Listeria monocytogenes is an important bacterial pathogen in neonates, immunosuppressed patients, elderly adults, pregnant women, and occasionally, previously healthy individuals.
Febrile gastroenteritis
- Listeria account for less than one percent of reported cases of bacterial foodborne infections, but outbreaks of febrile gastroenteritis from contaminated food have been described.
- Febrile gastroenteritis secondary to listerial infection typically occurs after ingestion of a large inoculum of bacteria from contaminated food.
- Common symptoms include fever, watery diarrhea, nausea, vomiting, headache, and pains in joints and muscles.
- The typical duration of symptoms is two days or less and recovery is generally complete.
- Invasive infection seems to be rare, with the risk being greatest in immunocompromised, pregnant, or elderly patients.
Infection in pregnancy
- Listeriosis in pregnancy occurs most commonly during the third trimester.
- Fever, chills, and back pain may occur as presenting features of listeriosis in pregnant women; a nonspecific flu-like illness is the most common presentation.
- The infection may be mild, resolve without therapy, and the diagnosis missed if blood cultures are not obtained.
- Listerial infection in pregnant women can lead to fetal death, premature birth, or infected newborns.
Sepsis of unknown origin
- Listerial sepsis occurs in patients of all ages.
- Neonates probably acquire infection during or after birth. Infection in the first week of life is usually manifested by sepsis, while disease manifestations after the first week are more variable and often include meningitis.
- Listeria meningoencephalitis most often occurs in neonates after three days of age and in immunocompromised and elderly adults.
- Adults with Listeria sepsis, most of whom are either immunocompromised or elderly, typically present with fever and chills.
- Septic shock can develop and there may be seeding of the brain and/or meninges, leading to meningoencephalitis or cerebritis.
CNS infection
- The most common central nervous system manifestation of listerial infection is meningoencephalitis. Cerebritis, which infrequently progresses to brain abscess, and rhombencephalitis (brainstem encephalitis) are less common.
- The clinical presentation of Listeria meningoencephalitis ranges from a mild illness with fever and mental status changes to a fulminant course with coma.
- The clinical presentation of cerebritis ranges from fever and headache to hemiplegia, resembling a stroke.
- Rhombencephalitis often follows a biphasic course, beginning with headache, fever, nausea and vomiting, followed in several days by cranial nerve palsies, ataxia, tremor, and other cerebellar signs, decreased consciousness, and possibly seizures and hemiparesis. Almost one-half develop respiratory failure.
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