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Vol. 19. Núm. 7.
Páginas 297-303 (Agosto 2001)
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Vol. 19. Núm. 7.
Páginas 297-303 (Agosto 2001)
DOI: 10.1016/S0213-005X(01)72649-3
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Infecciones por Listeria monocytogenes en el adulto. Aspectos clínicos y microbiológicos de una enfermedad cambiante
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Agustín Julián, Ángel Jiménez, Miguel de Górgolas, Ricardo Fernández, Manuel L. Fernández1
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mlfernandez@fjd.es

Correspondencia: Dr. M.L. Fernández Guerrero. Fundación Jiménez Díaz. Avda. Reyes Católicos, 2. 28040 Madrid
División de Enfermedades Infecciosas. Fundación Jiménez Díaz. Universidad Autónoma de Madrid
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Se revisaron 31 casos de infección por Listeria monocytogenes en adultos durante el período comprendido entre 1971 y 1999 dividiendo los mismos en dos grupos, el primero desde 1971 a 1984 que comprende 14 casos y el segundo desde 1985 a 1999 con 17 casos, tratando de establecer diferencias y analizar posibles cambios en la incidencia, clínica y evolución de la listeriosis en las últimas tres décadas

La incidencia de listeriosis se mantuvo constante a lo largo de los años con 1,2 casos/20.000 ingresos año con agrupamiento en algunos períodos. La edad media de los pacientes aumentó significativamente

(55 ± 11 frente a 68 ± 12 años; p 0,002). El 77% tenían una o más enfermedades subyacentes, observándose en el último período casos de listeriosis en personas sanas

La infección se presentó como meningitis o meningoencefalitis en el 48% de las ocasiones y como sepsis primaria en el resto. La mortalidad atribuible fue del 61% y estuvo estrictamente relacionada con la gravedad de la enfermedad subyacente. No se encontraron diferencias en la mortalidad de los pacientes con meningitis y sepsis (66% frente a 62%, p>0,05). El desarrollo de convulsiones y signos de romboencefalitis se asoció con mayor mortalidad (100% frente a 20%, p<0,05). La mortalidad de los enfermos tratados con penicilinas y aquellos que recibieron una combinación de penicilinas y aminoglucósidos (73% frente a 70%; p>0,05), tampoco fue significativamente diferente. El cotrimoxazol fue tratamiento eficaz en los 4 pacientes tratados

En resumen, la listeriosis en adultos sigue produciendo una elevada mortalidad dependiente de la naturaleza y gravedad de la enfermedad subyacente. La edad media de los pacientes aumenta y se observa mayor número de casos en personas aparentemente sanas. El cotrimoxazol es una terapia eficaz y podría emplearse como tratamiento inicial incluso en personas sin alergia a penicilinas

Palabras clave:
Listeria monocytogenes
clínica
Microbiología

Thirty-one cases of human listeriosis seen from 1971-1999 were reviewed. cases were grouped as follows: Group I composed of 14 patients were studied in the period 1971-1984; and group II composed of 17 cases studied in the period 1985-1999. We tried to assess changes in the incidence, clinical findings and outcome in both periods. The incidence of listeriosis remained constant along the years, 1.2 cases/20,000 discharges

The mean age of the patients significantly increased along the years (55 ± 11 years versus 68 ± 12 years; p 0.002). 77% of cases had one or more underlying diseases predisposing to listeriosis. We observed an increasing number of listeriosis in patients without chronic diseases in recent years. Listeriosis presented as meningitis or primary sepsis. Mortality was 61% and was strictly associated with the severity of the underlying disease. Patients with meningoencephalitis and seizures had a worse prognosis. We did not observe differences in mortality of patients who were treated with beta-lactam monotherapy in comparison with those who were treated with beta-lactam/aminoglucoside combination

Cotrimoxazole was uniformly successful treatment of human listeriosis in this serie

Key words:
Listeria monocytogenes
clinic
Microbiology
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