eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Listeria Infection
Updated: May 29, 2009
Introduction
Background
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.
Electron micrograph of a Listeria bacterium in tissue.
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.
Ingestion of Listeria by pregnant women can result in nausea, vomiting, diarrhea, fever, malaise, back pain, and headache. 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. 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. 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.
Frequency
United States
The estimated annual incidence of listeriosis is approximately 2-3 cases per million population. In 2004, 753 new cases of listeriosis were reported in the United States.
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.3 After years of decreasing incidence, recent trends throughout Europe, in particular France and Scandinavia, show an increasing incidence. This trend is accounted for by increased cases in the population older than 60 years. Neonatal and maternal incidence remains stable.4,5
Mortality/Morbidity
Early onset neonatal listeriosis has a 20-40% mortality rate.4 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.
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.
Clinical
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.
- 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
- 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.
More on Listeria Infection |
 Overview: Listeria Infection |
| Differential Diagnoses & Workup: Listeria Infection |
| Treatment & Medication: Listeria Infection |
| Follow-up: Listeria Infection |
| Multimedia: Listeria Infection |
| References |
| Next Page » |
References
Posfay-Barbe KM, Wald ER. Listeriosis. Semin Fetal Neonatal Med. Feb 19 2009;[Medline].
Bortolussi R. Listeriosis: a primer. CMAJ. Oct 7 2008;179(8):795-7. [Medline].
de Valk H, Jacquet C, Goulet V, et al. Surveillance of listeria infections in Europe. Euro Surveill. Oct 2005;10(10):251-5. [Medline].
Antal EA, Hogasen HR, Sandvik L, Maehlen J. Listeriosis in Norway 1977-2003. Scand J Infect Dis. 2007;39(5):398-404. [Medline].
Goulet V, Hedberg C, Le Monnier A, de Valk H. Increasing incidence of listeriosis in France and other European countries. Emerg Infect Dis. May 2008;14(5):734-40. [Medline].
[Guideline] Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. Nov 1 2004;39(9):1267-84. [Medline].
Albritton W. Listeriosis. In: 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. Apr 27 2000;342(17):1236-41. [Medline].
Banerji A, Noya FJ. Brain abscess associated with neonatal listeriosis. Pediatr Infect Dis J. Mar 1999;18(3):305-7. [Medline].
Bortolussi R, Schlech WF. Listeriosis. In: Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 5th ed. Philadelphia, Pa: WB Saunders and Co; 2001:1157-77.
Braden CR. Listeriosis. Pediatr Infect Dis J. Aug 2003;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].
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. Jul 2006;25(7):433-42. [Medline].
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].
Koch J, Stark J. Significant increase in listeriosis in Germany--epidemiological patterns 2001-2005. Euro Surveill. 2006;11:85-88. [Medline].
McLauchlin J, Jones D. Listeria. In: Topley and Wilson's Microbiology and Microbial Infections. Vol 2. 9th ed. 1998:691-708.
Mead PS, Dunne EF, Graves L, et al. Nationwide outbreak of listeriosis due to contaminated meat. Epidemiol Infect. 2005;1:1-8. [Medline].
Nolla-Salas J, Bosch J, Gasser I, et al. Perinatal listeriosis: a population-based multicenter study in Barcelona, Spain (1990-1996). Am J Perinatol. Aug 1998;15(8):461-7. [Medline].
Ogunmodede F, Jones JL, Scheftel J, et al. Listeriosis prevention knowledge among pregnant women in the USA. Infect Dis Obstet Gynecol. Mar 2005;13(1):11-5. [Medline].
Pickering LK, Baker CJ, Long SS, McMillan JA. Listeria monocytogenes infections (Listeriosis). In: Red Book 2006: Report of Committee on Infectious Diseases. 27th ed. 2006:426-8.
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. Dec 1996;47(6):431-3. [Medline].
Silver HM. Listeriosis during pregnancy. Obstet Gynecol Surv. Dec 1998;53(12):737-40. [Medline].
Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. Jun 1999;66(6):375-80. [Medline].
Temple ME, Nahata MC. Treatment of listeriosis. Ann Pharmacother. May 2000;34(5):656-61. [Medline].
Further Reading
Keywords
listeria infection, listeriosis, neonatal listeriosis, meningitis, Listeria monocytogenes, L monocytogenes, Listeria, chorioamnionitis, premature labor, spontaneous abortion, early onset neonatal listeriosis, late-onset neonatal listeriosis, granulomatosis infantisepticum, hydrocephalus, mental retardation, neonatal sepsis, Listeria meningitis, respiratory distress, treatment, diagnosis
