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Listeria Meningitis — SCE Infectious Diseases MCQ

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ModerateCNS InfectionListeria MeningitisSCE Infectious Diseases

A 33-year-old woman with systemic lupus erythematosus on Mycophenolate Mofetil and Prednisolone 20 mg daily presents with fever and progressive headache. CSF shows: opening pressure 28 cmH2O, WCC 180/µL (85% lymphocytes), protein 1.5 g/L, glucose 1.8 mmol/L (serum 5.0). CSF Gram stain shows Gram-positive rods. What is the most likely organism?

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Correct answer: D — Listeria monocytogenes

Gram-positive rods in CSF with lymphocytic predominance in an immunocompromised patient on high-dose steroids and Mycophenolate is highly suggestive of Listeria monocytogenes meningitis. Listeria is an important cause of meningitis in immunosuppressed patients, the elderly, neonates, and pregnant women. Treatment is IV Amoxicillin (2 g 4-hourly) for at least 21 days. Cephalosporins have no activity against Listeria. Trimethoprim may be added as synergistic combination.

Reference: NICE CG102 2010 – Bacterial meningitis; BSAC/BIA 2016 – Meningitis guidelines