CLINICAL MICROBIOLOGY Single Case Report
Catalase-Negative Listeria monocytogenes Causing Meningitis in an Adult Clinical and Laboratory Features MARSHA A. SWARTZ, M.D., 1 DAVID F. WELCH, P H D . , 2 RADHA P. NARAYANAN, M.D., 1 AND RONALD A. GREENFIELD, M.D. 1
Listeria monocytogenes, a facultative intracellular pathogen, is a recognized cause of invasive infection. Catalase production is one of the characteristics typically relied upon for separating Listeria from other morphologically similar bacteria.1"3 Catalase, along with superoxide dismutase, has been implicated in the pathogenicity of L. monocytogenes* We describe a case of listeriosis in which the isolate, a catalase-negative strain, expressed marked pathogenicity in an immunocompetent patient, producing both meningitis and abscess formation.
ative L. monocytogenes indicating that catalase production should not be a strict criterion for identification of Listeria. Furthermore, this clinical experience extends in vitro and experimental animal studies indicating that catalase production is not a necessary virulence factor for invasion by Listeria. (Key words: Catalase; Listeria monocytogenes; Meningitis; Virulence) Am J Clin Pathol 1991;96:130-133
the care of her physician, who presumptively diagnosed a urinary tract infection and prescribed a course of cephalexin. When the patient's symptoms persisted, she sought care again the next day and was admitted to a hospital. Her temperature on admission was 39.4 °C, and physical examination revealed no localizingfindings.Except for an elevated white blood cell (WBC) count, routine laboratory studies were unremarkable. She was begun on a regimen of cephapirin 2 g IV every 6 hours. The next day the patient became lethargic and confused, developed nausea and vomiting, and was noted to be dysarthric and to have hemiparesis of the right side. She continued to be febrile on the third hospital day, received gentamicin, and was transferred to the Oklahoma Medical Center. On arrival at our institution, the patient was restless and intermittently REPORT OF A CASE confused. She complained of headache. Her fever remained at 39.4 °C, In July 1989, a 63-year-old woman developed an illness characterized and nuchal rigidity was present. Her WBC was 24.5 X 109/L (24,500 by fever, chills, headache, and generalized weakness. After three days of cells/uL) with an increase in immature neutrophils. Chest x-ray was norself-medication with a nonsteroidal anti-inflammatory agent, she sought mal. Computer assisted tomographic scan of the head with and without contrast enhancement demonstrated no mass effect or hemorrhage. Lumbar puncture obtained cerebrospinal fluid that contained RBC 75 6 6 From the 'Infectious Diseases Section, Department ofMedicine, Uni- X 10 /L; WBC 3,850 X 10 /L (72% PMN); glucose 1.9 mmol/L (34 mg/ dL) (blood glucose was 9.9 mmol/L [179 mg/dL]), and protein 2.54 g/ versity of Oklahoma Health Sciences Center, and the Medical Service, Oklahoma City Department of Veterans Affairs Medical Center; and theL (245 mg/dL); Gram's stain was negative. Blood cultures (two sets em^Infectious Diseases/Immunology Section, Department of Pediatrics, and ploying lysis/centrifugation and biphasic media) were obtained. Supthe Clinical Microbiology Laboratories, Oklahoma Medical Center, portive therapy and a regimen of parenteral penicillin and chloramOklahoma City. Oklahoma. phenicol were begun. The next day, the patient was alert and oriented, complaining of a Received September 5, 1990; received revised manuscript and accepted stiff neck and photophobia. Growth of a catalase-negative Gram-positive for publication November 14, 1990. rod from CSF was reported. Antimicrobial chemotherapy was changed Supported in part by Department of Veterans Affairs Medical Research to ampicillin 3 g IV every 4 hours and gentamicin 120 mg IV every 8 funds. hours. The microorganism isolated from CSF was subsequently identified Address reprint requests to Dr. Greenfield: Infectious Diseases Section as a catalase-negative L. monocytogenes. (111 /C), Department of Veterans Affairs Medical Center, 921 N.E. 13th Street, Oklahoma City, Oklahoma 73104. Clinical improvement continued until the sixth hospital day, when
130
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A 63-year-old previously healthy woman presented with acute meningitis. Cultures of the cerebrospinal fluid yielded a serotype 1 /2a isolate of Listeria monocytogenes that was biochemically typical in all respects, other than the reproducible lack of catalase production. During therapy, the patient developed oculomotor dysfunction that was attributed to an abscess in the internal capsule. This case report documents the existence of catalase-neg-
SWARTZ ET AL.
