Listeria Infection
Practice Essentials
Listeriosis is an infection caused by the gram-positive motile bacterium Listeria monocytogenes. [1, 2] Listeriosis is relatively rare and occurs primarily in newborn infants, elderly patients, and patients who are immunocompromised. [3] See the image below.
Pathophysiology
L monocytogenes is a gram-positive, motile, rod-shaped bacterium that is ubiquitous in the environment. L monocytogenes can be isolated in soil, wood, and decaying matter in the natural environment; however, the principal route of acquisition of Listeria is through the ingestion of contaminated food products. Listeria has been isolated from prepared meat (eg, hot dogs, deli meat), dairy products, unwashed raw vegetables, and seafood. Soft cheeses and unpasteurized milk have been the most frequently incriminated dairy products. [4, 5, 6, 7, 8, 9, 10]
Ingestion of Listeria by pregnant women can result in nausea, vomiting, diarrhea, fever, malaise, back pain, and headache. [11] Many pregnant women can carry Listeria asymptomatically in their GI tract or vagina. Maternal infection with Listeria can result in chorioamnionitis, premature labor, spontaneous abortion, or stillbirth. Fetal infection can occur via transplacental transmission. Vertical transmission can also occur from mother to infant via passage through an infected birth canal or ascending infection through ruptured amniotic membranes. [12, 13] Nosocomial outbreaks from one infected infant to others in the same nursery are rare but have been reported.
Two clinical presentations of neonatal infections occur: early onset (< 5 d) and late onset (>5 d). Early onset neonatal listeriosis is usually associated with sepsis or meningitis. Late-onset neonatal listeriosis frequently presents with purulent meningitis (Gaschignard, 2011). Listeriosis often involves many organs with microabscesses or granulomas. A disseminated rash with small, pale, granulomatous nodules is histologically characteristic of granulomatosis infantisepticum. Beyond the neonatal period, most children with Listeria infections have an underlying immunodeficiency or are immunocompromised. Older children with Listeria infections frequently develop meningitis. [14, 15, 16]
Epidemiology
Frequency
United States
The estimated annual incidence of listeriosis is approximately 2-3 cases per million population. In the Unitied States, an estimated 1,600 people get listeriosis every year. [17]
In a study of reported listeria cases from 2009-2011, the CDC reported a case fatality rate of 21%. Almost all cases occurred in high-risk groups, including older adults, pregnant women, and people who were immunocompromised. [18]
International
The estimated annual incidence of listeriosis is approximately 4 cases per million population in Canada. Surveillance of listeria infections in Europe reported an incidence varying between 0.3 (Greece) and 7.5 (Sweden) cases per year. [19] After years of decreasing incidence, recent trends throughout Europe, in particular France and Scandinavia, show an increasing incidence. [20, 21, 22, 23, 24, 25, 26, 27, 28, 29] This trend is accounted for by increased cases in the population older than 60 years. Neonatal and maternal incidence remains stable. [30, 31]
Mortality/Morbidity
Early onset neonatal listeriosis has a 20-40% mortality rate. [30] Late-onset neonatal listeriosis has a 0-20% mortality rate. The mortality rate in older children is less than 10%. Hydrocephalus, mental retardation, and other CNS sequelae have been reported in survivors of Listeria meningitis.
A French nationwide prospective study by Charlier et al that included 818 listeriosis cases reported that the strongest mortality predictors in both bacteremia and neurolisteriosis were ongoing cancer, multi-organ failure, aggravation of any pre-existing organ dysfunction, and monocytopenia. Blood-culture positive patients and those receiving adjunctive dexamethasone had higher neurolisteriosis mortality. [32]
Age
Listeria infections occur most often in newborns and elderly patients. Neonatal infections can be subdivided into early onset and late-onset disease.
Early onset neonatal infections (< 5 d) begin at a mean age of 1.5 days.
Late-onset neonatal infections (>5 d) begin at a mean age of 14 days.
Postnatal infections usually occur in immunocompromised children and are less common than neonatal infections.
History
Consider listeriosis in cases of neonatal sepsis or meningitis and in cases of sepsis or meningitis in children who are immunocompromised.
Listeria is acquired by ingestion of contaminated food products.
Mothers who acquire Listeria may experience influenzalike illnesses, with headache, malaise, fever, backache, nausea, vomiting, diarrhea, and chills. Mothers with Listeria infections may also undergo premature labor. [11]
Listeria in newborns can be classified as early onset or late-onset infection.
Meconium-stained amniotic fluid is common in newborns with early onset Listeria.
Respiratory difficulty is common, including a history of cyanotic episodes, rapid breathing, and grunting.
Parents and health care providers may report poor feeding and fever.
Physical
Listeriosis presents in the same manner as other more common neonatal pathogens, such as group B streptococci and Escherichia coli.
