Nine cases, 3 adults and 6 children, with
Listeria monocytogenes meningitis were seen over a 10-year period at King Edward VIII Hospital, Durban. These cases accounted for 0.8% (3/374) and 0.6% (6/1,210) of all culture-positive cases of acute
bacterial meningitis in adults and children, respectively, and represented 2.9% (4/136) of all culture-positive cases in the neonatal age group and 5.7% (3/53) of culture-positive cases in adults 50 years and older. The patients had positive blood and cerebrospinal fluid (CSF) cultures. All isolates were sensitive to
ampicillin,
chloramphenicol,
sulphamethoxazole-
trimethoprim combination and
gentamicin. One isolate in an 11-month-old child was resistant to
penicillin and 2 isolates in the adult patients displayed intermediate sensitivity to this
antibiotic. The adults were over 50 years of age and presented with an abrupt onset of a pyrexial illness,
meningitis and focal neurological signs; only 1 survived. Only 1 8-week-old infant of the paediatric cases survived. A polymorphonuclear leucocytosis, low serum
glucose and elevated
protein values were common findings in the CSF and the features in some patients mimicked tuberculous or
viral meningitis. The fulminant course of the disease and the fact that
penicillin and not
ampicillin is the first-line
antibiotic makes it essential to consider
listeriosis as a possible diagnosis, particularly in the very ill patient.