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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 www.PosterPresentations.com § 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.