Clinical case report on treatment of Listeria monocytogenes meningoencephalitis: Intrathecal injection

Abstract

This article mainly reports the process of clinical diagnosis and treatment of a misdiagnosed Listeria monocytogenes meningoencephalitis. The patient's condition is aggravated because of the ineffective prophase therapy. In the later stage, we were mainly through combined antibiotics and given proper routes of administration, so that patient can recover quickly.

Keywords: Listeria monocytogenes; antibiotics; intrathecal injection; meningoencephalitis; misdiagnose.

Figure 1

The CT scan of the brain of this patient. A_1‐2, B_1‐2, and C_1‐2 represent the brain CT imaging of the same level of the different parts, respectively, before diagnosis, during, and after treatment. The red arrows show obvious dilatation of the bilateral ventricular, esp in the posterior corner of the temporal region and the surrounding brain interstitial edema as indicated by the blue arrows

Figure 2

The relationship between the change in temperature and cerebrospinal fluid's white blood cell count with the change in treatment program and treatment time : treatment‐1: ceftazidime alone (2 g/TID*ivgtt × 2 days), treatment‐2: meropenem (1.5 g/TID*ivgtt × 5 days)+ vancomycin (0.05 g/qod*intrathecal injection × 2 times), treatment‐3: meropenem (1.5 g/TID*ivgtt × 11 days)+ vancomycin (0.15 g/BID* ivgtt×11 days)+ vancomycin (0.05 g/qod* intrathecal injection × 4 times) + dexamethasone (5 mg/qod* intrathecal injection × 4 times), treatment‐4: piperacillin sodium and tazobactam sodium(4:1) : (2.5 g/TID*ivgtt × 20 days)