Listeria monocytogenes
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Epidemiology
- found in soil, dust, water, silage, sewage & raw unpasteurized milk
- most cases occur sporadically & the source is unknown
- transmission by foods such as coleslaw, unpasteurized milk & soft cheeses, cantaloupe has been reported[2][4]
- pregnant women, elderly, neonates & patients on glucocorticoids are at high risk
- dairy exposure & patients taking TNF-alpha inhibitors at risk[11]
- 28 cases reported across 10 states in 2014, including 26 hospitalizations & at least 4 deaths due to commercially produced, prepackaged caramel apples[7]
- ice cream, frozen yogurt, sherbet, & novelty treats from Blue Bell Creameries pulled from market due to possible contamination with Listeria monocytogenes April 2015[8]
- frozen fruits & vegetables recalled after multistate listeriosis outbreak due to Listeria monocytogenes[9]
- outbreak in Spain Aug 2019[10] `0) 3 dead, 22 hospitalized from two Listeria outbreaks in 18 states December 2021, linked to packaged salad from Fresh Express & Dole[11]
Pathology
- meningitis & brainstem encephalitis (rhombencephalitis)
- important cause of meningitis in pregnant & immunosuppressed patients
- non-bloody diarrhea (epidemic Listeriosis)
- defects in the immune system likely
- many patients with Listeriosis are immunosuppressed
- patients taking TNF-alpha inhibitors at risk[11]
- macrophages & T-cells are the most important host defenses against L monocytogenes
- virulence is related to production of listeriolysin O, a 52 kD protein with hemolytic & cytotoxic properties secreted by the organisms under conditions of low pH & low iron as would occur in a phago-lysosome
- listeriolysin O is postulated to bind irreversibly to cholesterol in the lysosomal membrane, causing disruption &allowing replication of the bacteria within the phagocyte cytoplasm
- human VASP, an actin-associated cytoskeletal protein in platelets, interacts with the Pro-rich domain of Listeria monocytogenes actA
- ARHGAP21 required for In1A-dependent entry of Listeria monocytogenes into cells
Clinical manifestations
- fever[13]
- myalgia
- fatigue
- headache
- non-bloody diarrhea (epidemic Listeriosis)
- neurologic
- brainstem encephalitis with cranial-nerve deficits
- cerebellar signs
- hemiparesis
- hemisensory deficit also possible
- confusion
- stiff neck
- ataxia
- seizures[13]
- brainstem encephalitis with cranial-nerve deficits
Laboratory
- Listeria monocytogenes serology
- Listeria monocytogenes DNA, Listeria monocytogenes rRNA
- cerebrospinal fluid analysis (CSF analysis)
- may be difficult to visualize organisms on gram stain
- neutrophil or lymphocyte predominance with cell counts of 10-500/mm3[3][6]
- CSF protein elevated
- CSF glucose may be normal[6]
- Listeria antibody in CSF
- Listeria identified by culture
- facultatively anaerobic
- coagulase-negative
- Voges-Proskauer positive
- gram-positive asporogenous rods
- non-spore-forming
- non-acid-fast
- pleomorphic: coccoid, coccobacillary or bacillary (rods)
- tumbling motility at room temp[2]
- see ARUP consult[4]
Differential diagnosis
- histoplasmosis less likely to cause diarrhea, more likely to cause pulmonary symptoms[11]
Management
- ampicillin 2 g IV every 4 hours (treatment of choice), or penicillin G 2 x 10E6 units IV every 2 hours
- in combination with IV aminoglycoside
- Bactrim is an alternate for penicillin-allergic patients
- treatment should be continued for at least 2-4 weeks
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 306
- ↑ 2.0 2.1 2.2 Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1148
- ↑ 3.0 3.1 Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 501, 569
- ↑ 4.0 4.1 4.2 ARUP Consult: Listeria monocytogenes The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/listeria-monocytogenes
- ↑ Centers for Disease Control and Prevention (CDC) Investigation Announcement: Multistate Outbreak of Listeriosis Linked to Rocky Ford Cantaloupes September 12, 2011 http://www.cdc.gov/nczved/divisions/dfbmd/diseases/listeriosis/091211.html
FDA STATEMENT: September 13, 2011 FDA investigates multistate outbreak of listeriosis http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm271634.htm - ↑ 6.0 6.1 6.2 Lorber B Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis. 2007 Mar 1;44(5):765-6. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17278080 Lorber B.
Listeriosis. Clin Infect Dis. 1997 Jan;24(1):1-9; quiz 10-1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/8994747 - ↑ 7.0 7.1 Centers for Disease Control and Prevention (CDC) Listeria (Listeriosis): Outbreaks: December 19, 2014 Multistate Outbreak of Listeriosis Linked to Commercially Produced, Prepackaged Caramel Apples. http://www.cdc.gov/listeria/outbreaks/caramel-apples-12-14/index.html
- ↑ 8.0 8.1 Centers for Disease Control and Prevention (CDC) Listeria (Listeriosis): Outbreaks: April 21, 2015 Multistate Outbreak of Listeriosis Linked to Blue Bell Creameries Products. http://www.cdc.gov/listeria/outbreaks/ice-cream-03-15/index.html
- ↑ 9.0 9.1 FDA Safety Alert. May 4, 2016 Updated: CRF Frozen Foods Expands Voluntary Recall to Include All Frozen Vegetable and Fruit Products Due To Possible Health Risk. http://www.fda.gov/Safety/Recalls/ucm499406.htm
Centers for Disease Control and Prevention (CDC) Outbreaks. May 3, 2016 Multistate Outbreak of Listeriosis Linked to Frozen Vegetables. http://www.cdc.gov/listeria/outbreaks/frozen-vegetables-05-16/index.html - ↑ 10.0 10.1 Reuters. Aug 21, 2019 Spain issues international alert as listeria cases hit 150. https://www.reuters.com/article/us-spain-listeria/spain-issues-international-alert-as-listeria-cases-hit-150-idUSKCN1VB1Z0
- ↑ 11.0 11.1 11.2 11.3 11.4 NEJM Knowledge+ Allergy/Immunology
- ↑ Centers for Disease Control & Prevention (CDC) Listeria Outbreak Linked to Packaged Salads Produced by Dole Food Safety Alert. December 22, 2021 https://www.cdc.gov/listeria/outbreaks/packaged-salad-mix-12-21/index.html
- ↑ 13.0 13.1 13.2 Centers for Disease Control & Prevention (CDC) Listeria (Listeriosis) Symptoms https://www.cdc.gov/listeria/symptoms.html