LISTERIA MONOCYTOGENES SEPTICEMIA IN A NEUTROPENIC PATIENT: A CASE REPORT

Abstract

Introduction: Listeria monocytogenes is a gram-positive facultative intracellular bacterium, commonly transmitted through the consumption of contaminated food. In immunocompetent individuals, it typically results in self-limiting gastroenteritis, whereas in immunocompromised patients, it can lead to more severe manifestations, including septicemia, meningitis, and encephalitis. Clinically, listeriosis may present with altered mental status, and seizures occur in approximately 25% of cases. Despite appropriate antimicrobial therapy, the mortality rate for listeriosis remains around 30%.

Case presentation: We report the case of a 60-year-old female with a 5-day history of high-grade fever (up to 40°C), headache, nausea, watery diarrhea, fatigue, and myalgia, who presented to the Infectious Diseases Emergency Department at UHC “Mother Teresa” in January 2024. The patient had a known history of diffuse infiltrative carcinoma of the gastric fundus and was undergoing chemotherapy. Laboratory investigations revealed severe leukopenia with a white blood cell (WBC) count of 1.0 K/μL. Despite the initiation of empirical antimicrobial therapy with ciprofloxacin and metronidazole, the treatment regimen was adjusted to target Listeria after blood cultures confirmed the presence of Listeria monocytogenes. On the fourth day of hospitalization, the patient developed 3-4 episodes of generalized tonic-clonic seizures, characterized by eye fixation and limb rigidity. Neurological evaluation, including a head computed tomography (CT) scan and lumbar puncture (LP), showed no abnormalities in cerebrospinal fluid (CSF) analysis. The patient was subsequently transferred to the intensive care unit (ICU) and intubated. However, despite aggressive treatment, her clinical condition continued to deteriorate, with a further decline in WBC count to 0.2 K/μL. Unfortunately, on the seventh day of hospitalization, the patient succumbed to the infection, resulting in Exitus Letalis.

Conclusion: Chemotherapy-induced intestinal paralysis, malnutrition, and myeloablation significantly increase the risk of bacterial translocation and sepsis, exacerbating the severity and worsening the prognosis of listeriosis. These factors must be carefully considered when selecting empirical anti-listerial antibiotic therapy for patients undergoing cytotoxic treatment. Although Listeria monocytogenes infections are rare, they represent a substantial threat to immunocompromised patients, often leading to severe and fatal outcomes, as demonstrated in this case.