Listeriosis Complicating Malignant Disease

Abstract

The literature on human infection with Listeria monocytogenes in children and adults was reviewed. Of 11 cases in which adequate clinical data were available, 78% had meningitis; the remaining 22% had other types of infections including 12 with bacteremia and 5 with endocarditis. There was some predilection for those over 50 years. Of the 100 patients, 26 had some underlying disease. Eighteen additional cases of listeric infection were seen; 16 of these arose in patients with established lymphatic malignancy. Seven manifested bacteremia and 11 meningitis. Among the patients with meningitis, cerebral spinal fluid findings varied markedly. Protein concentrations ranged from normal to 850 mg% and cells from 0 to 4800/mm3, differential counts showing a predominance of either mononuclear or polymorphonuclear cells. Prognosis could be correlated with initial cerebrospinal fluid glucose values, a reduced glucose value was an ominous prognostic sign. Twelve of the 18 patients were infected with L. monocytogenes type 1, an exact reversal of the general experience in which type 4b is responsible for approximately 2/3 of the cases of listeriosis in the United States. Disc susceptibility tests showed that several antibiotics inhibited L. monocytogenes growth in vitro. Penicillin, eryth-romycin and tetracycline were most consistently, but not always, effective. Animal experiments showed that L. monocytogenes often persisted in mouse tissues despite penicillin or tetracycline therapy. There was no evidence that persistence of experimental infections was related to L-form transformation. L. monocytogenes can cause secondary infection in those whose defenses are impaired by lymphatic malignancy.