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CORD-19:296d190c1ecd57e9be602ffc3e6c98ba3d5bd485 JSONTXT 10 Projects

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T1 0-105 Sentence denotes A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage:
T2 106-148 Sentence denotes A review of treatment options and outcomes
T3 150-158 Sentence denotes Abstract
T4 159-294 Sentence denotes Listeria monocytogenes is a gram-positive bacillus known to cause various human infections including central nervous system infections.
T5 295-567 Sentence denotes The most common central nervous system manifestations are meningitis and rhomboencephalitis, however rare complications including hydrocephalus and intracerebral hemorrhage can occur and are associated with increased mortality and incidence of lasting neurologic sequelae.
T6 568-668 Sentence denotes The mortality ranges from 17 % to greater than 30 % in patients with neurological involvement [1-3].
T7 669-864 Sentence denotes Various case reports have studied the differing treatment approaches and outcomes of patients who experienced these complications, and there is still no consensus on optimal treatment approaches.
T8 865-1082 Sentence denotes In this paper, we report a case of Listeria meningitis complicated by both acute hydrocephalus and intracerebral hemorrhage and analyze the factors that led to a favorable outcome by reviewing the existing literature.
T9 1084-1376 Sentence denotes Listeria monocytogenes is a gram positive bacillus known for causing invasive disease such as bacteremia and CNS (Central Nervous System) infections in vulnerable populations including pregnant women, immunosuppressed patients, and those at extremes of age including neonates and the elderly.
T10 1377-1484 Sentence denotes It is primarily thought to be acquired from food, including raw vegetables, dairy, meat, fish, and poultry.
T11 1485-1624 Sentence denotes CNS manifestations can range from a mild febrile illness with mental status changes to more severe manifestations including coma and death.
T12 1625-1799 Sentence denotes Meningoencephalitis is the most common CNS Listeria infection, with less common complications including ventriculitis, rhomboencephalitis, hemorrhage, and hydrocephalus [2] .
T13 1800-1949 Sentence denotes Hydrocephalus has been a recognized complication of Listeria monocytogenes meningoencephalitis (LMME) leading to significant morbidity and mortality.
T14 1950-2273 Sentence denotes The etiology of hydrocephalus is likely multifactorial and related to factors such as a high level of CSF protein and impaired CSF absorption due to the obliteration of the subarachnoid space by meningeal exudates or defective CSF reabsorption through arachnoid granulations because of severe inflammatory reaction [2, 4] .
T15 2274-2374 Sentence denotes After S. pneumoniae, L. monocytogenes is the second most common pathogen causing hydrocephalus [3] .
T16 2375-2541 Sentence denotes Intracranial hemorrhage associated with L monocytogenes has been reported even less frequently than hydrocephalus, with most cases occurring in pediatric populations.
T17 2542-2663 Sentence denotes However it has been reported in adults, where it has been found to be an independent marker of unfavorable outcomes [5] .
T18 2664-2918 Sentence denotes The underlying pathophysiology of intraventricular hemorrhage in L. monocytogenes infection is hypothesized to be related to dysregulation of both the coagulation and fibrinolytic pathways and to vascular endothelial cell swelling and activation [2, 5] .
T19 2919-3264 Sentence denotes We present a case of a 62 year old female with a past medical history significant for multiple myeloma status post stem cell transplant 16 months prior and subsequently treated with pomalidomide and biweekly dexamethasone, and well controlled diabetes who initially was brought to the hospital by her family for headaches beginning that morning.
T20 3265-3370 Sentence denotes Subsequently she became more lethargic, confused, and febrile to a temperature of 102 degrees Fahrenheit.
T21 3371-3458 Sentence denotes On arrival to the emergency department she was found to be septic, with a fever of 103.
T22 3459-3647 Sentence denotes 2 possible infiltrate on chest x-ray concerning for pneumonia, a urinalysis concerning for urinary tract infection, and a respiratory viral panel by PCR which was positive for coronavirus.
T23 3648-3728 Sentence denotes The patient was initiated on vancomycin and piperacillin-tazobactam empirically.