131
Catalase-Negative Listeria monocytogenes the patient was found to have photophobia, limitation of upward and lateral gaze, andrightupper extremity weakness. Suspicion that this may have been due to aminoglycoside-induced neuromuscular blockade led to discontinuation of gentamicin therapy. Lumbar puncture was repeated, and all parameters were improved; Gram's stain was negative, and culture remained negative. Magnetic resonance imaging (MRI) (Fig. 1A) of the head with gadolinium contrast enhancement demonstrated ventriculitis and areas of probable brain abscess in the left optic radiation and internal capsule. Antimicrobial therapy was changed to a regimen of ampicillin/ sulbactam 3 g IV every 4 hours. The patient was discharged after 32 days of parenteral antimicrobial therapy with continuing therapy with oral amoxicillin with clavulanic acid. Resolution of the abscesses was documented by a repeat MRI (Fig. IB) approximately 10 weeks after the initial study. A spinal tap showed normalization of all CSF parameters. She received an additional month of amoxicillin/clavulanic acid therapy. Other than improving lower extremity weakness, no sequela from the infection have been seen on close follow-up through nine months after presentation.
Infection with L. monocytogenes in adults most commonly manifests as meningitis.5,6 Sudden onset is usual, unlike the subacute onset in our patient. Nuchal rigidity and fever are common. Tremors, seizures, and coma also may occur. CSF glucose levels are low in 40% of cases, blood cultures are positive in 60-70%, but CSF Gram's stains generally are negative.5 Frequently attacking the very young and aged, L. monocytogenes causes sporadic disease, especially during summer months. The portal of entry is thought to be the gastrointestinal tract. Epidemics have been linked to refrigerated food. Focal infections consisting of osteomyelitis, endophthalmitis, pulmonary infection, septic arthritis, and hepatic abscess rarely occur in immunocompromised hosts. The preferred treatment is a regimen of ampicillin. The addition of gentamicin therapy may result in synergistic activity because of increased bacterial uptake of the aminoglycoside.5 We are unaware of data to support the use of beta-lactam/beta-lactamase inhibitor combinations in listeriosis. L. monocytogenes is described as a small, Gram-positive, pleomorphic rod that is motile at 25 °C, beta-hemolytic, catalase-positive, and is a facultative anaerobe.2,3'7 The isolate from this case fulfilled these criteria, except for catalase production, and also possessed the biochemical characteristics shown in Table 1. The identification of the organism was confirmed by the Centers for Disease Control (Atlanta, GA), where it was serotyped as l/2a. Additional characterization in our laboratory included cellular fatty acid analysis, which was consistent with L. monocytogenes (data not shown). The unusual finding in this case is the lack of catalase production. The catalase test has been described as a way to differentiate L. monocytogenes from diphtheroids,
L. Patient's Isolate monocytogenes B-hemolysis Camp test Acid production from: L-arabinose L-rhamnose Lactose Mannitol Sorbitol Sucrose Voges-Proskauer Hippurate
+ +
L. L. innocua ivanovii
+ +
0 0
+
0 0
0 0
0
0
0
+ +
+
0 0 0
0* 0 0 0
+
+
+ +
+ +
+ +
+ +
0 0 0
0 0 0
* See reference 3 for data on Listeria species.
