Listeria cerebritis: relapse of infection in renal transplant patients

Abstract

In 3 cases of Listeria cerebritis, 2 of the patients had relapse with cerebritis after antimicrobial therapy for acute Listeria septicemia or meningitis. Each had received 10 to 14 days of i.v. penicillin. Relapse occurred with fever and sudden focal cerebral dysfunction. Brain scans showed focal uptake; arteriograms and computerized tomography were normal. CSF was nondiagnostic; blood cultures yielded Listeria in 2 patients. Penicillin treatment for 6 wk produced rapid clinical responses that were complete in one and minimal residual in 2. Progress brain scans were normal. A relapse rate of 35% is reported in transplant patients with Listeria meningitis and/or bacteremia who are treated for < 3 wk; cerebritis in such patients has apparently not been reported previously. High-dose penicillin or ampicillin therapy for 4-6 wk is recommended for Listeria infections in this select group.