Listeriosis natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
[[Listeriosis]] is commonly [[transmission|transmitted]] through contaminated food. The clinical presentation of the disease depends on the baseline health status of the patient. Although [[asymptomatic]] carriers may be identified, the disease is commonly manifested as [[febrile]] [[gastroenteritis]]. Other more invasive manifestations include [[sepsis]] of unknown origin, [[bacteremia]], [[CNS infection|central nervous system (CNS) infection]], [[endocarditis]], and focal [[infections]]. Possible [[complications]] of [[listeriosis]] include [[acute respiratory distress syndrome]] ([[ARDS]]), [[rhabdomyolysis]], [[acute renal failure]], and [[pneumonia]]. The [[prognosis]] of [[listeriosis]] depends on the health status of the host, where healthy older children and adults show the lowest [[death rate]].<ref name=CDC>{{cite web | title = Listeria | url = http://www.cdc.gov/listeria/definition.html }}</ref>
Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia. Early clinical manifestations (usually fever) typically develop early within 24 hours of transmission If left untreated, patients typically progress within 1-90 days to develop ''Listeria''-associated complications, including bacteremia, abscess formation, pneumonia, ARDS, acute kidney injury, and CNS impairment. Among healthy children and young adults, the prognosis of listeriosis is generally good. Prognosis is poorer among high-risk populations, who are more likely to develop complications and death even with prompt management.


==Natural History==
==Natural History==
The majority of cases of [[listeriosis]] are sporadic. Although the source is often unknown, contaminated food is the most common vehicle of [[transmission]]. Some patients may be transitory carriers of the [[bacteria]] without manifesting signs of the disease.  Once the [[bacterium]] penetrates the [[gastrointestinal]] lining, it travels through the [[bloodstream]] to otherwise [[aseptic]] sites, such as the [[CNS]], the [[uterus]], and sometimes the [[heart]], leading to the following diseases such as:
*Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia.<ref name=Mandell>{{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]]
*The median [[incubation period]] for listeriosis-associated [[gastroenteritis]] is approximately 24 hours (range from 6 hours to 10 days).
* Infection in [[pregnancy]]
*Systemic manifestations of listeriosis may be slow-occurring, and the duration from transmission to development of systemic manifestations widely varies between 1 day to 90 days following transmission.<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>
* [[Sepsis]] of unknown origin
* [[Bacteremia]]
* [[CNS infection]]
* [[Endocarditis]]
* Focal [[infection]]s
 
The mean [[incubation period]] for febrile [[gastroenteritis]] following [[listeriosis]] is 24 hours, however, it may range from 6 hours up to 10 days. In invasive diseases, the mean [[incubation period]] is 35 days, ranging from 1 to 91 days.<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>


===Febrile Gastroenteritis===
===Febrile Gastroenteritis===
Febrile [[gastroenteritis]] accounts for less than 1% of reported [[bacterial]] food-born [[infections]], occurring usually after [[ingestion]] of a large inoculum of [[bacteria]] from contaminated foods. Illness typically occurs 24 hours after [[ingestion]] of contaminated food, presenting with [[symptoms]] such as [[fever]], [[nausea]], [[vomiting]], and [[watery diarrhea]].
*''Listeria''-associated gastroenterities typically occurs 24 hours following [[ingestion]] of contaminated food
 
*Patients typically manifest with [[fever]], [[nausea]], [[vomiting]], and [[watery diarrhea]].
It generally lasts for 2 days and the patient experiences complete recovery from the [[symptoms]]. Some patients may be [[asymptomatic]] for the disease, while others, [[immunocompromised]], pregnant women and elder patients, in rare cases, present with invasive [[infection]]. ''L. monocytogenes'' [[infection]] should be considered when outbreaks of foodborne [[gastroenteritis]] surge and stool cultures fail to identify the [[pathogen]].<ref name=Mandell>{{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>
*''Listeria''-associated gastroenteritis is usually self-limited and lasts for a mean of 2 days among healthy individuals.
*In high-risk patients, systemic manifestations of ''Listeria'' may occur, and patients are at higher risk of developing ''Listeria''-associated complications.<ref name=Mandell>{{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>


===Infection in Pregnancy===
===Infection in Pregnancy===
[[Pregnant]] women have greater risk of contracting [[listeriosis]] due to a slight impairment of [[cell-mediated immunity]] during [[pregnancy]]. ''Listeria'' is also able to proliferate in the [[placenta]], in hard-to-reach areas for the [[immune system]]. [[Infection]] occurs more frequently during the third trimester of [[gestation]]<ref name=Mandell>{{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> presenting most commonly with [[flu]]-like [[symptoms]], such as [[fever]] and [[chills]].
*Among pregnant women, listeriosis typically manifests during the third trimester of [[gestation]].<ref name=Mandell>{{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>  
 