Streptococcus species and enterococci. In Bergey's Manual of Systemic Bacteriology,1, Seeliger and Jones recommend this test to differentiate Listeria from streptococci and Lactobacilli. They note that catalase production may be absent because of nutrient deficiency in the media and that negative strains rarely occur naturally. We are aware of a case of neonatal sepsis due to catalase-negative Listeria (also confirmed by the CDC) occurring recently (personal communication, Joseph M. Campos, Children's Hospital National Medical Center, Washington, DC). The frequency of encountering catalase-negative clinical isolates may be underestimated because of under-recognition. In CSF smears, Listeria can be mistaken as corynebacteria, streptococci, and even Haemophilus influenzae.1 Bortolussi and colleagues,2 suggest the use of catalase activity, along with Gram-stain morphology and motility, to separate Listeria species from Enterococcus and group B streptococci. Noting the many similarities between L. monocytogenes and Streptococcus agalactiae, Kontnick and colleagues* reviewed the laboratory tests used to distinguish these organisms. Twenty-six commonly used tests were used to compare ten beta-hemolytic strains of each organism. While stating that absence of catalase essentially rules out L. monocytogenes, they note that both catalase and motility have been negative on subcultured organisms. Other authoritative references typically use a combination of characteristics to separate Listeria from seven other genera.7 However, catalase production generally is a prominent feature, and lack of catalase activity causes divergence in these schemes from Listeria.1,7 A compilation of tests and the usual reactions seen are presented in Table 2. There is not universal agreement that catalase, along with superoxide dismutase, contributes to the pathogenicity of this organism. Production of these enzymes may explain why it is able to escape the respiratory burst in
Vol. 96 • No. I
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DISCUSSION
TABLE 1. CHARACTERISTICS OF THE PATIENT'S ISOLATE AND THREE SPECIES OF LISTERIA
132
CLINICAL MICROBIOLOGY
Single Case Report
monocytes and proliferate there. Investigations supporting a role for catalase in virulence of Listeria include that of Bortolussi and colleagues,4 who found L. monocytogenes had both higher catalase activity and intracellular survival rates in the log phase than in the stationary phase of growth. Evasion of the phagocyte's oxidative products was attributed to the production of both enzymes. Welch and co-workers 910 found decreased virulence in strains with
TABLE 2. USUAL DIFFERENTIATING CHARACTERISTICS BETWEEN L. MONOCYTOGENES AND OTHER GRAM POSITIVE ORGANISMS L. monocytogenes
Group B Streptococci
Coryne Bacterium Enterococci
Gram Stain
PleomorphicRod
Cocci
Pleomorphic Rod
Catalase Motility B hemolysis Palisading Hippurate hydrolysis 6.5% NaCI tolerance
+ + + + + +
0 0 0 0 + 0
+ 0 + + 0 0
Cocci 0 0 +/0 0 0 +
no catalase activity and either decreased or increased superoxide dismutase activity. The catalase-positive strains survived in a medium containing superoxide radicals, whereas the negative variant, despite high levels of superoxide dismutase, was killed. In contrast, LeBlondFrancillard and associates" developed a transposon-induced catalase-negative mutant of L. monocytogenes and compared it with the catalase-positive parent strain. No difference in either the LD 50 of mice or the recovery of Listeria from liver and spleen was seen with the mutant compared with the parent strain. Despite the controversy as to whether or not catalase production in L. monocytogenes contributes to its virulence in experimental systems, a catalase-negative strain produced meningitis and cerebral abscesses in our patient. The virulence of this organism is readily apparent in this case, and awareness, especially among laboratorians, of catalase-negative Listeria is important for proper diagnosis and therapy. REFERENCES 1. Baron EJ, Finegold SM, eds. Listeria species. In: Bailey and Scott Diagnostic Microbiology. 8th ed. St. Louis: C.V. Mosby, 1990: 458-461.
Vol. 96 • No. I
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FlG. 1 (left). Magnetic resonance imaging (MRl) obtained after patient exhibited focal neurological symptoms. Present are abscess in both the left optic radiation and the internal capsule, (right). Follow-up MRl showing resolution of abscesses. The patient was free of the limitation of upward and lateral gaze and the right upper extremity weakness that had prompted the initial MRl.
