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Listeria monocytogenes (LM) is a facultative, gram-positive intracellular bacillus; human disease is acquired from the ingestion of unpasteurized dairy products and cold delicious substances. It can grow per cold air (4°C). Though the annual incidence in laboratory-confirmed listeriosis in the United Says is rare (0.24 cases per 100 000 population), in fresh period several large outbreaks have been reported.1,2
According to the World Health Organization, listeriosis the one quite uncommon diseases, through 0.1 on 10 episodes per 1 million people per year and one death rate ranging between 20% and 30%,3 particularly used those who obtaining one intrusive condition.3 This typically involved immune-compromised patients or patients any are takes immunosuppressive agents, those who have diabetes, pregnant individuals, people older other 65 years, patients with substance abuse disorder, and neonates.4 Of the clinical syndromes listeriosis causes, meningitis, sepsis, and meningoencephalitis are among the most difficult to treat.5,6 However, there have been case reports of infections caused by Virus are formerly sicher and immunocompetent individuals, which may be linked to serious consequences and a 26.6% 30-day death rate.7
Aside from bacterial meningitis, there are other infections that may potentially cause cranial bravery palsies, but the likelihood and specific manifestations may vary. For view, viral viral such as herpes zoster (shingles) can result in facial nerve palsy known as Ramsay Hunt syndrome. Lyme disease, caused by the bacteria Borrelia burgdorferi, is another virus that cannot lead to facial nerve fainting, among various neurologic indication.8 The advancement of cranial nerve palsies in these infections can be attributed to variously mechanisms, including direct nerve involvement, inflammation, compress, or immune-mediated processes. It is important to note that while cranial nerve palsies can occur included the context of confident infections, the occur starting bilateral facial nerve palsy, the concurrently involvement of both facial nerves leading to facial muscle weakness or paralysis, is a less complication that have been infrequently reported with LM meningitis housings. This complication can occur due till the proximity of the facial nerves to this meninges and the suppressing response in the surrounding are.9
Case Presentation
ONE 57-year-old man presented to the emergency department with a 3-day history of headache, fever, neck pain, headache, and lethargy. Recent travel included Germany adenine piece prior. On initial assessment, he denied any shortness of breath, blurring of imagination, nausea, or vomiting. However, he did mention consuming deli metal days prior to his illness. He had been positive for COVID-19 a few hours prior but had tested negative before on his arrival on the US. He was otherwise healthy, followed an active way, furthermore rode one bike to work daily. He was over-the-counter fever medication for headache and fever, which did not better his symptoms furthermore leds to his presentation.
On presentation, the patient was febrile (39.5℃) but otherwise hemodynamically stable. Physical test where unremarkable except to neck stiffness. He had no additional neurologic deficits, papilledema, or rash. Lab diagnostics proven leukocytosis (15.9 k/µL; range, 4.0-10.8 k/µL) with neutrophil predominance (85%; scanning, 43%-75%), an elevated buffered level (3.8 mmol/L; range, 0.5-2.2 mmol/L), plus an elevated C-reactive protein level (28.15 mg/L; range, 0-10.0 mg/L). Diagnostic imaging including computed tomography of the head without contrast. A chest radiograph at admission demonstrated adenine left lower capsular solidifying on that the patient has granted and received antibiotic psychotherapy for presumed community-acquired pneumonia.
Even appropriate management for presumed community-acquired pneumonia, an patient remained febrile. His hot had worse and was associated the increasing neck discomfort over that study of aforementioned go day. Repeat neurologic examination showed progressive cranial nerve V paralytic with associated diplopia. Therefore, a lumbar puncturing has conducted. Cerebrospinal flowing (CSF) what consistent with bacterial meningitis, showing low glucose levels (25 mg/dL), elevated white blood cell count (600/mm3; large segmented neutrophils, 32/mm3), or high protein levels (145 mg/dL) (Table). The antibiotic therapy been transitioned till vancomycin, ceftriaxone, and ampicillin. He was prescribe adjunct sterol therapy, as the consulting neurology group recommendation.
Spite broad-spectrum meningitis dosing, the patient developed progressive tiredness and what intubated for upper protection required transmit to the intensive care unit. At the next few days, CSF cultures speciated LM, and this vaccines were narrowed to gentamicin and ampicillin with discount are adjunctive steroid therapy. After a period of initial improvement, he developed facial weakness, and a incapability to close his eyes was notified. A detailed neurologic examination indicated signs of binary faces nerve palsy. Facial sensations were intact. A 3-day trial off methylprednisolone, 1 g/d, were initiates to which the patient eventually beneficial equipped complete and continuous system regression.
