Listeria Monocytogenes Clinical Presentation

  • Author: Karen B Weinstein, MD, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 17, 2012
 

History

Disease may be a self-limited gastrointestinal tract illness or a more severe CNS infection, bacteremia, or a localized infection such as monoarticular septic arthritis.

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Physical

Examination depends on the organ system involved.

Infection in pregnancy [5, 6]

Listeria may proliferate in the placenta and cause infection due to impaired cell-mediated immunity during pregnancy.

CNS infection is very rare during pregnancy, although it is observed frequently in other compromised hosts.

Fever, myalgias, arthralgias, back pain, and headache are classic symptoms of bacteremia. Symptoms may mimic those of a flulike illness. The infection may be mild and self-limited.

Listeriosis during pregnancy usually occurs during the third trimester, when cell-mediated immunity is at its lowest.

Preterm labor and/or delivery is common. Abortion, stillbirth, and intrauterine infection are possible.

Neonatal infection (granulomatosis infantisepticum)

Two forms are described.[5]

Early-onset sepsis, with Listeria acquired in utero via transplacental transmission, results in premature birth. Listeria can be isolated in the placenta, blood, meconium, nose, ears, and throat, among other sites, and manifests as abscesses and/or granulomas.

Late-onset meningitis is acquired through vaginal transmission, although it also has been reported with cesarean deliveries.

CNS infection [7]

Listeria has a predilection for the brain parenchyma, especially the brain stem, and the meninges.

Mental status changes are common.

Seizures, both focal and generalized, occur in at least 25% of patients.

Cranial nerve deficits may be present.

Strokelike syndromes with hemiplegia may occur.

Nuchal rigidity is less common.

Movement disorders may include tremor, myoclonus, and ataxia.

Patients may present with encephalitis, especially of the brainstem.[8]

Meningitis is possible.

Ventriculitis, particularly of the fourth ventricle, may develop.

Cervical myelitis has been reported.[9]

Brain abscess occurs in 10% of CNS infections, often located in the thalamus, pons, and medulla. This uncommon complication is associated with high mortality.[10]

Febrile gastroenteritis [2]

L monocytogenes can produce food-borne diarrheal disease, which is typically noninvasive.

The median incubation period is 1-2 days, with diarrhea lasting anywhere from 1-3 days.

The prevalence of diarrheal illness is high in individuals exposed to inocula of Listeria.

Patients present with fever, myalgias, and diarrhea and recover with supportive care.

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Causes

Most infections are due to food-borne transmission.

A substantial minority of infections are transmitted by other modes. Transmission can occur transplacentally or via an infected birth canal. Isolated incidences of cross-infection in neonatal nurseries have been reported.

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Contributor Information and Disclosures
Author

Karen B Weinstein, MD, FACP  Clinical Assistant Professor, Department of Internal Medicine, Loyola University; Assistant Attending, Department of Internal Medicine, Rush Medical College; Associate Program Director, West Suburban Medical Center

Karen B Weinstein, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Table. Epidemic Listeriosis
YearLocationSource
2011United StatesCantaloupe
2007MassachusettsMilk
2003United KingdomSandwiches
2002[13] United States (nationwide)Delicatessen turkey breast
August 1998 to January 1999Multiple states in the United StatesHot dogs, deli meats
1997[3] ItalyCorn
1997[14] SwedenRainbow trout
1995[15] SwitzerlandSoft cheese
1994[16] IllinoisChocolate milk
1992[17] FranceRillettes (pork product)
1985[18] CaliforniaMexican-style soft cheese
1983[19] New EnglandUnpasteurized milk
1981[20] CanadaColeslaw
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