Listeria monocytogenes meningitis at King Edward VIII Hospital, Durban : a 10-year experience, 1981 - 1990

: Nine cases, 3 adults and 6 children, with Listeria monocytogenes meningitis were seen over a 10-year period at King Edward VIII Hospital, Durban. These cases accounted for 0.8% (3/374) and 0.6% (6/1,210) of all culture-positive cases of acute bacterial meningitis in adults and children, respectively, and represented 2.9% (4/136) of all culture-positive cases in the neonatal age group and 5.7% (3/53) of culture-positive cases in adults 50 years and older. The patients had positive blood and cerebrospinal fluid (CSF) cultures. All isolates were sensitive to ampicillin, chloramphenicol, sulphamethoxazole-trimethoprim combination and gentamicin. One isolate in an 11-month-old child was resistant to penicillin and 2 isolates in the adult patients displayed intermediate sensitivity to this antibiotic. The adults were over 50 years of age and presented with an abrupt onset of a pyrexial illness, meningitis and focal neurological signs; only 1 survived. Only 1 8-week-old infant of the paediatric cases survived. A polymorphonuclear leucocytosis, low serum glucose and elevated protein values were common findings in the CSF and the features in some patients mimicked tuberculous or viral meningitis. The fulminant course of the disease and the fact that penicillin and not ampicillin is the first-line antibiotic makes it essential to consider listeriosis as a possible diagnosis, particularly in the very ill patient.