MEDizzy - An 87-year-old nursing home resident is brought by ambulance

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Infections and diseases 1

An 87-year-old nursing home resident is brought by ambulance to a local emergency department. He is obtunded and ill-appearing. Per nursing home staff, the patient has experienced low-grade temperatures, poor appetite, and lethargy over several days. A lumbar puncture is performed, and the Gram stain returns gram-positive rods and many white blood cells. Listeria meningitis is diagnosed and appropriate antibiotics are begun. Which of the following statements regarding Listeria meningitis distinguishes it from other causes of bacterial meningitis?

ExplanationListeria meningitis typically affects elderly and the chronically ill individuals. It is frequently a more subacute (developing over days) illness than other etiologies of bacterial meningitis. It may be mistaken for aseptic meningitis. Meningeal signs, including nuchal rigidity, are less common, as is photophobia, than in other more acute causes of bacterial meningitis. Typically, white blood cell (WBC) counts in the cerebrospinal fluid range from 100 to 5000/μL with a less pronounced neutrophilia. About 75% of patients will have a WBC count below 1000/μL. Gram stain is only positive in 30% to 40% of cases. Case fatality rates are approximately 20%.