A 64-year-old man with fever, nausea, vomiting, diarrhea and altered mental status was admitted to the infectious diseases unit. On physical examination, he had lethargy and acutely ill with a high fever (temperature 38℃), tachycardia and meningeal signs. The analysis of the CSF revealed a meningeal syndrome with increased levels of protein, pleocytosis with a predominance of PMNs. He had a history of chronic obstructive pulmonary disease. The CSF culture yielded serotype 4 L. monocytogenes. Two sets of blood cultures came out negative. He was treated with penicillin G (24MU/d for 14 days), and his condition transiently improved after administering the antibiotic treatment. The patient became afebrile and was discharged with a prescription for po ampicillin (4g/d) to complete a 21-day course of antibiotic therapy.
A 70-year-old man was hospitalized in the hematology unit, showing symptoms of fever (temperature 38℃) and night sweats. The patient, who was treated for acute myeloid leukemia and with his last chemotherapy having been 6 weeks ago, had pancytopenia (a WBC count of 400/mm3 with 20% PMNs). On day 3 of hospitalization, L. monocytogenes was cultured in blood samples. The therapy began with ampicillin (8g/d) and amikacin (1g/d). On day 9, his condition continued to detoriate. He developed orofaringeal candidiasis and laboratory findings revealed deep neutropenia (a WBC count of 100/mm3). Antibiotic therapy was continued and I.V. amphotericin B (1mg/kg/d) was added. Despite these therapies, he died on the 13th day of hospitalization.