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 57-year-old man with a history of chronic lymphocytic leukemia and hepatic cirrhosis with a positive serology for the hepatitis C virus was brought to the hospital with a fever (temperature 38.5℃), chills, night sweats, headaches, cough and anorexia. He was empirically treated with I.V. ampicillin/sulbactam (6g/d) and amikacine (1g/d). Two separate blood specimen cultures, drawn over 72 hours, yielded serotype 4 L. monocytogenes. The antibiotic therapy continued for 14 days. The patient's condition gradually improved with antibiotic therapy. When discharged, he was advised to take oral ampicillin/sulbactam (1,5g/d) for an additional 5 days.