Respiratory distress - Tachypnea, grunting, apnea, and retractions
Temperature instability
Poor feeding
Lethargy/irritability
Seizures
Granulomatosis infantisepticum
Erythematous rash
Small, pale nodules or granulomas
Causes
See the list below:
L monocytogenes is acquired via the ingestion of contaminated food products.
Newborns acquire Listeria transplacentally, by ascending infection via ruptured amniotic membranes or upon exposure during vaginal delivery.
Differential Diagnoses
Fever in the Young Infant
Laboratory Studies
See the list below:
Blood culture
Cerebrospinal fluid culture
Respiratory tract culture
Histopathology and culture of rash
Culture of other infected tissues
Joint
Pericardial fluid
Pleural fluid
Amniotic fluid
Placenta
Gastric aspirate
Imaging Studies
See the list below:
CT scanning or MRI may be useful in detecting abscesses in the brain or liver.
Medical Care
See the list below:
Care of a newborn with Listeria infection includes antibiotics as well as careful monitoring of the patient's temperature, respiratory system, fluid and electrolyte balance, nutrition, and cardiovascular support.
Critically ill newborns are best treated in a neonatal ICU.
Antibiotics
Class Summary
These agents are used for suspected bacterial infections. Ampicillin in combination with an aminoglycoside such as gentamicin is the therapy of choice. Listeria is not susceptible to cephalosporins of any generation. Therefore, cephalosporins should not be used to treat Listeria infections.
DOC. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity.
Usual neonatal dosage for treatment of septicemia or meningitis depends on gestational and postnatal age. Higher doses are used with severe infections or meningitis.
Useful in combination with ampicillin against listeria.
Second-line DOC for non-neonatal penicillin-allergic patients. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Can be used as an alternative to ampicillin. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity.
Deterrence/Prevention
See the list below:
Advice for all persons to avoid Listeria infection
Wash hands, knives, and cutting boards after handling uncooked food.
Thoroughly cook all meat.
Thoroughly wash all vegetables.
Keep raw meats separate from other foods during preparation to avoid cross-contamination.
Advice for pregnant patients or patients with immunocompromise
Avoid soft cheeses such as Feta, Brie, blue cheese, Mexican-style cheese, and Camembert.
Thoroughly reheat leftovers.
Avoid deli foods unless thoroughly heated.
Complications
Rhombencephalitis (brainstem encephalitis) is a well-recognized complication of CNS listeriosis. [33] Cranial nerve involvement has been reported in an immunocompetent toddler with novel H1N1 influenza. [34]
Prognosis
See the list below:
Prognosis is guarded and depends on whether meningitis or shock is present. Practice guidelines for the management of bacterial meningitis have been established. [35]
Hydrocephalus, mental retardation, and other CNS sequelae have been reported following meningitis.
References
1 Posfay-Barbe KM, Wald ER. Listeriosis. Semin Fetal Neonatal Med. 2009 Feb 19. [Medline].
2 Bortolussi R. Listeriosis: a primer. CMAJ. 2008 Oct 7. 179(8):795-7. [Medline].
Imanishi M, Routh JA, Klaber M, Gu W, Vanselow MS, Jackson KA, et al. Estimating the attack rate of pregnancy-associated listeriosis during a large outbreak. Infect Dis Obstet Gynecol. 2015. 2015:201479. [Medline]. [Full Text].
3 Barton Behravesh C, Jones TF, Vugia DJ, Long C, Marcus R, Smith K, et al. Deaths associated with bacterial pathogens transmitted commonly through food: foodborne diseases active surveillance network (FoodNet), 1996-2005. J Infect Dis. 2011 Jul. 204(2):263-7. [Medline].
4 Vital signs: incidence and trends of infection with pathogens transmitted commonly through food--foodborne diseases active surveillance network, 10 U.S. sites, 1996-2010. MMWR Morb Mortal Wkly Rep. 2011 Jun 10. 60(22):749-55. [Medline].
Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food - 10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010 Apr 16. 59(14):418-22. [Medline].
6 Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--10 States, 2008. MMWR Morb Mortal Wkly Rep. 2009 Apr 10. 58(13):333-7. [Medline].
7 Derra FA, Karlsmose S, Monga DP, Mache A, Svendsen CA, Félix B, et al. Occurrence of Listeria spp. in Retail Meat and Dairy Products in the Area of Addis Ababa, Ethiopia. Foodborne Pathog Dis. 2013 Jun 6. [Medline].
8 Muñoz AI. [Distribution of Listeria monocytogenes serotypes isolated from foods, Colombia, 2000-2009]. Biomedica. 2012 Sep. 32(3):408-17. [Medline].
Okada Y, Ohnuki I, Suzuki H, Igimi S. Growth of Listeria monocytogenes in refrigerated ready-to-eat foods in Japan. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013 Apr 29. [Medline].
