Female, 4 years 11 months old, with no relevant history.
He was admitted for a seven-day history characterized by fever, explosive vomiting, headache and progressive consciousness compromise.
Five days before admission to our hospital, she had been evaluated in a private health center for fever and meningeal signs.
Laboratory tests revealed leukocytosis with left shift, PCR 48 mg/dl and CSF cytochemical with 1,300 leukocytes (80% polymorphonuclear), glucose 13 mg/dl and bacterial protein 300 mg/dl admittance.
Two days later, when fever persisted, the antibiotic regimen was changed to cefoxime and vancomycin.
Brain computed tomography revealed a ventricular dilatation.
The patients condition was unfavorable: he lost sphincter control and was unable to communicate with the environment, so he was referred to our institution.
On physical examination at admission she was febrile, with meningeal signs present.
Treatment with ceftriaxone-vancomycin was continued.
On the second day of hospitalization, a new multislice cerebral tomography was performed, showing hypertensive hydrocephalia. An external ventricular shunt system (EVD) was installed.
The patient had a stationary clinical course, with serial CSF studies showing improvement (decrease in pleocytosis and proteinorrhachia).
CSF staining for cryptococcus and sero-agglutinations typic, paratyphic and Brucella were negative.
On the fourth day, culture results were received, isolation of L. in hemocultives and CSF culture.
Antibacterial therapy was changed to ampicillin (400 mg/kg/day) and gentamicin (7.5 mg/kg/day).
The determination of adenosine deaminase (ADA) in CSF was 55 U/L (reference value < 45 U/L).
PCR results for Mycobacterium tuberculosis in CSF, Ziehl Neelsen stain for gastric aspirate, and a last ADA control in CSF were negative (2.5 U/L).
Immunological studies were performed determining serum immunoglobulin concentrations, which were within normal parameters (Ig E: 17 mg/dl IgM, Ig A: 111 mg/dl, Ig dl: 122 mg/dl G: 922 mg).
HIV serology was negative.
The subsequent evolution was slowly favorable, with neurological sequelae such as speech deficit.
She was discharged after 39 days of hospitalization.
It was not possible to identify the direct source of the disease although in the epidemiological research it was discovered that the family devoted to the artisanal manufacture of cheeses and yogurt and that the minor consumed them frequently.
These dairy products could not be analyzed for the microorganism.
