Questions raised by Listeria-monocytogenes meningitis in children

Listeria monocytogenes human infections more frequently affect the newborn and the old adult; some of these infections may be related to an underlying disease or be due to an immunodeficiency, The following questions were raised by the case of a12 year old immunocompetent girl, suffering from a L. meningitis. The physician has to face two problems: one concerns the diagnosis of listeriosis, because of its low frequency among pediatric meningitis, and in this case a quick bacteriological answer is essential; the other concerns what treatment to undertake pending bacteriological results. Indeed, therapeutic guidelines issued by consensus conferences on pediatric bacterial meningitis do not take listeria into consideration. Consequently, the authors suggest adding amoxicillin to the initial treatment when listeriosis is suspected (immunosuppressive therapy, underlying disease, meningoencephalitis).