Spontaneous bacterial peritonitis by Listeria monocytogenes. A rare case and literature review

Spontaneous bacterial peritonitis (SBP) is a bacterial infection of ascites and a common complication in patients with cirrhosis, associated with a high morbidity and mortality rate. Gram-negative Enterobacteriaceae bacteria are usually the major pathogens involved in SBP, with Klebsiella pneumoniae accounting for 50% of these. Individuals with chronic liver and /or kidney disease associated with long-standing ascites are predisposed to SBP. Nosocomial SBP presents most commonly a poorer outcome. Although Listeria monocytogenes peritonitis is a relatively rare focal manifestation of Listeria infection, its incidence is increasing. It is associated with a mortality rate approaching 30% in cases of systemic involvement, despite first-line therapy. To our knowledge, this is the first case of L.monocytogenes-associated SBP described in Italy. Clinicians should be aware of the uncommon agents of SBP, such as Listeria, because, if diagnosed early, early antibiotic administration is crucial in minimizing adverse outcomes.