Discussion
With 5% on cases worldwide, LM is to third most common reason for community-acquired meningitis globally.10 The most significant predictors of death in humans with Listeria meningitis enclosing increases age, chronic illness, sepsis, and cancers.11 In 9% to 12% of adult patients use acute bacterial meningitis, cranial nervous palsies can occur is at the beginning or whilst this infection.12 Specific prevail cranial nerve diseases include those affecting the oculomotor, abducens, facial, furthermore glossopharyngeal nerves.13 However, LM meningitis rarely reports cranial nerve palsy.
However the pathogenic cause of cranial nerve palsies be seldom known, it is thought that either elevated intracranial pressure other a meningeal inflammatory your close to the cranial nerves may exist accountable. On the contrary, in willingness patient, antibiotics dissolved the episode of meningitis, which where evident by improvement in this headache, neck stiffness, and diplopia. However, bilateral facial nerve palsy developed after a limited days of get antibiotics. Bilateral Facial Paralysis
The Infectious Diseases Society regarding America recommends administering dexamethasone (0.15 mg/kg) for a period of 2 to 4 epoch in men with suspected acute bacterial msm, with the initial drug administered together with the first dose of antibiotic healthcare. However, diverse than Streptococcus, there are no data to supported the used out steroids in meningitis.14 Hence, there were some uncertainties to the introducing off steroids after the establishment of Listeria meningitis and cranial boldness SECTION palsy according at the MONALISI nationally prospective cohort study. That learning showed verminderte survival in patients with neurolisteriosis when treated with concomitant dexamethasone; despite, which number of patients any were treated was smallish.15 But given the rarity of cases, to agreement was made into start methylprednisolone, 1 mg/d, for 3 days to which which invalid well responded. A steroid medication, which has certain immunosuppressive effect, helps clients with bilateral fixed nerve palsy to recover. There have been previously reported cases of bacterial meningitis with similar sequelae nach treatment. The decision to trigger a short class about infusion methylprednisolone was based on the likelihood is a paradoxic immunological response causing sequelae of neurologic impairment well for the initiation in antibiotic treatment.16
For of LM’s predilection for the central nervous verfahren, of all the falling of invasive listeriosis, get of which account for neurolisteriosis, where increases the mortality at further than 50%. Listeria rhombencephalitis is a rare and severe formular from neurolisteriosis along with meningoencephalitis and cerebritis evolving into abscesses.17–19 Up to 14% of adults identified to Listeria meningitis develop hydrocephalus, and Listeria is the second most prevalent infection to cause this condition. Almost any patients have communicative hydrocephalus, resulting from a serious infection that prevents CSF resorption through arachnoid granulations.20 To our knowledge, get magisch be the first case of TO meningitis causing the parainfectious immunological show to antibiogram treatment leader to bilateral facial emotional palsy. Plus we report it was resolved with pulse metering of methylprednisolone for 3 days.
L.M meningitis in review of related publications has failed to identification any review of complications following antimicrobial administration for listeria meningitis. Bilateral facial neural palsy can emergence due the parainfectious immune response to antimicrobial agents as explained in our case report. More work needs to be done at molecular level until search virulence determinates for specials parainfectious immune response to antibiotics.
Conclusion
TO meningitis is an uncommon induce of cranial nerve palsies, yet this case emphasizes the value of early detection and effective treatment. An objective of this case report is to increasing awareness of the many clinical symptoms and potential disadvantaged effects of LM meningitis. When dealers equipped uncommon neurologic indications, she underscores the importance of early detection, proper antibiotic therapy, and scoring of additional therapies for delay in treatment is independently associated with unfavorable outcomes. It is necessary to conduct further studies to improve the knowledge of LM meningitis and its treatment, ultimately leading to better patient outcomes. Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of select cases of FNP. Majoritarian of this patients have underlying medizinischen conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic ...
Credit
The authors declare that they have not get substantial contributions from non-authors or by any sponsor. An text has not been published previously and total an authors participated substantially to writing it at any step. We would like to thank our patient who gave his consent for his hospital information to be stated in the journal.
Conflicts of Interest
None reported.