9 [Guideline] Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet Gynecol. 2014 Dec. 124 (6):1241-4. [Medline]. [Full Text].
10 Jackson KA, Iwamoto M, Swerdlow D. Pregnancy-associated listeriosis. Epidemiol Infect. 2010 Oct. 138(10):1503-9. [Medline].
11 Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, et al. Listeriosis in human pregnancy: a systematic review. J Perinat Med. 2011 May. 39(3):227-36. [Medline].
Guevara RE, Mascola L, Sorvillo F. Risk factors for mortality among patients with nonperinatal listeriosis in Los Angeles County, 1992-2004. Clin Infect Dis. 2009 Jun 1. 48(11):1507-15. [Medline].
12 Dilber E, Aksoy A, Cakir M, Bahat E, Kamasak T, Dilber B. Listeria monocytogenes meningitis in two immunocompetent children. Ann Trop Paediatr. 2009 Sep. 29(3):225-9. [Medline].
13 Peer MA, Nasir RA, Kakru DK, Fomda BA, Wani MA, Hakeem QN. Listeria monocytogenes meningoencephalitis in an immunocompetent, previously healthy 20-month old female child. Indian J Med Microbiol. 2010 Apr-Jun. 28(2):169-71. [Medline].
Listeria (Listeriosis). Centers for Disease Control and Prevention. Available at https://www.cdc.gov/listeria/faq.html. December 12, 2016; Accessed: January 9, 2018.
14 Vital signs: listeria illnesses, deaths, and outbreaks - United States, 2009-2011. MMWR Morb Mortal Wkly Rep. 2013 Jun 7. 62(22):448-52. [Medline].
15 de Valk H, Jacquet C, Goulet V, et al. Surveillance of listeria infections in Europe. Euro Surveill. 2005 Oct. 10(10):251-5. [Medline].
16 Smith B, Kemp M, Ethelberg S, Schiellerup P, Bruun BG, Gerner-Smidt P, et al. Listeria monocytogenes: maternal-foetal infections in Denmark 1994-2005. Scand J Infect Dis. 2009. 41(1):21-5. [Medline].
17 Cairns BJ, Payne RJ. Sudden increases in listeriosis rates in England and Wales, 2001 and 2003. Emerg Infect Dis. 2009 Mar. 15(3):465-8. [Medline]. [Full Text].
Gillespie IA, Mook P, Little CL, Grant KA, McLauchlin J. Human listeriosis in England, 2001-2007: association with neighbourhood deprivation. Euro Surveill. 2010 Jul 8. 15(27):7-16. [Medline].
18 Gillespie IA, McLauchlin J, Little CL, Penman C, Mook P, Grant K, et al. Disease presentation in relation to infection foci for non-pregnancy-associated human listeriosis in England and Wales, 2001 to 2007. J Clin Microbiol. 2009 Oct. 47(10):3301-7. [Medline]. [Full Text].
19 Mammina C, Aleo A, Romani C, Pellissier N, Nicoletti P, Pecile P, et al. Characterization of Listeria monocytogenes isolates from human listeriosis cases in Italy. J Clin Microbiol. 2009 Sep. 47(9):2925-30. [Medline]. [Full Text].
20 Yde M, Botteldoorn N, Bertrand S, Collard J, Dierick K. Microbiological and molecular investigation of an increase of human listeriosis in Belgium, 2006-2007. Euro Surveill. 2010 Feb 11. 15(6):[Medline].
21 Clark CG, Farber J, Pagotto F, Ciampa N, Doré K, Nadon C, et al. Surveillance for Listeria monocytogenes and listeriosis, 1995-2004. Epidemiol Infect. 2010 Apr. 138(4):559-72. [Medline].
22 Mook P, Grant KA, Little CL, Kafatos G, Gillespie IA. Emergence of pregnancy-related listeriosis amongst ethnic minorities in England and Wales. Euro Surveill. 2010 Jul 8. 15(27):17-23. [Medline].
23 Almeida G, Morvan A, Magalhães R, Santos I, Hogg T, Leclercq A, et al. Distribution and characterization of Listeria monocytogenes clinical isolates in Portugal, 1994-2007. Eur J Clin Microbiol Infect Dis. 2010 Oct. 29(10):1219-27. [Medline].
24 Taillefer C, Boucher M, Laferrière C, Morin L. Perinatal listeriosis: Canada's 2008 outbreaks. J Obstet Gynaecol Can. 2010 Jan. 32(1):45-8. [Medline].
25 Antal EA, Hogasen HR, Sandvik L, Maehlen J. Listeriosis in Norway 1977-2003. Scand J Infect Dis. 2007. 39(5):398-404. [Medline].
