COVID-19 and Listeria Meningitis Treated by Ampicillin, Sulfamethoxazole/Trimethoprim and Meropenem

• Published in: Infection and drug resistance 2023-07, Vol.16, p.4289-4295
• Main Authors: Seki, Masafumi, Karaushi, Haruka, Arai, Noriko, Hayashi, Takeshi, Mitsutake, Kotaro
• Format: Article
• Language: English
• Subjects: Ampicillin; antibiotics; Bacterial infections; Blood cell count; C-reactive protein; carbapenem; Care and treatment; Case Report; Contamination; drug rash; Food contamination; Listeria; Meningitis; penicillin; Pregnant women; sars-cov-2
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S414879

Secondary bacterial infection was initially rare in SARS-CoV-2 infectious disease (COVID-19) patients, but COVID-19-associated bacterial infectious diseases have recently been increasing. Furthermore, it might be difficult to distinguish COVID-19 from bacterial meningitis by the symptoms, and one might be uncertain about antibiotic therapy for infection-typically caused by eating contaminated food-in elderly persons and pregnant women. A 96-year-old woman who had been living alone was found to have SARS-CoV-2 infection in February 2023. She was admitted to our hospital with high fever and disturbance of consciousness and was started on treatment with remdesivir. Two days later, her consciousness was still disturbed, and she was found to have a stiff neck. In addition, increased white blood cell counts and C-reactive protein suggested bacterial infection. Therefore, a lumbar puncture was done, and was ultimately isolated from blood cultures and its genetic material was detected in cerebrospinal fluid. She had previously eaten refrigerated food and cheese products. Intravenous ampicillin 1.0 g 6×/day was started, but one week later, loss of consciousness continued, and the cerebrospinal findings were not improved, although nasal swab became negative for SARS-CoV-2. Intravenous sulfamethoxazole/trimethoprim (ST) 80/400 mg 3×/day was added, and her consciousness and fever improved by one week later. A drug rash appeared after ST was started, and she was switched to meropenem. Her condition finally improved. COVID-19-associated secondary listeria infection was found in an elderly woman. She was treated with not only ampicillin, but also ST and meropenem. Meningitis caused by should be considered as a secondary complication and carefully treated with antibiotics during the period of the COVID-19 pandemic.