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A case report of oral sulfamethoxazole in the treatment of posttransplant Listeria monocytogenes meningitis

ABSTRACT:

Background

Renal transplant recipients are prone to Listeria monocytogenes (Lm) infection due to immunosuppressive therapies. Ampicillin or penicillin G is regarded as the first-line treatment of Lm meningitis. For patients with allergy to penicillin, convention to trimethoprim-sulfamethoxazole (TMP-SMX) iv should ideally be performed since TMP-SMX remarkable bactericidal activity. But there’s still scarcity of reports indicating oral TMP-SMX regimen on Lm meningitis.

Case Description

A 30-year-old male who received a renal transplant 4 months ago was admitted to the hospital with generalized pain and headache for 3 days accompanied by diarrhea and fever for 1 day. The patient had been treated with regular oral immunosuppressants post-transplantation. After admission, the patient poorly responded to cefoperazone sulbactam and progressed rapidly with increasing headache, persistent diarrhea, diplopia, and dyspnea and was subsequently transferred to the intensive care unit (ICU) for ventilatory support. Later, as Lm was detected successively in the patient’s blood culture and cerebrospinal fluid culture, the patient was diagnosed with Lm infection. Due to the patient’s allergy to penicillins, the TMP-SMX was selected for oral treatment, and the patient well tolerated to TMP-SMX oral regimen without significant adverse effects and recovered after 2 weeks. After discharge, follow-up has shown that the patient has generally remained in good condition with stable graft function to date.

Conclusions

The case of our study demonstrated Lm infection post renal transplantation can be cured by oral TMP-SMX. Furthermore, the recent research and clinical progress of Lm microbiological characteristics, clinical manifestations, diagnosis, and treatment of listeriosis were summarized.

SUBMITTER: Ma Y

PROVIDER: S-EPMC10080344 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Project description:BackgroundListeria monocytogenes is a common cause of bacterial meningitis. We developed an animal model of listerial meningitis.MethodsIn survival studies, C57BL/6 mice received intracisternal injections with different L. monocytogenes sequence type 1 (ST1) colony forming units per milliliter (CFU; n = 48, 105, 106, 107, 108, and 109 CFU/ml). Second, mice were inoculated with 108 CFU/ml ST1 and sacrificed at 6 h and 24 h (n = 12/group). Outcome parameters were clinical score, CFUs, cyto- and chemokine levels, and brain histopathology. Third, 84 mice were inoculated (109 CFU/ml ST1) to determine optimal antibiotic treatment with different doses of amoxicillin and gentamicin. Fourth, mice were inoculated with 109 CFU/ml ST1, treated with amoxicillin, and sacrificed at 16 h and 24 h (n = 12/group) for outcome assessment. Finally, time point experiments were repeated with ST6 (n = 24/group).ResultsMedian survival time for inoculation with 108 and 109 CFU/ml ST1 was 46 h and 40 h; lower doses of bacteria led to minimal clinical signs of disease. Brain levels of IL-6, IL-17A, and IFN-γ were elevated at 24 h, and IL-1β, IL-6, IL-10, IFN-γ, and TNF-α were elevated in blood at 6 h and 24 h. Histopathology showed increased meningeal infiltration, vascular inflammation of meningeal vessels, hemorrhages, and ventriculitis. In the treatment model, brain levels of IL-6 and IL-17A and blood levels of IL-6 and IFN-γ were elevated. Compared to ST6, infection with ST1 led initially to higher levels of IL-1β and TNF-α in blood and more profound neuropathological damage. At 16 h post inoculation, IL-1β, IL-10, and TNF-α in blood and IL-6, IL17A, TNF-α, and IFN-γ levels in brain were higher in ST1 compared to ST6 without differences in CFUs between STs. At 24 h, neuropathology score was higher in ST1 compared to ST6 (p = 0.002) infected mice.ConclusionsWe developed and validated a murine model of listerial meningitis. ST1-infected mice had a more severe inflammatory response and brain damage as compared to ST6-infected mice.