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Listeria monocytogenes

Epidemiology: 1) found in soil, dust, water, silage, sewage & raw unpasteurized milk 2) most cases occur sporadically & the source is unknown 3) transmission by foods such as coleslaw, unpasteurized milk & soft cheeses, cantaloupe has been reported [2,4] 4) pregnant women, elderly, neonates & patients on glucocorticoids are at high risk 5) dairy exposure & patients taking TNF-alpha inhibitors at risk [11] 6) 28 cases reported across 10 states in 2014, including 26 hospitalizations & at least 4 deaths due to commercially produced, prepackaged caramel apples [7] 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] 8) frozen fruits & vegetables recalled after multistate listeriosis outbreak due to Listeria monocytogenes [9] 9) outbreak in Spain Aug 2019 [10] 10) 3 dead, 22 hospitalized from two Listeria outbreaks in 18 states December 2021, linked to packaged salad from Fresh Express & Dole [11] 11) production of liverwurst root cause of the listeria contamination in deli meat that caused a deadly listeria outbreak in Virginia 2024. Pathology: 1) meningitis & brainstem encephalitis (rhombencephalitis) - important cause of meningitis in pregnant & immunosuppressed patients 2) non-bloody diarrhea (epidemic Listeriosis) 3) defects in the immune system likely - many patients with Listeriosis are immunosuppressed - patients taking TNF-alpha inhibitors at risk [11] 4) macrophages & T-cells are the most important host defenses against L monocytogenes 5) 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 6) listeriolysin O is postulated to bind irreversibly to cholesterol in the lysosomal membrane, causing disruption &allowing replication of the bacteria within the phagocyte cytoplasm 7) human VASP, an actin-associated cytoskeletal protein in platelets, interacts with the Pro-rich domain of Listeria monocytogenes actA 8) 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] Laboratory: 1) Listeria monocytogenes serology 2) Listeria monocytogenes DNA, Listeria monocytogenes rRNA 3) cerebrospinal fluid analysis (CSF analysis) a) may be difficult to visualize organisms on gram stain b) neutrophil or lymphocyte predominance with cell counts of 10-500/mm3 [3,6] c) CSF protein elevated d) CSF glucose may be normal [6] e) Listeria antibody in CSF 4) Listeria identified by culture a) facultatively anaerobic b) coagulase-negative, catalase positive c) Voges-Proskauer positive d) gram-positive asporogenous rods e) non-spore-forming f) non-acid-fast g) pleomorphic: coccoid, coccobacillary or bacillary (rods) h) tumbling motility at room temp [2] i) beta-hemolytic when grown on blood agar [14] 3) see ARUP consult [4] Differential diagnosis: - histoplasmosis less likely to cause diarrhea, more likely to cause pulmonary symptoms [11] - other causes of meningitis Complications: - mortality of confirmed Listeria monocytogenes infection is ~15% [14] Management: 1) most people with mild symptoms do not require treatment [3] 2) treatment for invasive disease for serious symptoms - 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 for 1 week [13] - Bactrim is an alternate for penicillin-allergic patients 3) treatment should be continued for at least 2-4 weeks - bacteremia for 2 weeks in immunocompetent patients - longer courses if immunocompromised - meningitis for 3 weeks - endocarditis for 4-6 weeks - brain abscess for >= 6 weeks [13] * Listeria monocytogenes is resistant to all cephalosporins

General

Listeria

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 306
  2. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1148
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 501, 569 - Mayo Clinic Listeria infection https://www.mayoclinic.org/diseases-conditions/listeria-infection/diagnosis-treatment/drc-20355275
  4. ARUP Consult: Listeria monocytogenes The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/listeria-monocytogenes
  5. 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. Lorber B Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis. 2007 Mar 1;44(5):765-6. No abstract available. PMID: 17278080 Lorber B. - Listeriosis. Clin Infect Dis. 1997 Jan;24(1):1-9; quiz 10-1. PMID: 8994747
  7. 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. 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. 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. 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. NEJM Knowledge+ Allergy/Immunology
  12. 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. Weinstein KB et al Listeria Monocytogenes Infection (Listeriosis) Medication. https://emedicine.medscape.com/article/220684-medication
  14. Rogalla D, Bomar PA Listeria Monocytogenes StatPearls [Internet]. July 4, 2023 National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK534838
  15. Gumbrecht J Boar's Head to close Virginia plant linked to deadly listeria outbreak. CNN September 13, 2024
  16. Listeria (Listeriosis) Symptoms https://www.cdc.gov/listeria/symptoms.html