SWARTZ ET AL. Catalase-Negative Listeria monocytogenes 2. Bortolussi R, Schlech WF III, Albritton WL. Listeria. In: EH Lennett, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology, 1985:205-208. 3. Seeliger HPR, Jones D. Listeria. In: Sneath PHA, Mair NS, Sharpe ME, Holt JG, eds. Bergey's Manual of Systematic Bacteriology. Baltimore: Williams & Wilkins, 1986:1235-1245. 4. Bortolussi R, Vandenbroucke-Grauls CMJE, van Asbeck BS, Verhoef J. Relationship of bacterial growth phase to killing of Listeria monocytogenes by neutrophils and enzyme systems. Infect Immun 1987;55( 12):3197-3203. 5. Gellin BG, Broome CV. Listeriosis. JAMA 1989;261 (9): 1315-1320. 6. Neiman RRE, Lorber B. Listeriosis in adults: a changing pattern. Report of eight cases and review of the literature. Rev Infect Dis 1980;2(2):207-227. 7. Gilchrist MJR. Listeriosis. In: Balows A, Hausler WJ, Jr, Lennette
8. 9. 10. 11.
133
EH, et al, eds. Laboratory Diagnosis of Infectious Diseases: Principles and Practices. Vol 2. New York: Springer-Verlag, 1988: 353-359. Kontnick C, von Graevenitz A, Piscitelli V. Differential diagnosis between Streptococcus agalactiae and Listeria monocytogenes in the clinical laboratory. Ann Clin Lab Sci 1977;7(3):269-276. Welch DF. Role of catalase and superoxide dismutase in the virulence of Listeria monocytogenes. Ann Inst Pasteur Microbiol 1987; 138: 241-284. Welch DF, Sword CP, Brehm S, Dusanic D. Relationship between superoxide dismutase and pathogenic mechanisms of Listeria monocytogenes. Infect Immun 1979;23:863-872. Leblond-Francillard M, Gaillard J, Berche P. Loss of catalase activity in tnl545-induced mutants does not reduce growth of Listeria monocytogenes in vivo. Infect Immun 1989;57(8):2569-2573.
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 6, 2016
A . J . C . P . - J u l y 1991
Catalase-Negative Listeria monocytogenes Causing Meningitis in an Adult Clinical and Laboratory Features MARSHA A. SWARTZ, M.D., 1 DAVID F. WELCH, P H D . , 2 RADHA P. NARAYANAN, M.D., 1 AND RONALD A. GREENFIELD, M.D. 1
Listeria monocytogenes, a facultative intracellular pathogen, is a recognized cause of invasive infection. Catalase production is one of the characteristics typically relied upon for separating Listeria from other morphologically similar bacteria.1"3 Catalase, along with superoxide dismutase, has been implicated in the pathogenicity of L. monocytogenes* We describe a case of listeriosis in which the isolate, a catalase-negative strain, expressed marked pathogenicity in an immunocompetent patient, producing both meningitis and abscess formation.
