Journal of Infection (2015) xx, 1e3

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LETTER TO THE EDITOR Listeria monocytogenes meningitis in the elderly: Distinctive characteristics of the clinical and laboratory presentation

KEYWORDS Listeria monocytogenes; Streptococcus pneumoniae; Meningitis; Elderly; Infection

Domingo and colleagues, in this Journal, reported the increased incidence of Listeria meningitis in elderly amongst more recent cohorts.1 In ageing people, infections are not only more frequent compared to the younger population, but they also have a distinct epidemiological and clinical presentation, treatment and outcome.2 The aim of this prospective observational study was to evaluate, in patients aged over 50 years consecutively observed during a ten-year period at the ‘D. Cotugno’ hospital (Naples, Italy), the findings of Listeria meningitis and possibly distinguish its epidemiological, clinical and laboratory pictures from those of pneumococcal meningitis that is the most common form diagnosed in the elderly. The diagnosis of bacterial meningitis had to be based on the characteristic clinical signs and symptoms (i.e. fever, neck stiffness and impaired consciousness) and on cerebro-spinal fluid (CSF) pleocytosis (>10 cells/mL). The inclusion criteria were: i) diagnosis of pneumococcal or Listeria meningitis established by positive cultures and CSF pleocytosis; ii) age >50 years; iii) post-therapy follow-up of at least 8 weeks for surviving cases. The exclusion criterion was coinfection with HIV. One hundred and thirty-one patients were included in the study (22 cases Listeria meningitis and 109 cases pneumococcal meningitis). The patients with Listeria meningitis were more frequently immunocompromised (17/22 vs 47/109, c2 Z 7.23; p < 0.01) or were receiving immunosuppressive drugs such as steroids or a TNF-alpha inhibitor

(5/22 vs 5/109, c2 Z 6.16; p < 0.05). Infections outside the central nervous system such as pneumonia, otitis media and sinus infection or evidence of basal leak were found at admission mainly in patients with pneumococcal meningitis (1/22 vs 72/109, c2 Z 25.6; p < 0.0001) (Table 1). A higher proportion of cases with Listeria meningitis reported a Glasgow coma score (GCS) < 11 (21/22 vs 77/109, c2 Z 4.74; p < 0.05). Appropriate diagnosis and therapy within 48 h from the onset of general symptoms was given to 9/22 (41%) patients with Listeria meningitis and 77/109 (71%) patients with pneumococcal meningitis (c2 Z 7.18; p < 0.01; RR Z 2.01). Respiratory failure within 48 h from admission occurred more frequently in patients with pneumococcal meningitis (2/22 vs55/109, c2 Z 11.1; p < 0.001). Laboratory investigation revealed higher level of blood neutrophils (p < 0.05) and lower level of CSF glucose (p < 0.0001) in patients with pneumococcal meningitis; no difference was reported in the CSF cell count or CSF protein (Table 1). By multivariate analysis, we found an independent association between Listeria diagnosis and the absence of infective foci outside the central nervous system, current immunosuppressive therapy, a GCS

Listeria monocytogenes meningitis in the elderly: Distinctive characteristics of the clinical and laboratory presentation.

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