Clinical analysis of misdiagnosis in adult central nervous system infections due to Listeria monocytogenes

  Background  The manifestations of central nervous system Listeria monocytogenes infection (LMI) are often similar to those of various diseases and are easily to be misdiagnosed.

  Objective  To analyze the clinical characteristics and misdiagnosed causes of adult central nervous system LMI in our hospital and reported in literatures, in order to improve the diagnostic accuracy.

  Methods  A retrospective analysis on clinical data about adult patients with central nervous system LMI who were admitted to our hospital from 2018 to 2022 was conducted to summarize the information of misdiagnosed patients and analyze the causes. Clinical profiles of misdiagnosed adult central nervous system LMI patients were summarized by database retrieval.

  Results  A total of 7 patients with central nervous system LMI were admitted to our hospital, all of whom presented with fever and headache as the chief complaint, and some of them suffered from respiratory failure and consciousness disorder. The patients were diagnosed by microbiological tests. All of them were misdiagnosed at the early stage of the disease, of which 5 cases were diagnosed as upper respiratory tract infection, 3 cases as viral meningitis and 4 cases as tuberculous meningitis. The duration of misdiagnosis was (9.4 ± 4.8) d. Patients were mainly treated with rifampicin, quinolone and sulfanilamide. Five patients were recovered completely, two patients had sequelae. Totally 47 cases of misdiagnosed patients were found in literature reports, and most of them were diagnosed by cerebrospinal fluid culture. As for the types of misdiagnosed diseases, intracranial infection was the most common, followed by internal medicine diseases and other types of diseases. The median number of misdiagnosis days was 11(1.5-95) d. Most patients had a good prognosis after treatment with penicillin and other drugs.

  Conclusion  The clinical manifestations and auxiliary examinations of LMI in central nervous system are often atypical. Clinicians should improve the understanding of the disease and reduce or avoid the misdiagnosis.