Listeria meningitis in a three year old immunocompetent child: a case report from a tertiary care hospital in Nepal

Abstract

Listeria. monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in the pediatric age group. Listeria meningitis, though common in infants, is extremely infrequent in immunocompetent children. The course of meningoencephalitis by Listeria is often severe and even fatal, especially in those having an underlying predisposing condition. We hereby report a case of meningitis due to L. monocytogenes in a previously healthy three year old female child. The case is reported for its rarity and fatal outcome in an immunocompetent child. A three year old female child was referred to Manipal Teaching Hospital, a tertiary care hospital in western Nepal after three days of treatment with IV ceftriaxone for fever, excessive sleepiness and cough. The child had developed all features of meningitis and was kept on IV ceftriaxone and vancomycin. Culture of her CSF and blood grew L. monocytogenes. However, before the culture and sensitivity report for switch over of the antibiotics could be available, the child died in spite of supportive management for seizures, hypoxia and hypotension. This was an uncommon pathogen to cause meningitis considering the age of the child and her immune status. Thus there should always be a high index of suspicion among the clinicians and microbiologists for such rare pathogens which might be intrinsically resistant to many empirically administered antibiotics.