ative L. monocytogenes indicating that catalase production should not be a strict criterion for identification of Listeria. Furthermore, this clinical experience extends in vitro and experimental animal studies indicating that catalase production is not a necessary virulence factor for invasion by Listeria. (Key words: Catalase; Listeria monocytogenes; Meningitis; Virulence) Am J Clin Pathol 1991;96:130-133
the care of her physician, who presumptively diagnosed a urinary tract infection and prescribed a course of cephalexin. When the patient's symptoms persisted, she sought care again the next day and was admitted to a hospital. Her temperature on admission was 39.4 °C, and physical examination revealed no localizingfindings.Except for an elevated white blood cell (WBC) count, routine laboratory studies were unremarkable. She was begun on a regimen of cephapirin 2 g IV every 6 hours. The next day the patient became lethargic and confused, developed nausea and vomiting, and was noted to be dysarthric and to have hemiparesis of the right side. She continued to be febrile on the third hospital day, received gentamicin, and was transferred to the Oklahoma Medical Center. On arrival at our institution, the patient was restless and intermittently REPORT OF A CASE confused. She complained of headache. Her fever remained at 39.4 °C, In July 1989, a 63-year-old woman developed an illness characterized and nuchal rigidity was present. Her WBC was 24.5 X 109/L (24,500 by fever, chills, headache, and generalized weakness. After three days of cells/uL) with an increase in immature neutrophils. Chest x-ray was norself-medication with a nonsteroidal anti-inflammatory agent, she sought mal. Computer assisted tomographic scan of the head with and without contrast enhancement demonstrated no mass effect or hemorrhage. Lumbar puncture obtained cerebrospinal fluid that contained RBC 75 6 6 From the 'Infectious Diseases Section, Department ofMedicine, Uni- X 10 /L; WBC 3,850 X 10 /L (72% PMN); glucose 1.9 mmol/L (34 mg/ dL) (blood glucose was 9.9 mmol/L [179 mg/dL]), and protein 2.54 g/ versity of Oklahoma Health Sciences Center, and the Medical Service, Oklahoma City Department of Veterans Affairs Medical Center; and theL (245 mg/dL); Gram's stain was negative. Blood cultures (two sets em^Infectious Diseases/Immunology Section, Department of Pediatrics, and ploying lysis/centrifugation and biphasic media) were obtained. Supthe Clinical Microbiology Laboratories, Oklahoma Medical Center, portive therapy and a regimen of parenteral penicillin and chloramOklahoma City. Oklahoma. phenicol were begun. The next day, the patient was alert and oriented, complaining of a Received September 5, 1990; received revised manuscript and accepted stiff neck and photophobia. Growth of a catalase-negative Gram-positive for publication November 14, 1990. rod from CSF was reported. Antimicrobial chemotherapy was changed Supported in part by Department of Veterans Affairs Medical Research to ampicillin 3 g IV every 4 hours and gentamicin 120 mg IV every 8 funds. hours. The microorganism isolated from CSF was subsequently identified Address reprint requests to Dr. Greenfield: Infectious Diseases Section as a catalase-negative L. monocytogenes. (111 /C), Department of Veterans Affairs Medical Center, 921 N.E. 13th Street, Oklahoma City, Oklahoma 73104. Clinical improvement continued until the sixth hospital day, when
130
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A 63-year-old previously healthy woman presented with acute meningitis. Cultures of the cerebrospinal fluid yielded a serotype 1 /2a isolate of Listeria monocytogenes that was biochemically typical in all respects, other than the reproducible lack of catalase production. During therapy, the patient developed oculomotor dysfunction that was attributed to an abscess in the internal capsule. This case report documents the existence of catalase-neg-
SWARTZ ET AL.
131
Catalase-Negative Listeria monocytogenes the patient was found to have photophobia, limitation of upward and lateral gaze, andrightupper extremity weakness. Suspicion that this may have been due to aminoglycoside-induced neuromuscular blockade led to discontinuation of gentamicin therapy. Lumbar puncture was repeated, and all parameters were improved; Gram's stain was negative, and culture remained negative. Magnetic resonance imaging (MRI) (Fig. 1A) of the head with gadolinium contrast enhancement demonstrated ventriculitis and areas of probable brain abscess in the left optic radiation and internal capsule. Antimicrobial therapy was changed to a regimen of ampicillin/ sulbactam 3 g IV every 4 hours. The patient was discharged after 32 days of parenteral antimicrobial therapy with continuing therapy with oral amoxicillin with clavulanic acid. Resolution of the abscesses was documented by a repeat MRI (Fig. IB) approximately 10 weeks after the initial study. A spinal tap showed normalization of all CSF parameters. She received an additional month of amoxicillin/clavulanic acid therapy. Other than improving lower extremity weakness, no sequela from the infection have been seen on close follow-up through nine months after presentation.
