After Consuming Alcohol With Raw Beef, a Man Has Seizure, Pain

Aneesh Basheer, MD


December 05, 2022

The gastrointestinal tract is involved after ingestion of undercooked or raw meat from animals infected with anthrax.[1] In the patient in this case, the consumption of raw meat occurred under the influence of alcohol. The characteristic feature is necrotic ulcers in the intestine, which are akin to cutaneous eschars, with surrounding edema.[4] These ulcers may bleed, and the bleeding manifests as hematemesis, hematochezia, or melena. Although the gastrointestinal form of anthrax begins with abdominal pain and vomiting, as the disease progresses, ascites develops. Hypotension may be the result of hemorrhage, volume depletion, or capillary leak.

Immediate initiation of treatment on suspicion or confirmation is paramount in systemic anthrax. In patients with systemic anthrax in whom meningitis has been ruled out or is not suspected, the following regimen is advised[5]:

Linezolid may be used as an alternative to clindamycin at a dosage of 600 mg every 12 hours.

However, in the presence of suspected or confirmed meningitis, treatment should consist of:

  • Ciprofloxacin 400 mg intravenously every 8 hours plus

  • Meropenem 2 g intravenously every 8 hours plus

  • Linezolid 600 mg intravenously every 12 hours

The duration of therapy must be at least 2 weeks.[5] After completion of parenteral combination therapy, a course of oral doxycycline (100 mg twice daily) or ciprofloxacin (500 mg twice daily) for 60 days is recommended to reduce the risk for relapse due to viable spores.

In addition to antimicrobial therapy, adjunctive treatment with anthrax antitoxin is recommended for patients with systemic anthrax, because the disease is potentially lethal. When antitoxin is available, it must be started as soon as a provisional diagnosis is made.[6,7] The options include conventional anthrax immunoglobulin, raxibacumab, and obiltoxaximab; the latter two are monoclonal antibodies.

Listeriosis may present as gastroenteritis characterized by fever, watery diarrhea, vomiting, and generalized myalgia.[8] Pregnant, older, and immunocompromised patients have more severe disease. Although invasive listeriosis is rare, it is characterized by bacteremia, which manifests as a high-grade fever with chills, along with diarrhea.[9] Blood in the stools is unusual. However, patients with severe disease may develop shock. Bacteremia with involvement of the meninges leads to meningitis or meningoencephalitis, with seizures and altered sensorium. Brainstem inflammation (rhombencephalitis), cerebritis, brain abscess, and spinal abscess are uncommon complications of disseminated disease in immunocompromised patients.[10]

In the patient in this case, the presence of bloody diarrhea and other abdominal findings, including hemorrhagic ascites, argues against a diagnosis of invasive listeriosis. Furthermore, brain imaging revealed intracerebral hemorrhage, which is not seen in patients with listeriosis.

Although Listeria monocytogenes is gram-positive, it is a short rod that is difficult to identify on Gram staining because it may be confused with pneumococci or Haemophilus species. The typical appearance on blood agar shows zones of beta-hemolysis around colonies. Tumbling motility under light microscopy is characteristic. As with gastrointestinal anthrax, consumption of undercooked meat is a major risk factor for listeriosis, in addition to processed meats; dairy products, such as cheese; frozen foods; and salads.


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