Listeria monocytogenes infections in a tertiary hospital

Case report: An 82-year-old woman with a history of hypertension and diabetes mellitus was presented to the Emergency Room (ER) because of left facial weakness of sudden onset and pain on the mastoid region. She had a history of a recent viral upper airway infection. On examination, she had a peripheral left facial nerve paralysis, with no other abnormalities. She was diagnosed with a Bell's Palsy and discharged from the ER with a prescription of prednisolon and recommendation for eye care measures. After 4 days she was back to the ER, referring vertigo, nausea, vomiting and tinnitus. On examination, she had a vesicular rash on the left external ear; she had no hearing impairment. The diagnosis of a Ramsay-Hunt syndrome was made and she was discharged with an additional prescription of valaciclovir 800 mg po tid. Discussion: Bell's palsy is as an idiopathic acute peripheral facial nerve palsy, with an annual incidence of around 30 cases per 100,000 people. Prognosis is generally good, with most patients recovering completely. Herpes simplex virus (HSV) type 1 is probably the most common cause of acute onset peripheral facial palsy. Other infectious causes include varicella–zoster virus (VZV), cytomegalovirus, Epstein Barr virus, adenovirus, rubella virus, mumps, influenza B, and coxsackievirus. Treatment remains controversial: overall, data suggest that glucocorticoids decrease the incidence of permanent facial paralysis, but more studies are needed to determine whether antiviral therapy confers additional benefit. The Ramsay Hunt syndrome (herpes zoster oticus) consists on the reactivation of latent VZV from the geniculate ganglion, with involvement of the eighth cranial nerve (and possibly of the fifth, ninth and tenth). It typically includes facial paralysis, ear pain, vesicles in the auditory canal and auricle, and vertigo. Hearing, taste perception and lacrimation can be affected. The facial paralysis in Ramsey Hunt syndrome is generally associated to a poorer prognosis than that caused by HSV. It is usually managed with antivirals, although not much is known about this complication of VZV infection.