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Listeriosis

(Listeria)

By

Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University;


Maria T. Vazquez-Pertejo

, MD, FACP, Wellington Regional Medical Center

Reviewed/Revised Mar 2023
View PATIENT EDUCATION

Listeriosis is bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis caused by Listeria species. Symptoms vary with the organ system affected. Intrauterine infection may cause fetal death. Diagnosis is by laboratory isolation. Treatment includes penicillin or ampicillin (often with aminoglycosides) or trimethoprim/sulfamethoxazole.

Listeria are small, non–acid-fast, noncapsulated, nonsporulating, beta-hemolytic, aerobic, and facultative anaerobic gram-positive bacilli that have characteristic tumbling motility. They are present worldwide in the environment and in the gut of humans, nonhuman mammals, birds, and crustaceans. There are several species of Listeria, but L. monocytogenes is the primary pathogen in humans.

In the US, there are about 1600 cases of listeriosis annually, and about 260 people die (1 General reference Listeriosis is bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis caused by Listeria species. Symptoms... read more ). Peak is in the summer. Attack rates are highest in neonates, in adults ≥ age 60, and in immunocompromised patients, including patients with HIV/AIDS. Listeriosis is 10 times more likely in pregnant women and 24 times more likely in pregnant Hispanic women than in those in the general population (1 General reference Listeriosis is bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis caused by Listeria species. Symptoms... read more ).

Transmission

Because L. monocytogenes is ubiquitous in the environment, opportunities for contamination are numerous during the food production process. Nearly all types of food can harbor and transmit L. monocytogenes, but infection usually occurs via ingestion of contaminated dairy products, raw vegetables, meats, or, particularly, refrigerated foods that require no cooking before they are eaten. Contamination is favored by the ability of L. monocytogenes to survive and grow at refrigerator temperatures.

Infection may also occur by direct contact with and during slaughter of infected animals.

Pearls & Pitfalls

  • Listeria monocytogenes can reproduce at refrigerator temperatures, so lightly contaminated refrigerated food can become heavily contaminated.

Risk factors

Because L. monocytogenes multiplies intracellularly, control of listeriosis requires cell-mediated immunity; thus, the following people are at high risk:

  • Immunocompromised patients

  • Neonates

  • Older people

  • Pregnant women

In pregnant women, listerial infection is usually mild. However, the infection can spread antepartum and intrapartum from mother to child and can cause spontaneous abortion, stillbirth, premature birth, or early infant death.

Listeria can cause life-threatening infection in the neonate (see Neonatal Listeriosis Listeriosis ), including bacteremia Neonatal Listeriosis and pneumonia Neonatal Pneumonia , and are a common cause of neonatal bacterial meningitis Neonatal Bacterial Meningitis .

General reference

  • 1. CDC: People at Risk—Pregnant Women and Newborns. Accessed 12/22/2022.

Symptoms and Signs of Listeriosis

Primary listerial bacteremia is rare and causes high fever without localizing symptoms and signs. Endocarditis, peritonitis, osteomyelitis, septic arthritis, cholecystitis, and pleuropneumonia may occur. Febrile gastroenteritis may occur after ingestion of contaminated food. Listerial bacteremia during pregnancy can cause intrauterine infection, chorioamnionitis, premature labor, fetal death, or neonatal infections.

Meningitis is due to Listeria in up to 20% of cases in neonates and in patients > age 60. Twenty percent of cases progress to cerebritis, either diffuse encephalitis or, rarely, rhombencephalitis and abscesses; rhombencephalitis manifests as altered consciousness, cranial nerve palsies, cerebellar signs, and motor or sensory loss.

Oculoglandular listeriosis can cause ophthalmitis and regional lymph node enlargement (Parinaud syndrome). It may follow conjunctival inoculation and, if untreated, may progress to bacteremia and meningitis.

Diagnosis of Listeriosis

  • Culture

Listerial infections are diagnosed by culture of blood or cerebrospinal fluid. The laboratory must be informed when L. monocytogenes is suspected because the organism is easily confused with diphtheroids.

In all listerial infections, IgG agglutinin titers peak 2 to 4 weeks after onset.

Treatment of Listeriosis

  • Ampicillin or penicillin G, usually with an aminoglycoside

Listerial meningitis is best treated with ampicillin 2 g IV every 4 hours. Most authorities recommend adding gentamicin (1 mg/kg IV every 8 hours) based on synergy in vitro. Cephalosporins are not effective.

Endocarditis and primary listerial bacteremia are treated with ampicillin 2 g IV every 4 hours plus gentamicin (for synergy) given for 6 weeks (for endocarditis) or 2 weeks (for bacteremia) beyond defervescence.

Oculoglandular listeriosis and listerial dermatitis should respond to erythromycin 10 mg/kg orally every 6 hours, continued until 1 week after defervescence.

Cephalosporins have no in vitro activity and should not be used; failures with vancomycin have been reported. Trimethoprim/sulfamethoxazole 5/25 mg/kg IV every 8 hours is an alternative. Linezolid is active in vitro, but clinical experience is lacking.

Prevention of Listeriosis

Because food contamination is common and because L. monocytogenes can reproduce at refrigerator temperatures, lightly contaminated food can become heavily contaminated even during refrigeration. This problem is of particular concern when foods (eg, refrigerated ready-to-eat foods) are eaten without further cooking. Thus, appropriate food hygiene is important, particularly for at-risk people (eg, immunocompromised patients, pregnant women, older people). Those at risk should avoid eating the following:

  • Soft cheeses made with unpasteurized milk (eg, feta, Brie, Camembert, queso fresco, queso blanco); raw (unpasteurized) milk and milk products, although Listeria contamination can occur after pasteurization

  • Refrigerated ready-to-eat foods (eg, hot dogs, deli meats, pȃtés, meat spreads), unless they are heated to an internal temperature of 73.9° C (165° F) or until steaming hot just before serving

  • Refrigerated smoked seafood (eg, nova-style, lox, kippered, smoked, jerky), unless it has been cooked

Key Points

  • L. monocytogenes is very common in the environment but causes infection in only about 1600 people annually in the US, typically via contaminated food products.

  • Attack rates are highest in neonates, adults age 60, pregnant women, and immunocompromised patients.

  • Various organ systems can be affected; maternal infection during pregnancy may cause fetal death.

  • Give ampicillin, usually plus gentamicin.

  • Advise high-risk patients to prevent disease by not eating foods most likely to be contaminated.

Drugs Mentioned In This Article

Drug Name Select Trade
Pfizerpen
Principen
Garamycin, Genoptic, Genoptic SOP, Gentacidin, Gentafair, Gentak , Gentasol, Ocu-Mycin
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat
Primsol, Proloprim, TRIMPEX
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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