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Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis

  • Diagnostic Neuroradiology
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Abstract

Purpose

To describe the imaging findings and determine the incidence of a characteristic worm-like pattern along the white matter tracts in neurolisteriosis on CT/MRI.

Methods

An IRB-approved retrospective study in 21 consecutive neurolisteriosis cases during January 2002–July 2020. At least one of the following is required: (1) Positive Listeria monocytogenes (LM) in blood with clinical signs of meningeal irritation and/or abnormal CSF profile, (2) positive LM in blood with signs of encephalitis, (3) positive LM in CSF, (4) positive LM from brain biopsy/aspiration. Six cases were excluded due to the lack of contrast-enhanced images, leaving a total of 15 cases for analysis (mean age 53.5 years ± 18.8 SD). The imaging studies were independently reviewed by two blinded readers. Demographic data, imaging findings, and incidence of the worm-like pattern were reported. The Cohen’s kappa was used to calculate interrater reproducibility.

Results

Of the 12 patients with relevant imaging findings, nine cases (75%) had parenchymal lesions (eight cases in supratentorial compartment and one case in infratentorial compartment), four cases (33.3%) had leptomeningeal enhancement and two cases (16.7%) had hydrocephalus. Brain abscesses were found in eight cases and nodules evocative of abscess in one case. Restricted diffusion in the central area and hemosiderin deposition were observed in all cases. The involvement of white matter tract in a worm-like pattern was demonstrated in eight of nine patients with parenchymal lesions (88.9%).

Conclusion

Abnormal findings in brain CT/MRI images are common in neurolisteriosis. The incidence of worm-like spread along the white matter tracts is high and may help diagnose suspicious patients.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand

    Aimpavee Keeratiratwattana & Supada Prakkamakul

  2. Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand

    Aimpavee Keeratiratwattana & Supada Prakkamakul

  3. Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Abhinbhen W. Saraya

  4. Thai Red Cross Emerging Infectious Diseases and Health Science Centre (TRC-EID-HS), King Chulalongkorn Memorial Hospital - The Thai Red Cross Society, Bangkok, Thailand

    Abhinbhen W. Saraya

Authors
  1. Aimpavee Keeratiratwattana
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  3. Supada Prakkamakul
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Corresponding author

Correspondence to Supada Prakkamakul.

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Approved by IRB of Chulalongkorn University.

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Waived due to retrospective nature of the study.

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Key points

1. Abnormal findings on brain CT and magnetic resonance imaging are common in neurolisteriosis.

2. The incidence of worm-like spread along the white matter tracts is high in LM brain abscess.

3. The worm-like tunnels and hemorrhage are imaging features suggesting LM brain abscess with the differential diagnosis of B. pseudomallei brain abscess and cerebral sparganosis.

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Keeratiratwattana, A., Saraya, A.W. & Prakkamakul, S. Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis. Neuroradiology 66, 717–727 (2024). https://doi.org/10.1007/s00234-024-03313-2

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  • DOI: https://doi.org/10.1007/s00234-024-03313-2

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