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Primary spontaneous listerial peritonitis
Journal article   Open access   Peer reviewed

Primary spontaneous listerial peritonitis

Joseph Tholany, Hasan Samra, Takaaki Kobayashi and Kunatum Prasidthrathsint
IDCases, Vol.32, e01748
2023
DOI: 10.1016/j.idcr.2023.e01748
PMCID: PMC10038783
PMID: 36974133
url
https://doi.org/10.1016/j.idcr.2023.e01748View
Published (Version of record) Open Access

Abstract

A male in his mid-60s with chronic kidney disease, ischemic cardiomyopathy, and nonalcoholic cirrhosis due to congestive hepatopathy presented with fever and abdominal pain for two weeks. He underwent diagnostic paracentesis, which noted an ascitic neutrophil count over 7000/mm3. Gram stain of the ascitic fluid showed Gram-positive cocci. He was diagnosed with spontaneous bacterial peritonitis (SBP) and was started on ceftriaxone. Ascites cultures grew Listeria monocytogenes and antibiotics were changed to ampicillin. He received one week of ampicillin while inpatient and seven weeks of oral amoxicillin, at which point his ascitic neutrophil count was less than 250/mm3. He was continued on suppressive amoxicillin for an additional 14 weeks with no recurrence in over a year after the discontinuation of amoxicillin. Though uncommon, L. monocytogenes should be considered a pathogen causing SBP. Focal listerial infections can be treated with penicillins alone while invasive disease may require the addition of aminoglycosides. •Listeria monocytogenes is an intracellular Gram-positive coccobacillus with the ability to form biofilms.•L. monocytogenes is an uncommon cause of spontaneous bacterial peritonitis; as such, diagnosis may be delayed.•L. monocytogenes is intrinsically resistant to ceftriaxone which is the first-line therapy for community acquired SBP.•The diagnosis of bacterial peritonitis should include routine Gram-stain and culture to identify the causative pathogen.
 Listeria Spontaneous bacterial peritonitis

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