*Pregnant women typically first present with mild [[flu]]-like [[symptoms]], such as [[fever]] and [[chills]], that are difficult to diagnose.
The [[infection]] may be mild and the [[diagnosis]] can be missed when [[blood cultures]] are not obtained. Since [[bacteremia]] with no [[CNS]] involvement is common among pregnant women with [[listeriosis]], [[blood cultures]] should always be obtained in [[pregnant]] women who present with [[fever]], with no other possible cause, such as [[UTI]] or [[pharyngitis]]. Because cell-to-cell [[transmission]] facilitates maternal-fetal [[transmission]], [[listeriosis]] in [[pregnant]] women can result in [[fetal death]], [[premature birth]], or [[infected]] newborns.<ref name=Mandell>{{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>
*As the disease progresses, pregnant women typically develop ''Listeria''-associated bacteremia (typically without CNS involvement)
 
*If left untreated, [[listeriosis]] among [[pregnant]] women can result in [[fetal death]], [[premature birth]], or [[infected]] newborns.<ref name=Mandell>{{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>
Among [[pregnant]] women with [[listeriosis]], 2/3 of the surviving infants develop clinical [[neonatal]] [[listeriosis]].<ref name=Mandell>{{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>. The newborn also has a great risk of developing [[granulomatosis infantiseptica]], a severe ''[[in utero]]'' [[infection]] secondary to transplacental [[transmission]], which is characterized by the following:
* Disseminated [[abscesses]]
* [[Granulomas]] in multiple internal organs ([[brain]], [[lungs]], [[liver]], [[spleen]] and [[kidneys]])
* Papular or ulcerative [[skin lesions]]
* Stillborn infants or death soon after birth
 
''[[L. monocytogenes]]'' is one of the three major causes of neonatal [[meningitis]] worldwide.  The early [[diagnosis]] and treatment of pregnant women infected with ''Listeria'' may lead to the birth of a normal healthy child.<ref name=Mandell>{{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>
 
===Sepsis of Unknown Origin===
Sepsis of unknown origin can ccur in patients of all ages. [[Neonates]] usually tend to acquire the infection during or after [[birth]]. While infection during the first week of life usually manifests as [[sepsis]], infection after the first week of life tends to have more variable manifestations, such as [[meningitis]].
 
Early onset of [[sepsis]] is associated with higher [[neonatal]] mortality. In this case, ''L. monocitogenes'' can be isolated from [[conjunctiva]]e, [[amniotic fluid]], [[meconium]], [[placental]] [[blood]], with higher concentrations of [[bacteria]] in the [[neonatal]] [[lung]] and [[gut]].  These findings suggest that [[infection]] is acquired in [[uterus]] by inhalation of [[infected]] [[amniotic fluid]].<ref name=Mandell>{{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>
 
* Listerial [[meningoencephalitis]] is more common among neonates after 3 days of age, as well as among immunocompromised and elderly adults.
* Adults with Listerial [[sepsis]] are most commonly [[immunocompromised]] or elderly and typically present with fever and chills. [[Septic shock]] can occur with [[brain]] and/or [[meningeal]] involvement, leading to [[meningoencephalitis]] or [[cerebritis]].
 
===Bacteremia===
After the [[neonatal]] period, the most common manifestation of [[listeriosis]] is [[bacteremia]] without any evident focus of [[infection]]. The clinical manifestations may include [[fever]], [[myalgias]], and [[nausea]].


Often times, healthy individuals who experience these manifestations do not have [[blood culture]]s.  Therefore, these individuals a have higher probability of transient [[bacteremias]] going undetected.<ref name=Mandell>{{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>
===Neonates===
*Neonates may be infected either in-utero infection, which manifests with neonatal sepsis or during delivery, which manifests with neonatal meningitis.
*Both infections are usually rapid-occurring, and infected neonates appear sick-looking with greyish-bluish discoloration at birth.
*If left untreated, neonates may develop [[granulomatosis infantiseptica]], a severe in-utero infection, and death.<ref name=Mandell>{{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>


===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]].
*''L. monocytogenes'' has tropism for the [[brain stem]] and [[meninges]].
 
