Case Report

Meningitis due to Leuconostoc Mesenteroides Associated with Central Nervous System Tuberculosis: A Case Report

José Barletta1,3*, Tatiana Estrada1,3, María José Rolón1,3, Mariana Erbin2,3, Sara Kaufman2,3 and Héctor Pérez1,3
1Department of Infectious Diseases, Hospital Juan A Fernández, Argentina
2Department of Clinical Microbiology, Hospital Juan A Fernández, Argentina
3Department of Neurology, Hospital Juan A Fernández, Argentina

*Corresponding author: José Barletta, Servicio de Infectología, Hospital Juan A Fernández, Cerviño 3356 CABA C1425AGP. Argentina

Published: 06 Jan, 2017
Cite this article as: Barletta J, Estrada T, Rolón MJ, Erbin M, Kaufman S, Pérez H. Meningitis due to Leuconostoc Mesenteroides Associated with Central Nervous System Tuberculosis: A Case Report. Ann Clin Case Rep. 2017; 2: 1228.


Bacteria in the genus Leuconostoc are very infrequent opportunistic pathogens. We report a case of meningitis due to Leuconostoc mesenteroides sub sp. mesenteroides associated with central nervous system tuberculosis in a patient with advanced HIV/AIDS infection.

Keywords: Leuconostoc mesenteroides; HIV; Tuberculosis; Meningitis

Case Presentation

47-year-old male patient with a history of HIV/AIDS infection with poor adherence to Highly- Active Antirretroviral Therapy (HAART) and a CD4 count of 86 cells/mm3 is brought to the emergency department by his relatives because of disturbance of general behavior and disorientation. At the time of evaluation he was febrile, bradypsychic and inattentive, with no motor or sensory deficit objectifiable and with signs of frontal disinhibition.
Routine laboratory tests were performed, with mild hyponatremia as the only pathological finding; a brain CT scan was informed as normal and serum Cryptococcus neoformans antigen assay was negative. A lumbar puncture was performed with normal opening pressure; and a clear cerebrospinal fluid (CSF) with lymphocytic pleocytosis, hyperorpteinorraquia and low glucose level was obtained. A Polymerase Chain Reaction to detect Mycobacterium tuberculosis in CSF was performed (GeneXpert MTB / RIF®), with a positive result for rifampicin-sensitive Mycobacterium tuberculosis; and CSF culture was positive for Leuconostoc mesenteroides subsp. mesenteroides sensitive to ampicillin, gentamicin and minocycline. Meningitis due to Leuconostoc mesenteroides subsp. Mesenteroides associated with central nervous system tuberculosis was diagnosed, and treatment with antituberculous drugs, glucocorticoids and ampicillin was promptly started. The patient evolved unfavorably and died on the seventh day of hospitalization due to healthcareassociated pneumonia.


Leuconostoc is a genus of lactic-acid producing bacteria. Its members are usually found on the environment in pickled vegetables, dairy and viticulture products. Bacteria from the Leuconostoc genus are non-sporulated gram positive cocci, facultative anaerobes, grouped into pairs or chains and are intrinsically resistant to vancomycin [1]. They are usually considered opportunistic pathogens to the human host, affecting more frequently pediatric population [2]. The use of central venous catheters and parenteral nutrition [3], as well as a history of bacteriemic infections [4] and previous exposure to vancomycin [5] are risk factors present in most cases of infections due to pathogens from Leuconostoc genus described in the literature. Disruptions in gastrointestinal barrier such as observed in amyloidosis, short bowel syndrome or advanced HIV/AIDS infection may play a role in the translocation of Leuconostoc from the colonized gastrointestinal tract as well [6]. In central nervous system infections, Leuconostoc mesenteroides has been documented as a pathogen causing meningitis in adults [7,8] and neonates [9], as well as post-neurosurgical ventriculitis [10]. Although association between Leuconostoc and tuberculosis has been described in a patient with rheumatoid arthritis [6], it seems to be more related to the underlying immunosupresive condition than to a causal pathophysiological relationship between Leuconostoc and Mycobacterium tuberculosis. In individuals with HIV/AIDS, microorganisms from Leuconostoc genus were isolated in samples from patients with Lung [11] and endovascular [12] infections, in most cases as a germ associated with other pathogens (S. epidermidis, H. influenzae, and S. pneumoniae among others) [12] and with high-mortality.

Table 1

Another alt text

Table 1
L. mesenteroides subspecie mesenteroides: Microbiological Features.


Leuconostoc mesenteroides subsp. mesenteroides is an uncommon pathogen that is usually associated with other germs and produces infections with high mortality. Its microbiological features are listed in (Table 1). It should be taken into account as an etiological agent causing severe infections due to vancomycin-resistant gram-positive cocci in patients with risk factors for invasive infections, even in those without prior antibiotic exposure.


  1. Swenson JM, Facklam RR, Thornsberry C. Antimicrobial susceptibility of vancomycin-resistant Leuconostoc, Pediococcus, and Lactobacillus species. Antimicrob Agents Chemother. 1990; 34: 543-549.
  2. Jofré ML, Sakurada Z A, Ulloa F MT, Hormázabal O JC, Godoy M V, Fernández O J, et al. Leuconostoc infections in patients with short gut syndrome, parenteral nutrition and continuous enteral feeding. Rev Chilena Infectol. 2006; 23: 340-345.
  3. Hardy S, Rouff KL, Catlin EA, Santos JI. Catheter-associated infection with a vancomycin-resistant gram-positive coccus of the Leuconostoc sp. Pediatr Infect Dis J. 1988; 7: 519-520.
  4. Bou G, Saleta JL, Sáez Nieto JA, Tomás M, Valdezate S, Sousa D, et al. Nosocomial outbreaks caused by Leuconostoc mesenteroides subsp. mesenteroides. Emerg Infect Dis. 2008; 14: 968-971.
  5. Cuervo MSI, Cortés LJ, Rodríguez RE, Hormaza AN, Vargas SE. Leuconostoc sp in cancer patients: a descriptive study. Rev Chilena Infectol. 2008; 25: 184-188.
  6. Shin J, Her M, Moon C, Kim D, Lee S, Jung S. Leuconostoc bacteremia in a patient with amyloidosis secondary to rheumatoid arthritis and tuberculosis arthritis. Mod Rheumatol. 2011; 21: 691-695.
  7. Hatipoğlu CA, Yildiz E, Köktekir E, Ipekkan K, Karakoç EA, Demiröz AP. A case of vancomycin resistant Leuconostoc meningitis. Mikrobiyol Bul. 2008; 42: 695-699.
  8. Coovadia YM, Solwa Z, van den Ende J. Meningitis caused by vancomycinresistant Leuconostoc sp. J Clin Microbiol. 1987; 25: 1784-1785.
  9. Friedland IR, Snipelisky M, Khoosal M. Meningitis in a neonate caused by Leuconostoc sp. J Clin Microbiol. 1990; 28: 2125-2126.
  10. Deye G, Lewis J, Patterson J, Jorgensen J. A case of Leuconostoc ventriculitis with resistance to carbapenem antibiotics. Clin Infect Dis. 2003; 37: 869- 870.
  11. Ferrer S, de Miguel G, Domingo P, Pericas R, Prats G. Pulmonary Infection Due to Leuconostoc Species in a Patient with AIDS. Clin Infect Dis. 1995; 21: 225-226.
  12. del Nozal-Nalda M, Jiménez-Mejías ME, Suárez AI, Viciana P. Sepsis caused bt Leuconostoc cremoris, neutropenia and human immunodeficiency virus infection. Medicina Clínica. 1997; 108: 799.