Infection with L. monocytogenes in adults most commonly manifests as meningitis.5,6 Sudden onset is usual, unlike the subacute onset in our patient. Nuchal rigidity and fever are common. Tremors, seizures, and coma also may occur. CSF glucose levels are low in 40% of cases, blood cultures are positive in 60-70%, but CSF Gram's stains generally are negative.5 Frequently attacking the very young and aged, L. monocytogenes causes sporadic disease, especially during summer months. The portal of entry is thought to be the gastrointestinal tract. Epidemics have been linked to refrigerated food. Focal infections consisting of osteomyelitis, endophthalmitis, pulmonary infection, septic arthritis, and hepatic abscess rarely occur in immunocompromised hosts. The preferred treatment is a regimen of ampicillin. The addition of gentamicin therapy may result in synergistic activity because of increased bacterial uptake of the aminoglycoside.5 We are unaware of data to support the use of beta-lactam/beta-lactamase inhibitor combinations in listeriosis. L. monocytogenes is described as a small, Gram-positive, pleomorphic rod that is motile at 25 °C, beta-hemolytic, catalase-positive, and is a facultative anaerobe.2,3'7 The isolate from this case fulfilled these criteria, except for catalase production, and also possessed the biochemical characteristics shown in Table 1. The identification of the organism was confirmed by the Centers for Disease Control (Atlanta, GA), where it was serotyped as l/2a. Additional characterization in our laboratory included cellular fatty acid analysis, which was consistent with L. monocytogenes (data not shown). The unusual finding in this case is the lack of catalase production. The catalase test has been described as a way to differentiate L. monocytogenes from diphtheroids,
L. Patient's Isolate monocytogenes B-hemolysis Camp test Acid production from: L-arabinose L-rhamnose Lactose Mannitol Sorbitol Sucrose Voges-Proskauer Hippurate
+ +
L. L. innocua ivanovii
+ +
0 0
+
0 0
0 0
0
0
0
+ +
+
0 0 0
0* 0 0 0
+
+
+ +
+ +
+ +
+ +
0 0 0
0 0 0
* See reference 3 for data on Listeria species.
Streptococcus species and enterococci. In Bergey's Manual of Systemic Bacteriology,1, Seeliger and Jones recommend this test to differentiate Listeria from streptococci and Lactobacilli. They note that catalase production may be absent because of nutrient deficiency in the media and that negative strains rarely occur naturally. We are aware of a case of neonatal sepsis due to catalase-negative Listeria (also confirmed by the CDC) occurring recently (personal communication, Joseph M. Campos, Children's Hospital National Medical Center, Washington, DC). The frequency of encountering catalase-negative clinical isolates may be underestimated because of under-recognition. In CSF smears, Listeria can be mistaken as corynebacteria, streptococci, and even Haemophilus influenzae.1 Bortolussi and colleagues,2 suggest the use of catalase activity, along with Gram-stain morphology and motility, to separate Listeria species from Enterococcus and group B streptococci. Noting the many similarities between L. monocytogenes and Streptococcus agalactiae, Kontnick and colleagues* reviewed the laboratory tests used to distinguish these organisms. Twenty-six commonly used tests were used to compare ten beta-hemolytic strains of each organism. While stating that absence of catalase essentially rules out L. monocytogenes, they note that both catalase and motility have been negative on subcultured organisms. Other authoritative references typically use a combination of characteristics to separate Listeria from seven other genera.7 However, catalase production generally is a prominent feature, and lack of catalase activity causes divergence in these schemes from Listeria.1,7 A compilation of tests and the usual reactions seen are presented in Table 2. There is not universal agreement that catalase, along with superoxide dismutase, contributes to the pathogenicity of this organism. Production of these enzymes may explain why it is able to escape the respiratory burst in
Vol. 96 • No. I
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 6, 2016
DISCUSSION
TABLE 1. CHARACTERISTICS OF THE PATIENT'S ISOLATE AND THREE SPECIES OF LISTERIA
132