*Patients with ''Listeria''-associated CNS infection typically develop fever followed by altered mental status, seizures, cranial nerve palsy, hemiplegia, and ataxia.<ref name=Mandell>{{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>
[[CNS infection]] is commonly manifested by [[meningoencephalitis]], while [[cerebritis]] is a less common manifestation. In a study from the Massachusetts General Hospital about [[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]], [[liver disease]], [[immunosuppression]], [[steroid]] treatment, [[diabetes mellitus]], and [[HIV]]".<ref name=Mandell>{{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>
*Patients may either develop rhombencephalitis, cerebritis, spinal cord infection, meningitis alone, encephalitis alone, or both (meningoencephalitis).
 
*Patients with ''Listeria''-associated rhombencephalitis typically experience a bi-phasic course. First, patients develop worsening headache, fever, vomiting for a 3-5 days, followed by an abrupt-onset of neurological impairment (cranial nerve palsy, ataxia, altered mental status, seizures).<ref name=Mandell>{{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====
*If left untreated, brain abscesses may develop. The location of the brain abscesses is typically in the [[thalamus]], [[pons]], and/or [[medulla]].
Occurs more frequently in [[neonates]] after 3 days of age, 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, which will present with focal [[neurological]] signs, such as [[cranial nerve]] abnormalities, [[ataxia]], and [[hemiplegia]].
*The majority of patients with advanced CNS disease develop long-term sequelae.
 
====Cerebritis/ Encephalitis====
Evidence of direct hematogenous invasion of [[cerebral]] [[parenchyma]], with or without [[meningeal]] involvement, is probably a sign of an early localized [[infection]] of the [[parenchyma]], which may eventually progress into [[brain abscess]]. [[Cerebritis]] may occur along with [[meningitis]] in the same patient.
In these cases, the clinical picture is dominated by ''altered consciousness'' or ''cognitive disfunction''.  The disease might also manifest as [[fever]] and [[hemiplegia]].<ref name=Mandell>{{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>
 
====Rhombencephalitis====
Rhombencephalitis is a rare manifestation of ''Listeria'' [[CNS infection]], and it most commonly affects healthy individuals through the ingestion of food contaminated with ''Listeria'', often in [[outbreaks]].  Rhombencephalitis often follows a biphasic course, beginning with [[headache]], [[fever]], [[nausea]] and [[vomiting]] for the first 4 days.  This phase is followed by abrupt onset of asymmetric [[cranial nerve]] palsies, [[ataxia]], decreased [[consciousness]], [[seizures]], sensory deficits, and [[respiratory failure]].
 
In this type of the disease, [[mortality]] is high and the survivors likely experience serious [[sequelae]].
 
====Brain abscess====
Most cases occur in high risk patients. The [[subcortical]] [[abscesses]] are mostly located in the [[thalamus]], [[pons]], and/or [[medulla]], sites which are rarely affected by other [[bacteria]].<ref name=Mandell>{{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>.
 
====Spinal cord infection====
Rare cases of [[spinal cord]] involvement have been reported in listeriosis.  When the [[spinal cord]] is affected in the setting of acute [[bacterial meningitis]] of uncertain etiology, ''L. monocytogenes'' should be considered.<ref name=Mandell>{{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]] do not have specific characteristics. These [[infections]] occur more often in [[immunocompromised]] patients, and 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]], similar to [[viral hepatitis]], seen in patients with disseminated [[infections]]
*[[Peritonitis]], seen in [[cirrhosis]] and among continuous ambulatory [[peritoneal dialysis]] patients


===Endocarditis===
===Endocarditis===
Listerial [[endocarditis]] usually leads to [[native valve endocarditis|native]] and [[prosthetic valve]] disease, with an elevated rate of [[septic]] [[complications]]. Listerial [[endocarditis]] alone may be an indicator of a [[GI tract]] abnormality, such as [[cancer]].<ref name=Mandell>{{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>
Listerial [[endocarditis]] may affect either [[native valve endocarditis|native]] or [[prosthetic valve]]s.
*If left untreated, the majority of patients with ''Listeria-associated endocarditis progress to develop bacteremia.<ref name=Mandell>{{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>


