Listeriosis history and symptoms: Difference between revisions

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==Overview==
==Overview==
Listeriosis can present in different ways depending on the type of infection, such as: [[fever]], [[headache]]and [[muscle ache]]s, sometimes preceded by [[diarrhea]] or other gastrointestinal symptoms. Other less common symptoms may include: [[stiff neck]], [[confusion]] and [[convulsions]]. It has an [[incubation period]] which can range from a median of 24 hours, in ''Listeria'' [[gastroenteritis]], to a median of 35 days, in ''Listeria'' invasive disease. Manifestations of listeriosis are host-dependent. In older adults and persons with immunocompromising conditions, [[septicemia]] and meningitis are the most common clinical presentations. Pregnant women may experience a mild, [[flu]]-like illness followed by fetal loss or [[bacteremia]] and [[meningitis]] in their newborns. [[Immunocompetent]] persons may experience acute [[febrile]] [[gastroenteritis]] or no symptoms.
[[Fever]] is the most common symptom of listeriosis. Other symptoms develop on location of the [[infection]]: Patients with [[gastroenteritis]] may develop [[watery diarrhea]], [[abdominal pain]], [[vomiting]], and [[headache]]. Patients with [[CNS]] [[infection]] may develop symptoms of [[meningitis]], [[encephalitis]], [[cerebritis]], rhombencephalitis, or [[spinal cord]] [[infection]], such as [[headache]], [[back pain]], [[neck pain]], [[photophobia]], [[phonophobia]], [[deafness]], [[confusion]], [[ataxia]], [[seizures]], and neurological impairment.
 
==History==
Although the source is often unknown, contaminated food is the most common vehicle of [[transmission]]. ''[[Listeria monocytogenes|Listeria]]'' has an [[incubation period]] that can range from a median of 24 hours, in ''[[Listeria monocytogenes|Listeria]]'' [[gastroenteritis]], to a median of 35 days, in ''[[Listeria monocytogenes|Listeria]]'' invasive disease.<ref name="pmid15825036">{{cite journal| author=Ooi ST, Lorber B| title=Gastroenteritis due to Listeria monocytogenes. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 9 | pages= 1327-32 | pmid=15825036 | doi=10.1086/429324 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15825036  }} </ref><ref name="pmid8988887">{{cite journal| author=Dalton CB, Austin CC, Sobel J, Hayes PS, Bibb WF, Graves LM et al.| title=An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 2 | pages= 100-5 | pmid=8988887 | doi=10.1056/NEJM199701093360204 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8988887  }} </ref><ref name="pmid3137471">{{cite journal| author=Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C et al.| title=Epidemic listeriosis associated with Mexican-style cheese. | journal=N Engl J Med | year= 1988 | volume= 319 | issue= 13 | pages= 823-8 | pmid=3137471 | doi=10.1056/NEJM198809293191303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3137471  }} </ref>  Patients who present with symptoms suggestive of listeriosis should be inquired about history of ingested of uncooked meats and vegetables, unpasteurized (raw) milk and cheeses, processed (or ready-to-eat) meats, and smoked seafood within the last few weeks.


==Symptoms==
==Symptoms==
Although some patients may be transitory asymptomatic carriers of [[listeriosis]], others become [[symptomatic]]. There is a variety of clinical presentations depending on the affected systems and the [[immune]] status of the host.<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>
===Febrile Gastroenteritis===
===Febrile Gastroenteritis===
Symptoms may include:
* [[Fever]]
*[[fever]]
* [[Watery diarrhea]]
*[[watery diarrhea]]
* [[Nausea]]
*[[nausea]]
* [[Vomiting]]
*[[vomiting]]
* [[Abdominal pain]]
*[[headache]]
* [[Headache]]
*[[arthralgia|joint]] and [[myalgia|muscle pain]]
* [[Sore throat]]
* [[Arthralgia|Joint]] and [[myalgia|muscle pain]]


===Infection in Pregnancy===
===Infection in Pregnancy===
Symptoms may include:
* [[Fever]]
*[[Fever]]
* [[Chills]]
*[[Chills]]
* [[Back pain]]
*[[Back pain]]


===Sepsis of Unknown Origin===
===Sepsis of Unknown Origin===
* [[Fever]]
* [[Chills]]
* [[Malaise]]


===Bacteremia===
===Bacteremia===
Common symptoms may include:
* [[Fever]]
 
* [[Myalgias]]
*[[Fever]]
* [[Nausea]]
 
* [[Diarrhea]]
*[[Myalgias]]
 
*[[Nausea]]
 
*[[Diarrhea]]