T24 3729-3872 Sentence denotes Initial CT scan of the head was largely unremarkable, showing only mild prominence of the ventricles and global cerebral volume loss (Fig. 1) .
T25 3873-4092 Sentence denotes The patient was admitted to the medical wards, where she had rapid deterioration of her clinical status resulting in obtundation, acute hypoxic respiratory failure and septic shock requiring intubation and vasopressors.
T26 4093-4197 Sentence denotes The infectious work up revealed Escherichia coli bacteremia thought to be secondary to a urinary source.
T27 4198-4361 Sentence denotes On the second day of admission she was escalated to meropenem, but she continued to spike fevers with no improvement in mental status despite weaning off sedation.
T28 4362-4518 Sentence denotes On the 6th day of admission, a repeat CT scan of her head revealed a new hydrocephalus with transependymal flow and questionable midbrain lucency (Fig. 2) .
T29 4519-4605 Sentence denotes Subsequent Magnetic Resonance Imaging of the brain showed intraventricular hemorrhage.
T30 4606-4931 Sentence denotes An external ventricular drain (EVD) was placed emergently by neurosurgery, and the resulting cerebrospinal fluid analysis showed 22 nucleated cells with 35 % neutrophils and 35 % lymphocytes, an elevated protein of 84 and low normal glucose of 49, though cerebrospinal fluid glucose was less than 60 percent of serum glucose.
T31 4932-5106 Sentence denotes Cerebrospinal fluid PCR returned positive for Listeria monocytogenes and antimicrobials were changed to ampicillin, in addition to ceftriaxone to cover for E coli bacteremia.
T32 5107-5232 Sentence denotes The patient was later started on gentamicin to add double coverage for Listeria and was given a dose of intrathecal amikacin.
T33 5233-5402 Sentence denotes After 5 days the EVD was clamped, and when subsequent CT showed no further enlargement of the ventricles, the EVD was removed 8 days after originally having been placed.
T34 5403-5516 Sentence denotes The patient showed improvement in mental status, first localizing to voice and then partially following commands.
T35 5517-5567 Sentence denotes She was successfully extubated on hospital day 16.
T36 5568-5785 Sentence denotes Upon further questioning, her spouse mentioned that the patient had been to an international barbecue a week prior to admission, and might have eaten uncooked food there, illuminating the possible source of infection.
T37 5786-5919 Sentence denotes Neurolisteriosis, a central nervous system (CNS) infection caused by L. monocytogenes, represents 5 %-10 % of listeriosis cases [3] .
T38 5920-6080 Sentence denotes Hydrocephalus and intracranial hemorrhage are rare complications of listeriosis, occurring in 10 %-15 % and 3 % of neurolisteriosis cases, respectively [4, 6] .
T39 6081-6258 Sentence denotes This represents a higher incidence of hydrocephalus due to Listeria than the overall incidence of hydrocephalus as a complication of bacterial meningitis, estimated at 5 % [7] .
T40 6259-6416 Sentence denotes The likelihood of developing hydrocephalus is more with symptoms lasting >4 days, with incidence greater than 30 % as per the review by Pelegrin et al. [1] .
T41 6417-6590 Sentence denotes It is often not diagnosed on admission, and initial CT might appear normal, as with our patient, often leading to delayed detection up to a median of 6 days after admission.
T42 6591-6658 Sentence denotes This complication also carries significant morbidity and mortality.
T43 6659-6800 Sentence denotes In the study by Pelegrin et al., hydrocephalus was associated with a mortality of 75 %, representing 43 % of the total mortality due to LMME.
T44 6801-6963 Sentence denotes Another study by Charlier et al. reports a three-month mortality around 30 %, with persisting neurological impairment reported in 44 % of surviving patients [8] .
T45 6964-7202 Sentence denotes Liang et al. found a similar grim prognosis when reviewing 18 cases of non-perinatal listeriosis in patient's age range 3-75 years, with 27.7 % mortality (5/18) and 23 % (3/13) of the survivors with significant neurologic impairment [2] .