==Complications==
==Complications==
[[Immunosuppressed]] patients with [[listeriosis]] are more likely to develop serious [[complications]], such as life-threatening [[bacteremia]] and [[meningoencephalitis]].<ref name="Lorber-1997">{{Cite journal  | last1 = Lorber | first1 = B. | title = Listeriosis. | journal = Clin Infect Dis | volume = 24 | issue = 1 | pages = 1-9; quiz 10-1 | month = Jan | year = 1997 | doi =  | PMID = 8994747 }}</ref>
*Compared with the general population, high-risk patients are more likely to develop invasive disease and ''Listeria''-associated complications.<ref name="Lorber-1997">{{Cite journal  | last1 = Lorber | first1 = B. | title = Listeriosis. | journal = Clin Infect Dis | volume = 24 | issue = 1 | pages = 1-9; quiz 10-1 | month = Jan | year = 1997 | doi =  | PMID = 8994747 }}</ref>
 
*Complications of invasive disease include the following:<ref name=Mandell>{{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><ref name=WHO>{{cite web | title = Listeriosis | url = http://www.who.int/ith/diseases/listeriosis/en/ }}</ref>
Complications of invasive disease include:<ref name=Mandell>{{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><ref name=WHO>{{cite web | title = Listeriosis | url = http://www.who.int/ith/diseases/listeriosis/en/ }}</ref>
* [[Disseminated intravascular coagulation]]
* [[Disseminated intravascular coagulation]]
* [[ARDS]]
* [[ARDS]]
* [[Rhabdomyolysis]]
* [[Rhabdomyolysis]]
* [[Acute Renal Failure]]
* [[Acute kidney injury]]
* [[Septicemia]]<ref name=Gray_1966>Gray, M. L., and A. H. Killinger. 1966. Listeria monocytogenes and listeric infection. Bacteriol. Rev. 30:309-382.</ref>, [[meningitis]] (or [[meningoencephalitis]])<ref name=Gray_1966/>
* [[Septicemia]]<ref name=Gray_1966>Gray, M. L., and A. H. Killinger. 1966. Listeria monocytogenes and listeric infection. Bacteriol. Rev. 30:309-382.</ref>, [[meningitis]] (or [[meningoencephalitis]])<ref name=Gray_1966/>
* [[Encephalitis]]<ref name=Armstrong1993>Armstrong, R. W., and P. C. Fung. 1993. Brainstem encephalitis (Rhombencephalitis) due to Listeria monocytogenes:  case report and review. Clin. Infect. Dis. 16:689-702.</ref>
* [[Encephalitis]]<ref name=Armstrong1993>Armstrong, R. W., and P. C. Fung. 1993. Brainstem encephalitis (Rhombencephalitis) due to Listeria monocytogenes:  case report and review. Clin. Infect. Dis. 16:689-702.</ref>
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:* [[miscarriage|Spontaneous abortion]] (2nd/3rd trimester)
:* [[miscarriage|Spontaneous abortion]] (2nd/3rd trimester)
:* [[Stillbirth]]
:* [[Stillbirth]]
:* Surviving neonates of fetomaternal [[listeriosis]] may suffer from:
:* [[Granulomatosis]] infantiseptica: [[pyogenic]] [[granulomas]] distributed over the whole body, and the newborn may suffer from physical retardation
::* [[Granulomatosis]] infantiseptica: [[pyogenic]] [[granulomas]] distributed over the whole body, and the newborn may suffer from physical retardation
::* [[Influenza]]-like [[symptoms]]: including persistent [[fever]], which usually precedes the onset of the aforementioned disorders
*Reinfection (rare)


==Prognosis==
==Prognosis==
The [[prognosis]] of [[listeriosis]] depends on the health status of the host:<ref name=CDC>{{cite web | title = Listeria | url = http://www.cdc.gov/listeria/definition.html }}</ref>
The [[prognosis]] of [[listeriosis]] depends on the health status of the host:<ref name=CDC>{{cite web | title = Listeria | url = http://www.cdc.gov/listeria/definition.html }}</ref>
* Healthy older children and adults have a lower [[death rate]].
* Healthy children and young adults have a good prognosis and are at low-risk of developing ''Listeria''-associated complications and long-term sequelae.
* [[Listeriosis]] in a [[fetus]] or infant results in a poor [[outcome]] with a high death rate.
* High-risk populations, including pregnant women, neonates, elderly, and immunosuppressed individuals, have a poorer prognosis with a high death rate (even when treatment is administered promptly).
* Even with prompt treatment, some [[listeriosis]] cases result in death. This is particularly likely in older adults and in persons with other medical conditions.


==References==
==References==

Revision as of 19:14, 25 January 2016

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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

Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia. Early clinical manifestations (usually fever) typically develop early within 24 hours of transmission If left untreated, patients typically progress within 1-90 days to develop Listeria-associated complications, including bacteremia, abscess formation, pneumonia, ARDS, acute kidney injury, and CNS impairment. Among healthy children and young adults, the prognosis of listeriosis is generally good. Prognosis is poorer among high-risk populations, who are more likely to develop complications and death even with prompt management.

