• Clinical science

Listeriosis

Abstract

Listeriosis is an infectious disease caused by the gram-positive bacterium Listeria monocytogenes. The bacteria are usually transmitted to humans through ingestion of contaminated food (especially raw milk products). In immunocompetent patients, the disease is mostly asymptomatic, although mild flu-like symptoms or febrile gastroenteritis may occur. Invasive disease due to bacteria spreading beyond the gastrointestinal tract results in most symptoms and generally develops in high-risk groups, including immunocompromised, elderly, and pregnant patients. The clinical manifestation is usually mild in pregnant women, but consequences for the fetus can be very severe (see congenital listeriosis). In immunocompromised and elderly patients, invasive disease can lead to sepsis and meningitis. Suspected listeriosis can be differentiated from other causes of infection through blood cultures. Antibiotic therapy is indicated for high-risk groups; ampicillin or penicillin G are the drugs of choice.

Etiology

  • Pathogen: Listeria monocytogenes; a gram-positive, catalase-positive, rod-shaped, facultative intracellular, motile bacterium
  • Route of transmission
    • Contaminated food, especially raw milk products; : Listeria can grow in temperatures as low as -1.5 ºC.
    • Congenital listeriosis: transplacental transmission during pregnancy; or direct contact with infected vaginal secretions during birth
    • Incubation time: 3–70 days (usually within a month)
  • Risk factors

References:[1][2][3][4]

Pathophysiology

Listeria relies on several pathogenic mechanisms to permit infection and evasion of the host immune system:

  • Invasion: the bacteria enters host cells via binding of the virulence factor InlA to E-cadherin in cells of the intestinal epithelium, the blood–brain barrier, and the placenta.
  • Proliferation: once inside the phagosome, virulence factors (listeriolysin O, phospholipases) enable escape from the phagosome and entry into the cytoplasm.
    • Listeriolysin O also inactivates T cell receptors and impairs T cell activation by antigen presenting cells.
  • Cell to cell mobility: Listeria can move from cell to cell without being exposed to the extracellular environment via actin rocket tails.

Clearance of infection primarily relies on macrophage activation by T cells

  • T cells are exposed to Listeria antigens → secrete interferon-γ and TNF-αmacrophages are activated → increase production of reactive oxygen species
  • CD8+ T cells release of perforin and granzymes → lyse host cells infected with Listeria
  • Phagocytic mechanisms eventually outperform the evasive mechanisms of the bacteria, especially when acting in synergy with antibiotic drugs

Clinical features

Most infections are asymptomatic or mild, especially in immunocompetent individuals.

References:[5][6][7]

Diagnostics

Testing is generally not needed in immunocompetent individuals, as the infection is self-limiting and symptoms will have resolved by the time listeriosis is diagnosed.

  • Blood cultures
    • Indications: suspected listeriosis, particularly among high-risk groups (e.g., pregnant women)
    • Culture from other infected tissues: respiratory tract, pus, vaginal secretions, stool, joints
  • Lumbar puncture: indicated for suspected Listeria meningitis
  • Polymerase chain reaction (PCR)
    • Not yet available for patients
    • A PCR assay has been produced and tested to detect Listeria in CSF as a complementary test to culture.
    • This test may have a higher sensitivity than culture, since CNS listeriosis usually manifests with low amounts of bacteria in the CSF.

Treatment

Prevention

  • High-risk individuals: avoid food products made from unpasteurized milk and soft cheeses (e.g., brie, feta, and camembert).
  • Properly cook meat prior to consumption
    • Meat and fish should be heated at 160°F (71°C) for at least two minutes.
    • Milk should be pasteurized at 160°F (71°C).
  • Obligation to report: Listeriosis is a notifiable disease in the United States.