Spontaneous bacterial peritonitis caused by Listeria monocytogenes: A rare infection with very high leukocyte counts in ascitic fluid–case report and review of the literature - 31/05/23

Doi : 10.1016/j.clinre.2023.102130

Amelie Meurer ^a, Christoph Antoni ^a, Matthias P. Ebert ^a, Anna Trimborn ^b,^{^{1
These authors contributed equally to this work.}}, Michael Hirth ^a,^{^{1
These authors contributed equally to this work.},}^⁎
^a Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Federal Republic of Germany
^b Institute of Medical Microbiology and Hygiene, Medical Faculty of Mannheim, University of Heidelberg, Federal Republic of Germany

^⁎Corresponding author.

Learning points

•	Listeria monocytogenes is a rare cause of spontaneous bacterial peritonitis. 1% of humans are asymptomatic carriers of Listeria monocytogenes, which can lead to endogenous infection in cirrhosis.
•	In case of high leukocyte count in peritoneal fluid, Listeria-induced SBP is an important differential diagnosis to intestinal perforation in patients with cirrhosis.
•	Listeria is not covered by empiric therapy with cephalosporins. A combination of aminopenicillin and aminoglycoside is recommended. Early and correct antimicrobial therapy reduces the mortality significantly.

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Abstract

We present a rare case of Listeria monocytogenes-induced spontaneous bacterial peritonitis (SBP) in cirrhosis. Examination of the patient's peritoneal fluid revealed an extremely high leukocyte count. We suspect, that the patient belongs to 1% of individuals in which Listeria monocytogenes is part of the intestinal flora. Cephalosporins as empiric antibiotics have a Listeria gap. A combination of aminopenicillin and aminoglycoside is recommended. Therefore, early microbiological diagnosis from ascites and blood is essential. Listeria should be considered as a rare cause of SBP, especially in case of very high leukocyte count in peritoneal fluid or lack of response to empiric therapy.

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Keywords : Spontaneous bacterial peritonitis, Cirrhosis, Listeria monocytogenes, Ascites, Infection

Abbreviations : SBP

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Vol 47 - N° 6

Article 102130- juin 2023 Retour au numéro

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Spontaneous bacterial peritonitis caused by Listeria monocytogenes: A rare infection with very high leukocyte counts in ascitic fluid–case report and review of the literature - 31/05/23

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