Listeria Monocytogenes 

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

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]

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.

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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.

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Epidemiology

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.

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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.

References

  1. Mook P, O'Brien SJ, Gillespie IA. Concurrent conditions and human listeriosis, England, 1999-2009. Emerg Infect Dis. Jan 2011;17(1):38-43. [Medline].

  2. Ooi ST, Lorber B. Gastroenteritis due to Listeria monocytogenes. Clin Infect Dis. May 1 2005;40(9):1327-32. [Medline].

  3. Aureli P, Fiorucci GC, Caroli D, Marchiaro G, Novara O, Leone L, et al. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. N Engl J Med. Apr 27 2000;342(17):1236-41. [Medline].

  4. Pappas G, Panagopoulou P, Christou L, Akritidis N. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect Dis Clin North Am. Jun 2006;20(2):395-421, x. [Medline].

  5. Mylonakis E, Paliou M, Hohmann EL, Calderwood SB, Wing EJ. Listeriosis during pregnancy: a case series and review of 222 cases. Medicine (Baltimore). Jul 2002;81(4):260-9. [Medline].

  6. Sheffield JS. Sepsis and septic shock in pregnancy. Crit Care Clin. Oct 2004;20(4):651-60; viii. [Medline].

  7. Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore). Sep 1998;77(5):313-36. [Medline].

  8. Armstrong RW, Fung PC. Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin Infect Dis. May 1993;16(5):689-702. [Medline].

  9. Josephson SA, Pillai DR, Phillips JJ, Chou D. Neurolisteriosis presenting as cervical myelitis in an immunocompetent patient. Neurology. Apr 11 2006;66(7):1122-3. [Medline].

  10. Dee RR, Lorber B. Brain abscess due to Listeria monocytogenes: case report and literature review. Rev Infect Dis. Nov-Dec 1986;8(6):968-77. [Medline].

  11. Faidas A, Shepard DL, Lim J, Nelson JE, Baddour LM. Magnetic resonance imaging in listerial brain stem encephalitis. Clin Infect Dis. Jan 1993;16(1):186-7. [Medline].

  12. Charlier C, Leclercq A, Cazenave B, Desplaces N, Travier L, Cantinelli T, et al. Listeria monocytogenes-Associated Joint and Bone Infections: A Study of 43 Consecutive Cases. Clin Infect Dis. Jan 2012;54(2):240-8. [Medline].

  13. Gottlieb SL, Newbern EC, Griffin PM, Graves LM, Hoekstra RM, Baker NL, et al. Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis. Jan 1 2006;42(1):29-36. [Medline].

  14. Ericsson H, Eklow A, Danielsson-Tham ML, Loncarevic S, Mentzing LO, et al. An outbreak of listeriosis suspected to have been caused by rainbow trout. J Clin Microbiol. Nov 1997;35(11):2904-7. [Medline].

  15. Büla CJ, Bille J, Glauser MP. An epidemic of food-borne listeriosis in western Switzerland: description of 57 cases involving adults. Clin Infect Dis. Jan 1995;20(1):66-72. [Medline].

  16. Dalton CB, Austin CC, Sobel J, Hayes PS, Bibb WF, Graves LM, et al. An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk. N Engl J Med. Jan 9 1997;336(2):100-5. [Medline].

  17. Goulet V, Rocourt J, Rebiere I, Jacquet C, Moyse C, Dehaumont P, et al. Listeriosis outbreak associated with the consumption of rillettes in France in 1993. J Infect Dis. Jan 1998;177(1):155-60. [Medline].

  18. Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C, et al. Epidemic listeriosis associated with Mexican-style cheese. N Engl J Med. Sep 29 1988;319(13):823-8. [Medline].

  19. Schlech WF 3rd, Lavigne PM, Bortolussi RA, Allen AC, Haldane EV, Wort AJ, et al. Epidemic listeriosis--evidence for transmission by food. N Engl J Med. Jan 27 1983;308(4):203-6. [Medline].

  20. Evans JR, Allen AC, Stinson DA, Bortolussi R, Peddle LJ. Perinatal listeriosis: report of an outbreak. Pediatr Infect Dis. May-Jun 1985;4(3):237-41. [Medline].

  21. Lorber B. Listeriosis. Clin Infect Dis. Jan 1997;24(1):1-9; quiz 10-1. [Medline].

  22. Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, MI: Physicians Press; 2008.

  23. Armstrong D, Cohen J, eds. Listeria Monocytogenes. In: Infectious Diseases. London, UK: Mosby; 1999:8.15.1-8.15.20.

  24. Berenguer J, Solera J, Diaz MD, Moreno S, Lopez-Herce JA, Bouza E. Listeriosis in patients infected with human immunodeficiency virus. Rev Infect Dis. Jan-Feb 1991;13(1):115-9. [Medline].

  25. Blatt SP, Zajac RA. Treatment of Listeria bacteremia with vancomycin. Rev Infect Dis. Jan-Feb 1991;13(1):181-2. [Medline].

  26. Broome CV. Listeriosis: Can we prevent it?. ASM News. 1993;59:444-6.

  27. Calubiran OV, Horiuchi J, Klein NC, Cunha BA. Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis. Heart Lung. Jan 1990;19(1):21-3. [Medline].

