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 59-year-old man was admitted to the infectious diseases unit with a 2-day history of fever, altered mental status and headaches. He had a coronary heart disease. On admission to hospital the patient was afebrile. On day 2 of hospitalization, he developed a high fever (temperature 38.5℃) and meningeal signs. Examination of the CSF revealed a meningeal syndrome. The CSF culture yielded serotype 4 L. monocytogenes. The patient received penicillin G (24MU/d) and amikacin (1g/d) intravenously for 14-day. On day 6 of hospitalization, he became afebrile and his symptoms and findings gradually improved after administering of the therapy. The patient was diagnosed with diabetes mellitus. Antibiotic therapy continued with po ampicillin (4g/d) for 4 days, and then he was discharged.