Download An Unusual Case of Listeria monocytogenes in the Midst of a

An Unusual Case of Listeria monocytogenes in the Midst of a Community Outbreak
Greg Burfeind MS31, Mark Reid MD2 1University of Colorado School of Medicine, Aurora, CO 2Denver Health Medical Center, Denver CO Introduc4on •  Listeria monocytogenes is a known but rare cause
of spontaneous bacterial peritonitis (SBP).
Background •  L. monocytogenes is a well-known pathogen in
pregnant females, neonates, elderly, and
immunocompromised individuals.
Case Discussion §  It is important to consider Listeria monocytogenes
in patients with SBP due to its high mortality rates
and lack of susceptibility to empiric thirdgeneration cephalosporin treatment make in SBP.2
•  50-year-old HIV positive male with cirrhosis caused
by hepatitis C and chronic alcohol abuse presents
with two-day history of abdominal distention,
weakness, and decreased oral intake. No fever,
chills, abdominal pain, nausea or vomiting.
§  The presence of gram positive bacilli on a gram
stain of ascitic fluid suggests the diagnosis of
listeria SBP.
•  Physical exam: temperature: 38.7oC; heart rate:
112 beats/min; blood pressure: 148/88 mmHg;
respiratory rate: 24 breaths/min. Abdomen
distended, firm and mildly tender to palpation.
•  Paracentesis: 18,140 white blood cells/mm3, with
91% neutrophils (ascites neutrophil count of 16,507/
mm3).
The described case of L. monoytogenes SBP occurred shortly
after the peak of a local and national outbreak of L.
monocytogenes traced back to cantaloupe from Jensen
Farms in Granada, CO.
•  Started intravenous levofloxacin for empiric
treatment of SBP.
•  Commonly attributed to ingestion of unpasteurized
milk products, soft cheeses, and deli meats.
•  Patients with impaired T-cell-mediated immunity,
such as patients with HIV, are especially prone to
infections caused by L. monocytogenes.
•  Common disease manifestations of L.
monocytogenes include febrile gastroenteritis,
meningitis, and sepsis.
RESEARCH POSTER PRESENTATION DESIGN © 2011
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§  This case illustrates the importance of considering
L. moncytogenes as a causative agent of SBP in
immunocompromised patients, especially in the
setting of a recent community outbreak.
References 1. Centers for Disease Control and Prevention.
Investigation Update: Multistate Outbreak of
Listeriosis Linked to Whole Cantaloupes from Jensen
Farms, Colorado. Available at: http://
www.cdc.gov/listeria/outbreaks/cantaloupesjensen-farms/110211/index.html. Accessed
December 6, 2011.
•  Gram stain of ascitic fluid revealed gram-positive
bacilli. Antibiotic coverage was immediately
changed to intravenous ampicillin and vancomycin
to cover for gram-positive organisms.
•  The organism from the ascitic fluid cultures wass
identified as L. monocytogenes.
• The patient received a two-week course of
intravenous ampicillin and recovered completely.
Conclusions As of November 1, 2011, 139 cases of listeriosis from 28
states, including 8 deaths in Colorado, had been reported to
the CDC.1
2. Frachtman S, Lu L, Lau M, Greensberg S.
Spontaneous Bacterial Peritonitis Due to Listeria
monocytogenes: A Case Report and a Review of
Listeria monocytogenes Peritonitis. Infectious
Diseases in Clinical Practice. Vol 17, Number 1, Jan
2009: 63 – 65.