NEUROMENINGEAL LISTERIOSIS IN ADULTS - CL INICAL-FEATURES AND EFFECTIVENESS OF COTRIMOXAZOLE ALONE

A series of 28 patients suffering from neuromeningeal listeriosis is r eported. This disease is consecutive to infection by Listeria monocyto genes - an ubiquitous and opportunistic Gram-positive bacillus - and h as become a public health problem: its incidence is increasing and its prognosis is very severe despite the development of new bacteriologic al identification methods. Human beings are contaminated by food, whic h explains the frequent outbreaks of epidemics which are widely public ized, the infection being one of the consequences of the unprecedented development of the food industry and the cold food chain. The predomi nant clinical picture is one of non-specific meningoencephalitis. In a bout 50 percent of the cases the subjects infected are <<immunodepress ed>> and/or more than 60 years' old. The diagnosis is difficult since the bacteriological identification is delayed (direct examination of t he cerebrospinal fluid is rarely positive) and this fluid may be steri le (hence the value of blood cultures). A probability treatment theref ore must be initiated before the diagnosis is confirmed if an unfavour able outcome is to be avoided. In Listeria monocytogenes infection cot rimoxazole administered alone seems to be a better antibacterial thera py than the reference ampicillin-aminoside combination.