T46 7203-7356 Sentence denotes These high morbidity and mortality figures occurred in the setting of a range of treatment courses, as there is no clear consensus on optimal management.
T47 7357-7651 Sentence denotes In several cases, patients did not receive appropriate coverage for Listeria until the organism was confirmed by either culture or PCR analysis, while in other cases Listeria was covered empirically from the onset of hospitalization, with or without double coverage utilizing an aminoglycoside.
T48 7652-8134 Sentence denotes While dual therapy with ampicillin and aminoglycosides has been proposed in guidelines, Pelegrin and colleagues found no mortality difference between ampicillin montherapy and combination therapy with an aminoglycoside [1, 9] In the same study, while adjunctive administration of dexamethasone and phenytoin did not provide a clear mortality benefit, the use of dexamethasone showed a trend towards fewer neurologic sequelae and those who received phenytoin experienced no seizures.
T49 8135-8257 Sentence denotes Dexamethasone did not show any clear benefit in prophylaxis against hydrocephalus, as had been suggested by animal models.
T50 8258-8391 Sentence denotes Most patients we reviewed received an external ventricular catheter without significant differences in outcome from those who hadn't.
T51 8392-8725 Sentence denotes Appropriate empirical antimicrobial therapy and consultation with neurosurgery regarding management of hydrocephalus were seen as the key features of management by Pelegrin and colleagues, while inappropriate empiric antimicrobial therapy and hydrocephalus were the main independent prognostic factors associated with mortality [1] .
T52 8726-8823 Sentence denotes The use of intrathecal/intraventricular antimicrobials in this setting has not been well studied.
T53 8824-8986 Sentence denotes A review of the existing literature reveals no standard protocol for the administration of intraventricular antimicrobials in the setting of CNS infections [10] .
T54 8987-9165 Sentence denotes The risk reward profile focuses on the advantages of higher doses of antimicrobials in the CSF than can cross the blood brain barrier alone versus the increased risk of toxicity.
T55 9166-9408 Sentence denotes A clinical cohort study by Shoft and colleagues found a mortality benefit with no significant adverse events when utilizing intraventricular antimicrobials alongside systemic antimicrobials in a population of postneurosurgical patients [11] .
T56 9409-9641 Sentence denotes A case report by Richards and colleagues demonstrated the efficacy of using intraventricular antimicrobials in a patient with recurrent Listeria monocytogenes meningitis following treatment failure with systemic therapy alone [12] .
T57 9642-9883 Sentence denotes Our case is unique as the patient experienced two rare complications of neurolisteriosis: hydrocephalus and intraventricular hemorrhage both of which are associated with high morbidity and mortality, as well as lasting neurologic impairment.
T58 9884-10038 Sentence denotes Despite these complications she did relatively well, regaining most of her functional status prior to discharge aside from some mild cognitive impairment.
T59 10039-10357 Sentence denotes This could be influenced by multiple factors including the initiation of appropriate antimicrobials within 24 h of presentation, double coverage with an aminoglycoside as well as intraventricular administration, the placement of an EVD, steroids for the initial 5 days of hospitalization, and anti-seizure medications.
T60 10358-10610 Sentence denotes As previously discussed, the data on the utility of steroids, dual antimicrobial coverage, and anti-epileptics in the setting of neurolisteriosis is conflicting, and there is no definitive evidence if it played a role in our patient's positive outcome.
T61 10611-10822 Sentence denotes The utilization of a dose of an intrathecal aminoglycoside was relatively novel compared to other reported cases and merits further study as a potentially beneficial addition to standard therapy in this setting.
T62 10823-10860 Sentence denotes There was no funding for this report.
T63 10861-10876 Sentence denotes Not applicable.
T64 10877-11146 Sentence denotes Author contribution 1) Shawn Gerstein: resources, conceptualization, writing-original draft, writing-review and editing 2) Pranisha Gautam-Goyal: resources, conceptualization, writingoriginal draft, writing-review and editing 3) Sameer Goyal: writing-review and editing
T65 11147-11199 Sentence denotes The authors have no conflicts of interest to report.