  28. Chang J, Powles R, Mehta J, Paton N, Treleaven J, Jameson B. Listeriosis in bone marrow transplant recipients: incidence, clinical features, and treatment. Clin Infect Dis. Nov 1995;21(5):1289-90. [Medline].

  29. Charpentier E, Gerbaud G, Jacquet C, Rocourt J, Courvalin P. Incidence of antibiotic resistance in Listeria species. J Infect Dis. Jul 1995;172(1):277-81. [Medline].

  30. Cherubin CE, Appleman MD, Heseltine PN, Khayr W, Stratton CW. Epidemiological spectrum and current treatment of listeriosis. Rev Infect Dis. Nov-Dec 1991;13(6):1108-14. [Medline].

  31. Cunha BA. Central nervous system infections in the compromised host: a diagnostic approach. Infect Dis Clin North Am. Jun 2001;15(2):567-90. [Medline].

  32. Cunha BA, Fatehpuria R, Eisenstein LE. Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: the differential diagnostic importance of cerebrospinal fluid lactic acid levels. Heart Lung. May-Jun 2007;36(3):226-31. [Medline].

  33. Cunha BA, Filozov A, Remé P. Listeria monocytogenes encephalitis mimicking West Nile encephalitis. Heart Lung. Jan-Feb 2004;33(1):61-4. [Medline].

  34. Decker CF, Simon GL, DiGioia RA, Tuazon CU. Listeria monocytogenes infections in patients with AIDS: report of five cases and review. Rev Infect Dis. May-Jun 1991;13(3):413-7. [Medline].

  35. Farber JM, Peterkin PI. Listeria monocytogenes, a food-borne pathogen. Microbiol Rev. Sep 1991;55(3):476-511. [Medline].

  36. Gellin BG, Broome CV, Bibb WF, Weaver RE, Gaventa S, Mascola L. The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group. Am J Epidemiol. Feb 15 1991;133(4):392-401. [Medline].

  37. Gorbach SL, Bartlett JB, Blacklow NR, eds. Listeria Monocytogenes. In: Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:1750-5.

  38. Gross E, Slauson S. Update on emerging infections: news from the Centers for Disease Control and Prevention. Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003. Ann Emerg Med. Nov 2004;44(5):532-6. [Medline].

  39. Hof H, Nichterlein T, Kretschmar M. Management of listeriosis. Clin Microbiol Rev. Apr 1997;10(2):345-57. [Medline].

  40. John JF. Listeria Monocytogenes. In: Vinken PJ, Bruyn GW, eds. Handbook of ClinicalNeurology. Vol 8. New York, NY: Elsevier Science; 1988:89-101.

  41. Klein NC, Schoch PE, Cunha BA. Listeria. Infect Control Hosp Epidemiol. May 1991;12(5):311-4. [Medline].

  42. Latcha S, Cunha BA. Listeria monocytogenes meningoencephalitis: the diagnostic importance of the CSF lactic acid. Heart Lung. Mar-Apr 1994;23(2):177-9. [Medline].

  43. Lorber B. Listeria Monocytogenes. In: Mandell GL, Bennett GE, Dolin R, eds. Principles and Practices of Infectious Diseases. 6th ed. Pennsylvania, PA: Churchill and Livingstone; 2005:2478.

  44. Pigrau C, Almirante B, Pahissa A, Gasser I, Martinez Vasquez JM. Clinical presentation and outcome in cases of listeriosis. Clin Infect Dis. Jul 1993;17(1):143-4. [Medline].

  45. Pinner RW, Schuchat A, Swaminathan B, Hayes PS, Deaver KA, Weaver RE, et al. Role of foods in sporadic listeriosis. II. Microbiologic and epidemiologic investigation. The Listeria Study Group. JAMA. Apr 15 1992;267(15):2046-50. [Medline].

  46. Riedo FX, Pinner RW, Tosca ML, Cartter ML, Graves LM, Reeves MW, et al. A point-source foodborne listeriosis outbreak: documented incubation period and possible mild illness. J Infect Dis. Sep 1994;170(3):693-6. [Medline].

  47. Schneider JI. Rapid infectious killers. Emerg Med Clin North Am. Nov 2004;22(4):1099-115. [Medline].

  48. Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med. Oct 2 1997;337(14):970-6. [Medline].

  49. Skogberg K, Syrjanen J, Jahkola M, Renkonen OV, Paavonen J, Ahonen J, et al. Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy. Clin Infect Dis. Apr 1992;14(4):815-21. [Medline].

  50. Spitzer PG, Hammer SM, Karchmer AW. Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev Infect Dis. May-Jun 1986;8(3):427-30. [Medline].

  51. Swaminathan B, Rocourt J, Bille J. Listeria. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995:341-8.

  52. Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. Jun 1999;66(6):375-80. [Medline].

  53. Tappero JW, Schuchat A, Deaver KA. Reduction in the incidence of human listeriosis in the United States. Effectiveness of prevention efforts? The Listeriosis Study Group. JAMA. Apr 12 1995;273(14):1118-22. [Medline].

  54. Uldry PA, Kuntzer T, Bogousslavsky J, Regli F, Miklossy J, Bille J, et al. Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases. J Neurol. 1993;240(4):235-42. [Medline].

  55. Walsh RD, Gurevich I, Cunha BA. Listeria: A potential cause of febrile transfusion reactions. J Hosp Infect. 1993;18:81-82.

 
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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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