I The British Society for the Study of Infection
288
L. M A S C O L A E T A L .
case of listeriosis arose in a healthy 7-year-old child. A more recent case of the disease, reported from Los Angeles County, was in a 4-month-old infant receiving adrenocorticotropic h o r m o n e ( A C T H ) for an epileptic disorder. This case report summarises the hospital course of this i m m u n o c o m p r o m i s e d infant with listeria meningitis. Diagnostic and therapeutic aspects of the illness will be discussed. Six other cases will also be briefly described. Case report
This was the second hospital admission for this 4-month-old black girl, who presented to the emergency room with fever to 4 r °C and nasal congestion of 2 days' duration. On the day of admission her m o t h e r reported that the child had decreased appetite and activity as well as four episodes of bilious vomiting. T h e r e was no history of diarrhoea or cough. All other family members, including a 3-year-old sibling, were well. Travel history was negative. T h e m o t h e r had had an uneventful pregnancy. T h e child was born by normal vaginal delivery, with a birth weight of 3.430 kg. Epileptic fits, which had begun at I week of age, were diagnosed as infantile spasms. She was first admitted to hospital at 2 months of age, when a full neurological evaluation confirmed the presence of Aicardi's syndrome, i.e. a left-sided detached retina, a cavernous haemangioma under the right eye, agenesis of the corpus callosum and cystic encephalomalacia. T h e child had been receiving A C T H at a dose of I2o units per square metre of body surface from 2 m o n t h s of age. Other medicines administered in the m o n t h before her admission to hospital included oral nystatin and an 'over-the-counter' cold and cough medicine. On admission the child's temperature was 39'2 °C rectally, pulse rate I 4 4 / p m , respiration rate 4 8 / p m , blood pressure IO4/72 m m H g and weight 4"52 kg (25th percentile). She was lethargic, with intermittent spasms of the arms and legs, and was unresponsive to verbal or painful stimuli. Additional physical findings included an open metopic suture with swelling of the sagittal suture, a right-sided orbital haemangioma, left-sided nystagmus, patchy thrush lesions on the buccal mucosa and oral pharynx together with abdominal distension without enlargement of the abdominal organs. Laboratory investigations showed a WBC count of 3"7 × IO9/1 with 55 % segmented neutrophils, 6 % band forms, and 3 9 % lymphocytes. T h e cerebrospinal fluid (CSF) cell count showed 3"2 × Io9/1 RBC, 5"7 × Io8/1 WBC of which 85 % were polymorphonuclear and I5 % were mononuclear cells. C S F protein was r'98 g/1 and C S F sugar was 2.I mmol/1. A Gram-stained preparation demonstrated a few Gram-negative organisms and occasional Gram-positive rods with a moderate n u m b e r of WBC. T h e child was treated with intravenous cefotaxime 225 mg rv (5o m g / k g body weight) every 6 h, phenobarbitone I I m g IM (2"5 m g / k g body weight) every 12 h, and A C T H 40 units I M daily. T h e infant's neurological and general clinical condition rapidly deteriorated. On her second day in hospital, dexamethasone at a daily dose of o-6 m g / k g body weight, given in equally divided doses every 6 h, was added to the therapeutic regimen. A computerised tomographic scan was not performed. On her third day in h o ~- "*al a blood culture done on admission was reported
Listeriosis in an immunocompromised infant
289
as positive for L. monocytogenes. T h e CSF culture was similarly positive. Ampicillin at a dose of 225 mg IV (5o m g / k g body weight) every 6 h was then added to the therapeutic regimen. On her fourth day in hospital, the child developed bradycardia that was unresponsive to cardiopulmonary resuscitation. At autopsy the child was found to have right-sided micro-ophthalmia with an intraorbital cyst, left-sided micro-ophthalmia with agenesis of the corpus callosum and intracerebral cysts, meningitis (most severe in the posterior fossa, brain and spinal cord), ascites, hepatomegaly and adrenal hyperplasia. Post-mortem cultures were not performed. Other cases of paediatric listeriosis
