A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage: A review of treatment options and outcomes

Gerstein, Shawn; Gautam-Goyal, Pranisha; Goyal, Sameer

These high morbidity and mortality figures occurred in the setting of a range of treatment courses, as there is no clear consensus on optimal management. In several cases, patients did not receive appropriate coverage for Listeria until the organism was confirmed by either culture or PCR analysis, while in other cases Listeria was covered empirically from the onset of hospitalization, with or without double coverage utilizing an aminoglycoside. While dual therapy with ampicillin and aminoglycosides has been proposed in guidelines, Pelegrin and colleagues found no mortality difference between ampicillin montherapy and combination therapy with an aminoglycoside [1, 9] In the same study, while adjunctive administration of dexamethasone and phenytoin did not provide a clear mortality benefit, the use of dexamethasone showed a trend towards fewer neurologic sequelae and those who received phenytoin experienced no seizures. Dexamethasone did not show any clear benefit in prophylaxis against hydrocephalus, as had been suggested by animal models. Most patients we reviewed received an external ventricular catheter without significant differences in outcome from those who hadn't. Appropriate empirical antimicrobial therapy and consultation with neurosurgery regarding management of hydrocephalus were seen as the key features of management by Pelegrin and colleagues, while inappropriate empiric antimicrobial therapy and hydrocephalus were the main independent prognostic factors associated with mortality [1] .