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Listeria monocytogenes in a healthy young adult

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To the Editor: Meningitis caused by Listeria monocytogenes is rare in immunocompetent adults.1 In the absence of risk factors for L. monocytogenes infection, Australian antibiotic guidelines recommend a third-generation cephalosporin alone for management of community-acquired meningitis, which has no activity against L. monocytogenes.2

A 22-year-old immunocompetent woman presented to our hospital with 3 days of fever, headache, photophobia and neck stiffness. This had been preceded by a 2-day prodrome of diarrhoea. Medications on admission were cephalexin for 1 day and a combined oral contraceptive. The patient had a history of coeliac disease, controlled on a gluten-free diet, and penicillin allergy. On examination, she was febrile (temperature, 38.7°C), with nuchal rigidity and positive Kernig’s sign, but with no rash. Heart rate (80 beats/min), respiratory rate (18 beats/min) and blood pressure (145/80 mmHg) were within normal range. White cell count (WCC) (16 × 109/L; reference interval [RI], 5–10 × 109/L) and C-reactive protein concentration (206 mg/L; RI, < 2 mg/L) were elevated.…