T h e other six cases of listeriosis in infants and children reported to our surveillance system fell into three categories: older late-onset cases, cancer cases and a normal category. T h r e e infants (two boys and one girl) were between I month and 2 months of age at the time of their infection. T h e y had not had any previous illnesses and presented with signs of sepsis and meningitis very similar clinically, to late-onset listeriosis. T w o other cases were in older Hispanic children with cancer, one being a boy and the other a girl. Both children had recent histories of intensive chemotherapy. One child had listeria sepsis and meningitis, the other had listeria sepsis only. T h e last case of listeriosis was in a 7-year-old black boy, who had blood for culture taken in the emergency room due to high fever, sore throat and a high WBC count. He was treated with a single intramuscular dose of ceftriaxone and sent home. He remained well I year after diagnosis and has not had any sequelae due to what might be presumed inadequate therapy of listeria infection. Discussion
Our case illustrates a weakness in the prevailing treatment of bacterial meningitis in children. In a recent poll of paediatric infectious disease programme directors reporting on therapy of presumed bacterial meningitis in infants 5 months to children I2 years of age, over 62 0/0 recommended cefotaxime, ceftriaxone or cefuroxime only2 For therapy of presumed bacterial sepsis of children in the same age-range, over 76% recommended a cephalosporin only. 9 Although L. monocytogenes is relatively sensitive in vitro to cephalothin, TM cephalosporins are not usually listed in treatment regimens for this organism. T M Reports have described resistance of the organism to cefotaxime. 6 We have noted other clinical failures, especially in febrile pregnant women with listeria infection, and who were treated with a cephalosporin, and in whom perinatal transmission of the organism was not prevented. In light of the decreasing use of ampicillin for empirical therapy of meningitis, this case highlights the importance of the CSF Gram-stain. T h e CSF Gram-stain on admission of the child to hospital revealed a mixed flora which included Gram-positive rods. Any time that Gram-positive bacilli are seen in the CSF, regardless of the patient's age or underlying condition, therapy for L. monocytogenes, e.g. ampicillin and gentamicin, must be included.
290
L. MASCOLA E T ,4L.
Review of both the paediatric and adult clinical literature, 1-7'13-15 however, reveals that nearly all patients with listeria meningitis have negative C S F Gram-stains on admission. In one series alone, of 25 patients with listeria meningitis, organisms were not seen in the C S F on their admission to hospital in I9 ( 7 6 % ) patients. ~3 F u r t h e r m o r e , bacterial antigen tests are not commercially available for L. monocytogenes. Therefore, empirical treatment of purulent meningitis with a negative C S F G r a m - s t a i n and negative bacterial antigen tests should also include ampicillin. T h e low incidence of listeria infection n o t e d in infants and children in our surveillance system is consistent with the findings of past studies. 3'~5 It is surprising that this ubiquitous organism does not m o r e often cause infection in i m m u n o s u p p r e s s e d children. In our case, regular A C T H therapy for an epileptic disorder m a y have p u t the child at risk of acquiring listeriosis. Several observations m a y explain the low rate of listeriosis in infants and children. Although estimates suggest that I - 5 % persons in the general population harbor L. monoeytogenes in their gastro-intestinal tracts, 16 i m m u n o competent and i m m u n o s u p p r e s s e d infants and children often receive multiple courses of antibiotics in their first years of life and which m a y alter their gastro-intestinal flora or even eradicate L. monocytogenes. Both amoxicillin and co-trimoxazole appear to be effective in cases o f listeriosis. 