CLINICAL MICROBIOLOGY
Single Case Report
monocytes and proliferate there. Investigations supporting a role for catalase in virulence of Listeria include that of Bortolussi and colleagues,4 who found L. monocytogenes had both higher catalase activity and intracellular survival rates in the log phase than in the stationary phase of growth. Evasion of the phagocyte's oxidative products was attributed to the production of both enzymes. Welch and co-workers 910 found decreased virulence in strains with
TABLE 2. USUAL DIFFERENTIATING CHARACTERISTICS BETWEEN L. MONOCYTOGENES AND OTHER GRAM POSITIVE ORGANISMS L. monocytogenes
Group B Streptococci
Coryne Bacterium Enterococci
Gram Stain
PleomorphicRod
Cocci
Pleomorphic Rod
Catalase Motility B hemolysis Palisading Hippurate hydrolysis 6.5% NaCI tolerance
+ + + + + +
0 0 0 0 + 0
+ 0 + + 0 0
Cocci 0 0 +/0 0 0 +
no catalase activity and either decreased or increased superoxide dismutase activity. The catalase-positive strains survived in a medium containing superoxide radicals, whereas the negative variant, despite high levels of superoxide dismutase, was killed. In contrast, LeBlondFrancillard and associates" developed a transposon-induced catalase-negative mutant of L. monocytogenes and compared it with the catalase-positive parent strain. No difference in either the LD 50 of mice or the recovery of Listeria from liver and spleen was seen with the mutant compared with the parent strain. Despite the controversy as to whether or not catalase production in L. monocytogenes contributes to its virulence in experimental systems, a catalase-negative strain produced meningitis and cerebral abscesses in our patient. The virulence of this organism is readily apparent in this case, and awareness, especially among laboratorians, of catalase-negative Listeria is important for proper diagnosis and therapy. REFERENCES 1. Baron EJ, Finegold SM, eds. Listeria species. In: Bailey and Scott Diagnostic Microbiology. 8th ed. St. Louis: C.V. Mosby, 1990: 458-461.
Vol. 96 • No. I
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FlG. 1 (left). Magnetic resonance imaging (MRl) obtained after patient exhibited focal neurological symptoms. Present are abscess in both the left optic radiation and the internal capsule, (right). Follow-up MRl showing resolution of abscesses. The patient was free of the limitation of upward and lateral gaze and the right upper extremity weakness that had prompted the initial MRl.
SWARTZ ET AL. Catalase-Negative Listeria monocytogenes 2. Bortolussi R, Schlech WF III, Albritton WL. Listeria. In: EH Lennett, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology, 1985:205-208. 3. Seeliger HPR, Jones D. Listeria. In: Sneath PHA, Mair NS, Sharpe ME, Holt JG, eds. Bergey's Manual of Systematic Bacteriology. Baltimore: Williams & Wilkins, 1986:1235-1245. 4. Bortolussi R, Vandenbroucke-Grauls CMJE, van Asbeck BS, Verhoef J. Relationship of bacterial growth phase to killing of Listeria monocytogenes by neutrophils and enzyme systems. Infect Immun 1987;55( 12):3197-3203. 5. Gellin BG, Broome CV. Listeriosis. JAMA 1989;261 (9): 1315-1320. 6. Neiman RRE, Lorber B. Listeriosis in adults: a changing pattern. Report of eight cases and review of the literature. Rev Infect Dis 1980;2(2):207-227. 7. Gilchrist MJR. Listeriosis. In: Balows A, Hausler WJ, Jr, Lennette
8. 9. 10. 11.
133
EH, et al, eds. Laboratory Diagnosis of Infectious Diseases: Principles and Practices. Vol 2. New York: Springer-Verlag, 1988: 353-359. Kontnick C, von Graevenitz A, Piscitelli V. Differential diagnosis between Streptococcus agalactiae and Listeria monocytogenes in the clinical laboratory. Ann Clin Lab Sci 1977;7(3):269-276. Welch DF. Role of catalase and superoxide dismutase in the virulence of Listeria monocytogenes. Ann Inst Pasteur Microbiol 1987; 138: 241-284. Welch DF, Sword CP, Brehm S, Dusanic D. Relationship between superoxide dismutase and pathogenic mechanisms of Listeria monocytogenes. Infect Immun 1979;23:863-872. Leblond-Francillard M, Gaillard J, Berche P. Loss of catalase activity in tnl545-induced mutants does not reduce growth of Listeria monocytogenes in vivo. Infect Immun 1989;57(8):2569-2573.
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A . J . C . P . - J u l y 1991
