Did my mother die due to toxic granuloma caused by listeria?

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Listeria is a Gram-positive bacillus that is food-borne and causes listeriosis in adults and children. It is more life-threatening in extremes of age groups, particularly the elderly and neonates. It could affect pregnant women, which could affect the growing fetus. The presentation of listeriosis is highly variable. It could well be asymptomatic and fatal if untreated. However, most of the symptomatic cases affect the gastrointestinal system, causing diarrhea, skin rashes, neurological symptoms, encephalitis, seizures, and systemic symptoms such as fever. Respiratory listeriosis, including pneumonia, is extremely rare. The reports attached (attachment removed to protect the patient's identity) do not signify listeriosis.

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Listeriosis primarily affects the gastrointestinal system, nervous system, skin, and, rarely, the lungs. Chronic granulomatosis is a disorder that causes the immune system to malfunction, resulting in a form of immunodeficiency. Mutations in certain genes can cause chronic granulomatous disease. Fungal infections are more common. The reports attached (attachment removed to protect the patient's identity) show Staphylococci with antibiotic sensitivity profiles. The other blood tests suggest increased hematocrit, WBC (white blood cell counts), raised AST (aspartate transaminase), and ALT (alanine transaminase) in the liver function tests. Radiology of the chest shows interstitial pneumonia, often idiopathic. Was your mother admitted for any other condition or respiratory symptoms? What makes you think she had listeriosis? Is there any test isolating Listeria monocytogenes in blood, urine, or cerebrospinal fluid?

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Granulomas are small lumps of immune cells that form in your body in areas where there is infection or inflammatory disease. They are most commonly found in the lungs and are a defensive mechanism. From the reports attached (attachment removed to protect the patient's identity), it is suggestive of old granulomas. The causes are sarcoidosis, tuberculosis, histoplasmosis, and an immune condition. Symptoms are shortness of breath, wheezing, dry cough, chest pain and fever. Coupled with evidence of Staphylococci, and no evidence relating to listeriosis, I cannot confirm that there was a Listeria infection. The patient's neutropenia and lymphopenia are suggestive of viral or bacterial infection. There is severe hypoxia, indicative of lung involvement.

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Toxic granulations are darker-coloured granules with the presence of neutrophils. These are larger and abundant than normal granules, and their presence is non-specific. Toxic granulation might indicate infections and inflammations, rarely in genetic disorders, following treatment with myeloid growth factors.

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There is no suggestive evidence suggestive of Listeria monocytogens such as;

1. Blood cultures - Results are positive in 60 to 75 % of patients especially with central nervous system infections.

2. Gram stain results of body fluids like cerebrospinal fluid affected by listeriosis are positive in about 50 % of patients.

3. Rapid testing with monoclonal antibodies may detect the Listeria genus.

A combination of these tests might have provided you with a degree of evidence for listeriosis.

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I have given my opinion earlier. Kindly refer.

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