Listeriosis

Listeria are Gram-positive non-sporing rods which are ubiquitous in the environment and found world-wide.¹
Listeria monocytogenes is the major pathogen, although occasional human infections with L. ivanovii and L. seeligeri have been reported.

Listeria are not very pathogenic to healthy adults, who are likely to experience only mild infection, causing flu-like symptoms or gastroenteritis. However listeria infection can occasionally lead to septicaemia or meningitis. Pregnant women, the elderly and people with weakened immune systems are more susceptible to Listeria infection. Unborn babies and neonates are at particular risk of severe illness and Listeria infection in pregnancy can cause miscarriage, premature delivery or severe illness in a newborn child.¹

• L. monocytogenes is common in wild animals, domesticated animals and in soil and water. It causes disease in many animals and is a common cause of miscarriage and stillbirth in domestic animals.
• Most cases of infection in humans are thought to be food-borne.² Some cases occur by direct contact with animals (particularly during calving, lambing, and post-mortem examinations). Spread from mother to fetus may occur in utero or during birth.
• Listeria spp. has a peculiar property of being able to grow at low temperatures, ie. on contaminated refrigerated food, and is an important food-borne pathogen. Soft cheeses and meat-based pate have been implicated in outbreaks.
• The bacterium has been isolated from a range of raw foods including vegetables, uncooked meats and processed foods. Eating cooked food that has then been refrigerated and recooked is a particular risk of causing infection. Usually killed by cooking or pasteurization, it can survive some forms of pasteurization, particularly if the bacterial count is high.
• Listeria monocytogenes is often carried in the human bowel (1-10% carrier rate).

• Incubation time can vary from 3-70 days in adults, and a few days to a few weeks in infants.¹
• Infection in healthy children and adults, including maternal infections, may be asymptomatic.
• L. monocytogenes most often causes an influenza-like illness. More severe infection in risk groups may lead to stillbirth, septicaemia or meningo-encephalitis.
• Infection of a pregnant woman early in pregnancy often leads to miscarriage. Maternal presentation of infection during pregnancy may include fever, myalgia, headache, sore throat, cough, vomiting, diarrhoea and vaginitis.
• The organism may be transmitted across the placenta. Infections in late pregnancy may lead to stillbirth, or death of the infant within a few hours of birth. About half of infected infants at or near term will die.
• Infants with Listeria infection may present in the first few days of life with poor feeding, lethargy, jaundice, vomiting, respiratory distress, skin rash and shock. Infants usually have pneumonia. The death rate is very high.
• Infants presenting at age 5 days or older often present with meningitis.
• In adults, the disease is usually asymptomatic or causes mild illness such as an influenza-type illness, conjunctivitis, skin lesions or gastroenteritis. More severe infection, particularly in immunocompromised adults, may cause meningitis, pneumonia, septicaemia and endocarditis.
• Vets and farmers may develop cutaneous listeriosis, presenting as papular or pustular lesions on the arms or hands, following contact with infected animals.³

• Cultures of amniotic fluid, blood, urine and CSF; stool cultures are not sensitive or specific.
• Serological testing is unreliable.
• Chest x-ray.
• MRI is superior to CT scan for demonstrating CNS disease, especially in the brainstem.
• Transoesophageal echocardiography should be performed if endocarditis is suspected.

• Meningitis caused by Listeria: intravenous ampicillin plus gentamicin for 14 days. Intravenous ampicillin alone should then be continued for a further 2 to 4 weeks for meningoencephalitis and a further 4 to 6 weeks for endocarditis.⁵
• Listeria is resistant to cephalosporins and where listeriosis is a clinical possibility, e.g. acute pyogenic meningitis, and organism is unknown, intravenous ampicillin should always be part of the regimen.⁶
• Gentamicin should be avoided in pregnancy and ampicillin is then used alone.
• Erythromycin is used instead of ampicillin if the patient is allergic to penicillin.
• Intravenous co-trimoxazole is the best second-line treatment for listeria meningoencephalitis.⁷

Infants who survive listeriosis may suffer long-term neurological damage and delayed development.

• Infection of the fetus with L. monocytogenes results in a poor outcome with approximately a 50% death rate.
• The late infant onset form also has a high death rate.
• Healthy older children and adults have a lower death rate but there is a 20-50% mortality from septicaemia and meningoencephalitis, with significant long-term morbidity in survivors.

• Pregnant women should avoid contact with wild and domestic animals.
• Pregnant women should avoid consumption of soft cheeses, deli meats, patés, spreads, refrigerated smoked seafood, and cold salads from salad bars.
• Non-pasteurized soft cheeses have also been implicated in outbreaks of listeriosis.
• Food should always be adequately cooked, or thoroughly reheated.