17'~8 Less exposure m a y also play a role since the diet of children m a y not include high-risk foods, especially raw vegetables. Unfortunately, accurate denominator data for children at risk of listeria infection are not readily available. Therefore, the exact rate of infection in children is difficult to calculate. Paediatricians should advise parents of highrisk patients not to give t h e m foods such as raw dairy products, u n d e r c o o k e d poultry, raw meats (especially uncooked hot dogs), and raw fish; also thoroughly to wash raw vegetables and salads before consumption. 19 Despite the rarity of listeriosis in children, clinicians treating undiagnosed meningitis or sepsis in infants and children (especially those with underlying i m m u n o c o m p r o m i s i n g conditions or w h o are receiving corticosteroids) should always consider L. monocytogenes as a possible aetiological agent. (We thank Mr Alan Wald, Dr Francine Kaufman, Dr Stephen Waterman and Dr Gary Overturf for reviewing this case report and Ms Juanita Orta for her secretarial support.) References
I. Maguire BJ, Riley HD Jr. Infections due to Listeria monocytogenes in infants and children. Am J Med Sci I967; 254: 421-428. 2. Colagiuri PM, Leslie CJ. Listeria monocytogenes infection in children. N Y State J Med x96I; 6I: 2ii0-2ii2. 3. Tim MW, Jackson MA, Shannon K, Cohen B, McCracken GH Jr. Non-neonatal infection due to Listeria monocytogenes. Pediatr Infect Dis i984; 3:213-217 • 4. Nichols W Jr, Woolley PV Jr. Listeria monocytogenes meningitis. J Pediatr I962; 6x: 337-350. 5. Trang TTH, Joly JB, Odi~vre M. Infection fi Listeira monocytogenes chez le grand enfant. Arch Fr Pediatr I987; 44: 449-45I. 6. Hervas JA, Fiol M, Cuesta M. Non-neonatal relapsing meningitis caused by Listeria monocytogenes (Letter). Pediatr Infect Dis I986; 6: 72I.
Listeriosis in an immunocompromised infant
291
7. Visintine A M , Oleske JM, Nahmias AJ. Listeria monocytogenes infection in infants and children. Am J Dis Child I977; I3x: 393-397. 8. Gellin BG, Broome CV. Listeriosis. J A M A I989; 26x: I313-I32o. 9. W o r d BM, Klein JO. Therapy of bacterial sepsis and meningitis in infants and children: i989 poll of directors of programs in pediatric infectious diseases. Pediatr Infect Dis I989; 8 : 635-637. Io. van Keulen PHJ, Limburg M, de Gans J. Treatment of Listeria meningitis with cephalothin combined with trimethoprim (Letter). J Infect I986; I3: 303-305. I I. Bortolussi R, Hawkins A, Evans J, Albritton W L . Listeriosis. In: Feigin RD, Cherry JD, Eds. Textbook of pediatric infectious diseases. Philadelphia: WB Sannders, I987 : I 2 o 6 - I 2 i I. I2. Armstrong D. Listeria monocytogenes. In: Mandell G L , Douglas R G Jr, Bennett JE, Eds. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, I99o : I587-I593. I3. Lavetter A, Leedom JM, Mathies A W Jr, Ivler D, Wehrle PF. Meningitis due to Listeria monocytogenes. A review of 25 cases. N Engl ff Med I97I ; 285: 598-6o:~. I4. Nieman RE, Lorber B. Listeriosis in adults : a changing pattern. Report of eight cases and review of the literature, I968-I978. Rev Infect Dis I98o; 2: 2o7-zz7. 15. Kessler SL, Dajani AS. Listeria meningitis in infants and children. Pediatr Infect Dis I99O; 9: 61-63. I6. Jacobs JL, Murray I-IW. Why is Listeria monocytogenes not a pathogen in the acquired immunodeficiency syndrome? (Editorial.) Arch lntern A4ed I986; x46: I299--I3oo. 17. Spitzer PG, H a m m e r SM, Karchmer A W . Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev lnfect Dis 1986; 8 : 427-430. I8. Gunther G, Philipson A. Oral trimethoprim as follow-up treatment of meningitis caused by Listeria monocytogenes. Rev Infect Dis 1988; IO: 53-55. 19. Schwartz B, Broome CV, Brown G R et al. Association of sporadic listeriosis with consumption of uncooked hot dogs and undercooked chicken. Lancet I988; ii: 779--782.
12
JIN23