Natural History

  • Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia.[1]
  • The median incubation period for listeriosis-associated gastroenteritis is approximately 24 hours (range from 6 hours to 10 days).
  • Systemic manifestations of listeriosis may be slow-occurring, and the duration from transmission to development of systemic manifestations widely varies between 1 day to 90 days following transmission.[2][3][4]

Febrile Gastroenteritis

  • Listeria-associated gastroenterities typically occurs 24 hours following ingestion of contaminated food
  • Patients typically manifest with fever, nausea, vomiting, and watery diarrhea.
  • Listeria-associated gastroenteritis is usually self-limited and lasts for a mean of 2 days among healthy individuals.
  • In high-risk patients, systemic manifestations of Listeria may occur, and patients are at higher risk of developing Listeria-associated complications.[1]

Infection in Pregnancy

  • Among pregnant women, listeriosis typically manifests during the third trimester of gestation.[1]
  • Pregnant women typically first present with mild flu-like symptoms, such as fever and chills, that are difficult to diagnose.
  • As the disease progresses, pregnant women typically develop Listeria-associated bacteremia (typically without CNS involvement)
  • If left untreated, listeriosis among pregnant women can result in fetal death, premature birth, or infected newborns.[1]

Neonates

  • Neonates may be infected either in-utero infection, which manifests with neonatal sepsis or during delivery, which manifests with neonatal meningitis.
  • Both infections are usually rapid-occurring, and infected neonates appear sick-looking with greyish-bluish discoloration at birth.
  • If left untreated, neonates may develop granulomatosis infantiseptica, a severe in-utero infection, and death.[1]

CNS Infection

  • L. monocytogenes has tropism for the brain stem and meninges.
  • Patients with Listeria-associated CNS infection typically develop fever followed by altered mental status, seizures, cranial nerve palsy, hemiplegia, and ataxia.[1]
  • Patients may either develop rhombencephalitis, cerebritis, spinal cord infection, meningitis alone, encephalitis alone, or both (meningoencephalitis).
  • Patients with Listeria-associated rhombencephalitis typically experience a bi-phasic course. First, patients develop worsening headache, fever, vomiting for a 3-5 days, followed by an abrupt-onset of neurological impairment (cranial nerve palsy, ataxia, altered mental status, seizures).[1]
  • If left untreated, brain abscesses may develop. The location of the brain abscesses is typically in the thalamus, pons, and/or medulla.
  • The majority of patients with advanced CNS disease develop long-term sequelae.

Endocarditis

Listerial endocarditis may affect either native or prosthetic valves.

  • If left untreated, the majority of patients with Listeria-associated endocarditis progress to develop bacteremia.[1]

Complications

Prognosis

The prognosis of listeriosis depends on the health status of the host:[11]

  • Healthy children and young adults have a good prognosis and are at low-risk of developing Listeria-associated complications and long-term sequelae.
  • High-risk populations, including pregnant women, neonates, elderly, and immunosuppressed individuals, have a poorer prognosis with a high death rate (even when treatment is administered promptly).

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 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.
  2. ↑ Ooi ST, Lorber B (2005). "Gastroenteritis due to Listeria monocytogenes". Clin Infect Dis. 40 (9): 1327–32. doi:10.1086/429324. PMID 15825036.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Lorber, B. (1997). "Listeriosis". Clin Infect Dis. 24 (1): 1–9, quiz 10-1. PMID 8994747. Unknown parameter |month= ignored (help)
  6. ↑ "Listeriosis".
  7. ↑ 7.0 7.1 Gray, M. L., and A. H. Killinger. 1966. Listeria monocytogenes and listeric infection. Bacteriol. Rev. 30:309-382.
  8. ↑ Armstrong, R. W., and P. C. Fung. 1993. Brainstem encephalitis (Rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin. Infect. Dis. 16:689-702.
  9. ↑ Holland, S., E. Alfonso, H. Gelender, D. Heidemann, A. Mendelsohn, S. Ullman, and D. Miller. 1987. Corneal ulcer due to Listeria monocytogenes. Cornea 6:144-146.
  10. ↑ Whitelock-Jones, L., J. Carswell, and K. C. Rassmussen. 1989. Listeria pneumonia. A case report. South African Medical Journal 75:188-189.
  11. ↑ "Listeria".

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