===CNS Infection===
===CNS Infection===
Because ''L. monocytogenes'' has tropism for the [[brain stem]] and [[meninges]], unlike other causes of [[bacterial meningitis]], ''Listeria'' tends to cause [[parenchymal]] [[brain]] [[infections]]. Therefore, most patients will experience altered consciousness, [[seizures]] and/or movement disorders, and will truly have [[meningoencephalitis]]. [[Central Nervous System]] [[infection]] most commonly manifests by [[meningoencephalitis]], while [[cerebritis]], which usually progresses into [[brain abscess]] and [[rhombencephalitis]], is a less common manifestation. "In a study from the Massachusetts General Hospital, with [[CNS]] [[listeriosis]] outside [[neonatal]] period and [[pregnancy]], the most common predisposing factor for developing ''listerial'' [[meningitis]] was [[malignancy]], the second most common factor being [[transplantation]], followed by [[alcoholism]] and [[liver disease]], [[immunosuppression]] and [[steroid]] treatment, [[diabetes mellitus]] and [[HIV]]".<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref>.
====Meningoencephalitis====
 
The clinical presentation can range from mild [[fever]] and mental status changes, to a more aggressive course with [[coma]]. Focal [[neurological]] signs might be present, such as:<ref name="pmid8592552">{{cite journal |vauthors=Southwick FS, Purich DL |title=Intracellular pathogenesis of listeriosis |journal=N. Engl. J. Med. |volume=334 |issue=12 |pages=770–6 |year=1996 |pmid=8592552 |doi=10.1056/NEJM199603213341206 |url=}}</ref>
'''1. Meningoencephalitis'''
*[[Cranial nerve]] abnormalities, most commonly [[Sixth nerve palsy|6th]] and [[Facial palsy|7th cranial nerve palsies]]
Occurs more frequently in [[neonates]] after 3 days of age and in [[immunocompromised]] and elderly patients. The clinical presentation can range from mild [[fever]] and mental status changes, to a more aggressive course with [[coma]]. There may also be an [[encephalic]] component present, which will present with focal [[neurological]] signs, such as:
*Abnormal [[gait]] ([[ataxia]])
*[[Cranial nerve]] abnormalities
*[[Ataxia]]
*[[Tremors]]
*[[Tremors]]
*[[Hemiplegia]]
*[[Weakness]] of one side of the body ([[hemiplegia]])
*[[Deafness]]
*[[Deafness]]
*[[Seizures]]
*Abnormal movements ([[seizures]])


'''2. Cerebritis/ Encephalitis'''
====Cerebritis/ Encephalitis====
Results from direct hematogenous invasion of [[cerebral]] [[parenchyma]], with or without [[meningeal]] involvement, probably representing an early localised [[infection]] of the [[parenchyma]], which might eventually progress into [[brain abscess]]. [[Cerebritis]] may occur alongside [[meningitis]] in the same patient.
In [[cerebritis]]/[[encephalitis]], the clinical picture is dominated by altered [[consciousness]] and [[cognitive]] dysfunction. Additional symptoms include:<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>
In these cases, the clinical picture is dominated by ''altered consciousness'' or ''cognitive disfunction'', but may also manifest as<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>:
*[[Fever]]
*[[Fever]]
*[[Headache]]
*[[Headache]]
*[[Hemiplegia]]
*[[Hemiplegia]]


'''3. Rhombencephalitis'''
====Rhombencephalitis====
Rare manifestation of CNS infection, which affects more commonly healthy individuals through the ingestion of ''Listeria'' contaminated food, often in outbreaks. Rhombencephalitis often follows a biphasic course, beginning with:
Rhombencephalitis often follows a biphasic course.  The initial phase lasts for about 4 days and is characterized by the following symptoms:
*[[Headache]]
*[[Headache]]
*[[Fever]]
*[[Fever]]
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*[[Vomiting]]
*[[Vomiting]]


