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P676. Listeria monocytogenes infection in inflammatory bowel disease patients: case series

J. Miranda-Bautista1, C. Padilla Suárez1, E. Bouza2, P. Muñoz2, M. Rodriguez-Creixems2, L. Menchen1, I. Marin-Jimenez1, 1Hospital General Universitario “Gregorio Marañón”, Gastroenterology Unit, Madrid, Spain, 2Hospital General Universitario “Gregorio Marañón”, Microbiology Unit, Madrid, Spain

Background

Listeria monocytogenes (LM) is a Gram positive intracellular bacillus that in immunodeficient patients, children, geriatric patients, pregnant women and even in healthy individuals can develop central nervous system infection, bacteremia and other clinical manifestations, becoming a relevant pathogen.

Methods

From Microbiology Service data of “Gregorio Marañón” Hospital we selected all positive biological samples cultures for LM in Inflammatory Bowel Disease (IBD) patients, from January 1986 until January 2011. These cases were included in a SPSS data base, analyzing several basal clinical characteristics and factors related to the infection.

Results

Five patients diagnosed with IBD had positive cultures for LM during this period. Four of them were male, and also four of them had the diagnosis of Crohn's disease (CD), with another one of unclassifiable colitis. Four patients had corticosteroid cumulated dose more than 400 mg (equivalency in methylprednisolone doses), three patients were under anti-tumor necrosis factor (TNF) alpha treatment (2 adalimumab and 1 certolizumab). Prior colonoscopy with biopsies was found in two cases. Clinical presentation of the infection was bacteremia in four patients, accompanied by central nervous system infection in 2 cases. One case consisted in isolated meningoencephalitis. Despite of correct empiric treatment, one patient died related to the infection, due to a rombencephalitis refractory to medical treatment. Increased incidence of LM bacteremia in IBD patients was found, compared with general population (27.6 bacteremias per 100,000 IBD patient-years, compared with 1.6 bacteremias per 100,000 person-years), with an OR of 16.9.

Conclusion

IBD patients may be at risk of more frequent and serious LM infection comparing with general population.