26 Goulet V, Hedberg C, Le Monnier A, de Valk H. Increasing incidence of listeriosis in France and other European countries. Emerg Infect Dis. 2008 May. 14(5):734-40. [Medline].
27 Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017 May. 17 (5):510-519. [Medline].
28 Moragas M, Martínez-Yélamos S, Majós C, Fernández-Viladrich P, Rubio F, Arbizu T. Rhombencephalitis: a series of 97 patients. Medicine (Baltimore). 2011 Jul. 90(4):256-61. [Medline].
29 Pinninti SG, Tolan RW, Jr. Listeria monocytogenes meningitis with unilateral abducens palsy complicating novel H1N1 influenza in a toddler. Infect Dis Clin Pract. Sept 2011. 19(5):357-8.
30 [Guideline] Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1. 39(9):1267-84. [Medline]. [Full Text].
31 US Food and Drug Administration. FDA investigates multistate outbreak of listeriosis. September 13, 2011. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm271634.htm.
32 McCollum JT, Cronquist AB, Silk BJ, et al. Multistate outbreak of listeriosis associated with cantaloupe. N Engl J Med. 2013 Sep 5. 369 (10):944-53. [Medline]. [Full Text].
33 Centers for Disease Control and Prevention. Multistate outbreak of listeriosis associated with Jensen Farms cantaloupe--United States, August-September 2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 7. 60(39):1357-8. [Medline].
34 Albritton W. Listeriosis. Behrman RE, ed. Nelson's Textbook of Pediatrics. Philadelphia, Pa: WB Saunders and Co; 2004. 810-1.
Aureli P, Fiorucci GC, Caroli D, et al. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. N Engl J Med. 2000 Apr 27. 342(17):1236-41. [Medline].
35 Banerji A, Noya FJ. Brain abscess associated with neonatal listeriosis. Pediatr Infect Dis J. 1999 Mar. 18(3):305-7. [Medline].
36 Bortolussi R, Schlech WF. Listeriosis. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 5th ed. Philadelphia, Pa: WB Saunders and Co; 2001. 1157-77.
37 Braden CR. Listeriosis. Pediatr Infect Dis J. 2003 Aug. 22(8):745-6. [Medline].
Colodner R, Sakran W, Miron D, et al. Listeria monocytogenes cross-contamination in a nursery. Am J Infect Control. 2003. 31:322-324. [Medline].
38 Doorduyn Y, de Jager CM, van der Zwaluw WK, et al. Invasive Listeria monocytogenes infections in the Netherlands, 1995-2003. Eur J Clin Microbiol Infect Dis. 2006 Jul. 25(7):433-42. [Medline].
39 Gaschignard J, Levy C, Romain O, Cohen R, Bingen E, Aujard Y, et al. Neonatal Bacterial Meningitis: 444 Cases in 7 Years. Pediatr Infect Dis J. 2011 Mar. 30(3):212-7. [Medline].
40 Gottlieb SL, Newbern EC, Griffin PM, et al. Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis. 2006. 42:29-36. [Medline].
41 Koch J, Stark J. Significant increase in listeriosis in Germany--epidemiological patterns 2001-2005. Euro Surveill. 2006. 11:85-88. [Medline].
42 McLauchlin J, Jones D. Listeria. Topley and Wilson's Microbiology and Microbial Infections. 9th ed. 1998. Vol 2: 691-708.
Mead PS, Dunne EF, Graves L, et al. Nationwide outbreak of listeriosis due to contaminated meat. Epidemiol Infect. 2005. 1:1-8. [Medline].
43 Nolla-Salas J, Bosch J, Gasser I, et al. Perinatal listeriosis: a population-based multicenter study in Barcelona, Spain (1990-1996). Am J Perinatol. 1998 Aug. 15(8):461-7. [Medline].
44 Ogunmodede F, Jones JL, Scheftel J, et al. Listeriosis prevention knowledge among pregnant women in the USA. Infect Dis Obstet Gynecol. 2005 Mar. 13(1):11-5. [Medline].
Pickering LK, Baker CJ, Kimberlin DW, Long SS. Listeria monocytogenes infections (Listeriosis). Red Book: 2009 Report of Committee on Infectious Diseases. 28th ed. 2009. 428-30.
45 Salgado MJ, Damani NN, Llewellyn CG, et al. Magnetic resonance imaging of abscesses of the brain stem and cerebellum complicating Listeria monocytogenes rhombencephalitis. Can Assoc Radiol J. 1996 Dec. 47(6):431-3. [Medline].
Silver HM. Listeriosis during pregnancy. Obstet Gynecol Surv. 1998 Dec. 53(12):737-40. [Medline].
46 Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. 1999 Jun. 66(6):375-80. [Medline].
47 Temple ME, Nahata MC. Treatment of listeriosis. Ann Pharmacother. 2000 May. 34(5):656-61. [Medline].
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