Which lasts for about 4 days, and is followed by an abrupt onset of:
The initial phase is followed by an abrupt onset of:
*Asymetrical [[cranial nerve]] [[palsies]]
*Asymetrical [[cranial nerve]] palsies
*[[Ataxia]]
*[[Ataxia]]
*[[Tremor]]
*[[Tremor]]
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*[[Hemiparesis]] and/or hemisensory deficits
*[[Hemiparesis]] and/or hemisensory deficits
*[[Respiratory failure]]
*[[Respiratory failure]]
Mortality is high and the survivors tend to experience serious sequelae.
'''4. Brain abscess'''
Most cases occur in patients at risk for [[infection]]. The [[subcortical]] [[abscesses]] tend to be located in the [[thalamus]], the [[pons]] and/or [[medulla]], sites which are rarely affected by other [[bacteria]].<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>.
'''5. Spinal cord infection'''
Rare cases of [[spinal cord]] involvement have been reported. However, if spinal symptoms develop, in the setting of [[acute bacterial meningitis]] of uncertain etiology, ''L. monocytogenes'' should be considered"<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>.
Despite the fact of ''Listeria'' being the most common [[infectious]] cause of rhombencephalitis, it must be distinguished from other [[infectious]] etiologies, such as:
*[[Herpes simplex]] [[encephalities]]
*[[Tuberculosis]]
*[[Toxoplasmosis]]
*[[Cryptococcosis]]
*[[Lyme disease]]
*[[Epstein-Barr virus]]
*[[Brucellosis]]
*[[JC virus]]
There are also noninfectious conditions which may cause [[brainstem]] and/or [[cerebral]] lesions, such as:
*[[Multiple sclerosis]]
*[[Sarcoidosis]]
*Systemic [[rheumatic diseases]]
*[[Lymphoma]]
*[[Paraneoplastic syndrome]]
The diagnosis of [[rhombencephalitis]] can be delayed by the fact that [[CSF]] analysis often reveals only mild abnormalities, but may be demonstrated by [[Magnetic resonance]].
===Endocarditis===
Listerial [[endocarditis]] affects the population at risk for ''[[streptococcus viridans]]'' [[endocarditis]], producing [[native valve endocarditis|native]] and [[prosthetic valve]] disease and having an elevated rate of septic complications. Listerial [[endocarditis]] alone, may be an indicator of a [[GI tract]] abnormality, such as [[cancer]]<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>.
===Focal infections===
Most focal infections have no specific characteristics, but do share a most common host, the [[immunocompromised]] patient. These might include:
*[[Skin]] or [[eye]] [[infections]]
*Oculoglandular syndrome, [[pneumonia]], [[empyema]], [[myocarditis]], [[lymphadenitis]], [[septic arthritis]], [[osteomyelitis]] and [[necrotizing fasciitis]].
*[[Brain|Brain abscess]] and [[spinal]] [[abscesses]], as well as [[cholecystitis]], resulting from hematogenous dissemination.
*[[Acute hepatitis]], simulating [[viral hepatitis]], seen in patients with disseminated infections.
*[[Peritonitis]], seen in [[cirrhosis]] and continuous ambulatory [[peritoneal dialysis]] patients.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 22:31, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Fever is the most common symptom of listeriosis. Other symptoms develop on location of the infection: Patients with gastroenteritis may develop watery diarrhea, abdominal pain, vomiting, and headache. Patients with CNS infection may develop symptoms of meningitis, encephalitis, cerebritis, rhombencephalitis, or spinal cord infection, such as headache, back pain, neck pain, photophobia, phonophobia, deafness, confusion, ataxia, seizures, and neurological impairment.

History

Although the source is often unknown, contaminated food is the most common vehicle of transmission. Listeria has an incubation period that can range from a median of 24 hours, in Listeria gastroenteritis, to a median of 35 days, in Listeria invasive disease.[1][2][3] Patients who present with symptoms suggestive of listeriosis should be inquired about history of ingested of uncooked meats and vegetables, unpasteurized (raw) milk and cheeses, processed (or ready-to-eat) meats, and smoked seafood within the last few weeks.

Symptoms

Although some patients may be transitory asymptomatic carriers of listeriosis, others become symptomatic. There is a variety of clinical presentations depending on the affected systems and the immune status of the host.[4]

Febrile Gastroenteritis

Infection in Pregnancy

Sepsis of Unknown Origin

Bacteremia

CNS Infection

Meningoencephalitis

The clinical presentation can range from mild fever and mental status changes, to a more aggressive course with coma. Focal neurological signs might be present, such as:[5]

Cerebritis/ Encephalitis

In cerebritis/encephalitis, the clinical picture is dominated by altered consciousness and cognitive dysfunction. Additional symptoms include:[6]

Rhombencephalitis

Rhombencephalitis often follows a biphasic course. The initial phase lasts for about 4 days and is characterized by the following symptoms:

The initial phase is followed by an abrupt onset of:

References

  1. ↑ Ooi ST, Lorber B (2005). "Gastroenteritis due to Listeria monocytogenes". Clin Infect Dis. 40 (9): 1327–32. doi:10.1086/429324. PMID 15825036.
  2. ↑ Dalton CB, Austin CC, Sobel J, Hayes PS, Bibb WF, Graves LM; et al. (1997). "An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk". N Engl J Med. 336 (2): 100–5. doi:10.1056/NEJM199701093360204. PMID 8988887.
  3. ↑ Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C; et al. (1988). "Epidemic listeriosis associated with Mexican-style cheese". N Engl J Med. 319 (13): 823–8. doi:10.1056/NEJM198809293191303. PMID 3137471.
  4. ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
  5. ↑ Southwick FS, Purich DL (1996). "Intracellular pathogenesis of listeriosis". N. Engl. J. Med. 334 (12): 770–6. doi:10.1056/NEJM199603213341206. PMID 8592552.
  6. ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.

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