Listeriosis in Adults: A Changing Pattern. Report of Eight Cases and Review of the Literature, 1968-1978

Abstract

One hundred eighty-six cases of adult listeriosis are reviewed. Listeria infections appear to be increasing in frequency, and some of the clinical characteristics of infection have changed since the last critical review. Meningitis remains the most common form of listeriosis in adults. Prominent clinical features of meningitis include ataxia, tremors, seizures, and fluctuating consciousness. Cerebrospinal fluid findings are variable; the result of gram stain is usually negative. Nonmeningitic infections of the central nervous system are characterized by an acute onset of hemiparesis or cranial nerve palsies. Blood cultures almost invariably yield Listeria monocytogenes. Primary listeria bacteremia, previously considered rare, is being reported with increasing frequency. Patients with malignancy, those receiving immunosuppressive drugs, and pregnant women seem particularly prone to this form of listeriosis. Listeria endocarditis is increasing in frequency and clinically resembles other forms of subacute endocarditis. Most patients with listeria endocarditis have an underlying, predisposing heart lesion. Renal transplant recipients are particularly prone to develop listeriosis. Mortality in listeriosis is highest among individuals with infection of the central nervous system, those with an underlying malignancy, and those receiving immunosuppressive therapy.