Listeria Monocytogenes Infection (Listeriosis): Background, Pathophysiology, Epidemiology

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Listeria Monocytogenes Infection (Listeriosis)

Sections Listeria Monocytogenes Infection (Listeriosis)
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Tables
References

Overview

Background

Listeria monocytogenes, although an uncommon cause of illness in the general population, is an important pathogen in pregnant patients, neonates, elderly individuals, and immunocompromised individuals. Patients with cancer, particularly those of blood, are also at high risk for listeria infection.^[1]See the image below.

Electron micrograph of an artificially colored Listeria bacterium in tissue.

It is typically a food-borne organism. Listeria is also a common veterinary pathogen, being associated with abortion and encephalitis in sheep and cattle. It can be isolated from soil, water, and decaying vegetation.

The most common clinical manifestation is diarrhea. A mild presentation of fever, nausea, vomiting, and diarrhea may resemble a gastrointestinal illness.^[2]The microorganism has gained recognition because of its association with epidemic gastroenteritis. In 1997, an outbreak of noninvasive gastroenteritis occurred in 2 schools in northern Italy, involving more than 1500 children and adults.^[3]

Bacteremia and meningitis are more serious manifestations of disease that can affect individuals at high risk. Unless recognized and treated, Listeria infections can result in significant morbidity and mortality.

Pathophysiology

L monocytogenes is a motile, non–spore-forming, gram-positive bacillus that has aerobic and facultatively anaerobic characteristics. It grows best at neutral to slightly alkaline pH and is capable of growth at a wide range of temperatures, from 1-45°C. It is beta-hemolytic and has a blue-green sheen on blood-free agar. It exhibits characteristic tumbling motility when viewed with light microscopy and is difficult to isolate in mixed cultures. It may be mistaken for streptococci or contaminants such as corynebacteria.

Most infections occur after oral ingestion, with access to the systemic circulation after intestinal penetration. Protection against Listeria is mediated via lymphokine activation of T cells on macrophages and by interleukin-18.

CNS infection may manifest as meningitis, meningoencephalitis, or abscess. Endocarditis is another possible presentation. Localized infection may manifest as septic arthritis, osteomyelitis, and, rarely, pneumonia.

Frequency

United States

The frequency of L monocytogenes infection is 9.7 cases per million population. Annually, 2500 cases are reported, with higher incidence rates during the summer months.^[4]Pregnant women account for 27% of all cases, and most occur during the third trimester. Seventy percent of all nonperinatal infections occur in immunocompromised patients. Corticosteroid therapy is the most important predisposing association in patients who are not pregnant. Other risk factors include advanced age and recent chemotherapy.

Mortality/Morbidity

The overall mortality rate of L monocytogenes infection is 20-30%.

Of all pregnancy-related cases, 22% resulted in fetal loss or neonatal death, but mothers usually survive.

Sex

With the exception of pregnant women, no sex predilection is recognized.

Age

Women of childbearing age are commonly affected.

Neonates and elderly individuals are at risk.

Clinical Presentation

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Media Gallery

Electron micrograph of an artificially colored Listeria bacterium in tissue.

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Table. Epidemic Listeriosis

Table. Epidemic Listeriosis

Year	Location	Source
2014	United States	Prepackaged caramel apples
2011	United States	Cantaloupe
2007	Massachusetts	Milk
2003	United Kingdom	Sandwiches
2002^[13]	United States (nationwide)	Delicatessen turkey breast
August 1998 to January 1999	Multiple states in the United States	Hot dogs, deli meats
1997^[3]	Italy	Corn
1997^[14]	Sweden	Rainbow trout
1995^[15]	Switzerland	Soft cheese
1994^[16]	Illinois	Chocolate milk
1992^[17]	France	Rillettes (pork product)
1985^[18]	California	Mexican-style soft cheese
1983^[19]	New England	Unpasteurized milk
1981^[20]	Canada	Coleslaw

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Author

Karen B Weinstein, MD, FACP Associate Professor, Department of Internal Medicine, Rush University 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, Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Sections Listeria Monocytogenes Infection (Listeriosis)
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Tables
References

Listeria Monocytogenes Infection (Listeriosis)

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Pathophysiology

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Sex

Age

References

Tables

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