Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 29, Num. 1, 2011, pp. 79-79

Indian Journal of Medical Microbiology, Vol. 29, No. 1, January-March, 2011, pp. 79

Correspondence

Neonatal listeriosis: A case report from sub-Himalayas

R Adhikary, S Joshi

Department of Microbiology, Manipal Hospital, Airport Road, Bangalore 560 017, India

Correspondence Address: R Adhikary, Department of Microbiology, Manipal Hospital, Airport Road, Bangalore 560 017, India, dr_ranjeeta_adhikary@yahoo.com

Date of Submission: 06-Dec-2010
Date of Acceptance: 26-Dec-2010

Code Number: mb11023

PMID: 21304207

DOI: 10.4103/0255-0857.76536

Dear Editor,

With reference to the case report on neonatal listeriosis ^[1] in the October 2010 issue of the journal, we would like to share our experience of Listeria monocytogenes from a case of prosthetic valve endocarditis. There are few case reports of endocarditis due to this organism. ^[2],[3]

A 33-year-old female presented with fever and breathlessness since 10 days. She was a known case of Fallot′s tetralogy with aortic valve disease having undergone aortic valve replacement with bioprosthesis, ventricular septal defect closure, and pulmonary valvuloplasty 6 months earlier. On examination she was febrile (39ºC), with elevated jugular venous pressure and bilateral pedal edema. Cardiovascular examination showed a pulse rate of 120 beats/min and blood pressure of 100/60 mm Hg with a systolic murmur. Respiratory basal crepitations and abdominal distension were also noted. The transesophageal echocardiogram showed large vegetations on septal chordae of the right ventricle with dehiscence and an acquired Gerbode defect of left-ventriculo-right-atrial shunt. Total leukocyte count was 11,320/mm ³ with 71% neutrophils. She was treated in the intensive care unit along with ventilator support, and she developed generalized tonic clonic seizures after 5 days. Three blood cultures done at hourly intervals on the day of admission using BacTalert (bioMerieux) yielded L. monocytogenes. This was identified by colony morphology, hemolysis, tumbling motility, ability to grow at 4 ºC, typical CAMP test, and VITEK system (bioMerieux). It was susceptible to penicillin, gentamicin, trimethoprim-sulfamethoxazole, erythromycin, and resistant to cephalosporins. ^[4] She was treated with ampicillin, gentamicin, and anticonvulsants. The relatives were informed about the poor prognosis of the patient, but they insisted on discharge against medical advice with no further follow-up.

The present communication highlights the grave prognosis and the need to be vigilant to identify L. monocytogenes as it maybe wrongly dismissed as culture contaminant ^[5] because of its diphtheroid ^[4],[5] appearance and therefore may be under-reported.

References

1.	Mokta KK, Kanga AK, Kaushal RK. Neonatal Listeriosis: A case report from sub-Himalayas. Indian J Med Microbiol 2010;28:385-7.  Back to cited text no. 1  [PUBMED]
2.	Fernandez Guerrero ML, Rivas P, Rabago R, Nunez A, de Gorgolas M, Martinell J. Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews. Int J Infect Dis 2004;8:97-102.  Back to cited text no. 2
3.	Spyrou N, Anderson M, Foale R. Listeria endocarditis: current management and patient outcome- world literature review. Heart 1997;77:380-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Mitchell RG. Listeria, Erysipelothrix, Chapter 16. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney practical medical microbiology, 14 th ed. Edinburgh, Churchill Livingstone, 1996;309-15.  Back to cited text no. 4
5.	Sheinman BD, Evans T, Sage R. Listeria monocytogenes endocarditis. Postgrad Med J 1985;61:51-2.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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