$Unique_ID{BRK03943} $Pretitle{} $Title{Listeriosis} $Subject{Listeriosis Listeria Infection Neonatal Listeriosis Perinatal Listeriosis Listeria Meningitis Listeriosis of Pregnancy Granulomatous Infantiseptica Listeria Sepsis Listeria Meningoencephalitis Salmonellosis Botulism} $Volume{} $Log{} Copyright (C) 1989, 1992 National Organization for Rare Disorders, Inc. 601: Listeriosis ** IMPORTANT ** It is possible that the main title of the article (Listeriosis) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Listeria Infection Neonatal Listeriosis Perinatal Listeriosis Listeria Meningitis Disorder Subdivisions: Listeriosis of Pregnancy Granulomatous Infantiseptica Listeria Sepsis Listeria Meningoencephalitis Information on the following diseases can be found in the Related Disorders section of this report: Salmonellosis Botulism General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Listeriosis is a disorder caused by a bacterial infection (Listeria monocytogenes) transmitted to humans through contaminated food products, usually improperly pasteurized milk or cheese. Some cases have been transmitted through contact with other infected persons or animals. Cases range in severity from a transient carrier state with no apparent symptoms, to acute suddenly occurring (fulminant) spread of bacteria throughout the blood stream (septicemia). Many factors may contribute to development of symptoms which are not well understood. However, prompt recognition and treatment of the disease is necessary to avoid complications. Symptoms Listeriosis can occur in different forms including a carrier state with no symptoms (asymptomatic), listeriosis of pregnancy, granulomatous infantiseptica, listeria sepsis, listeria meningoencephalitis, and localized listeria infections. Most forms of Listeriosis are primarily characterized by flu-like symptoms. Listeriosis of pregnancy may exhibit no symptoms or may be marked only by a fever and back pain. This condition can be mistaken for a bacterial infection of the kidney (pyelonephritis). The diagnosis can be confirmed by a blood test. Most commonly occuring during the last three months of pregnancy, this infection can seriously affect the fetus, even though many cases have been documented without fetal damage. Granulomatous Infantiseptica results from Listeria infection transmitted from a pregnant woman to the fetus through the membrane connection (placenta) before birth. This form of Listeriosis is characterized by widespread abscesses and abnormal grainy tissue (granulation) in internal organs of the infant. Babies should be treated promptly if this disease is suspected. Cultures of blood, spinal fluid and intestinal discharges of the newborn infant (meconium) should be tested for the presence of the bacterial infection (listeria monocytogenes) to confirm the diagnosis. Skin and/or eye infections may be associated with Granulomatous Infantiseptica. Listeria Sepsis may occur in infants infected during vaginal delivery or in immunosuppressed adults. The presence of the bacteria (listeria monocytogenes) can be determined by a blood culture. Flu-like symptoms and lowered blood pressure (hypotension) occur. Marked reduction in blood platelets necessary for clotting (coagulation) with reduction in other clotting factors, occur as a result of widespread clotting inside veins (consumptive coagulopathy). Listeria Meningoencephalitis can occur in immunosuppressed patients or newborns. Persons with cirrhosis of the liver, or those with no apparent disease may also contract this form of Listeriosis. The onset may be gradual or acute and sudden, with lack of appetite (anorexia), abnormal tiredness (lethargy), behavioral changes and/or low-grade fever. Throat infection (pharyngitis), middle ear infection (otitis media), and cranial nerve palsies may be present. Signs of inflammation of the membranes surrounding the brain and spinal cord (meningitis) and inflammation of the brain (encephalitis) may also be found. This disorder may be mistaken for viral (aseptic) meningitis. Localized listeria infection may follow direct contact with the listeria monocytogenes bacteria on the skin or eyelids (conjunctiva). Other cases may result from the presence of the bacteria in circulating blood (bacteremia). In these cases inflammation of joints (arthritis), inflammation of bone marrow and adjacent bone (osteomyelitis), inflammation of the membrane lining the heart (endocarditis), or inflammation of the membrane lining the abdominal cavity (peritonitis) may occur. Causes Listeriosis is caused by the infectious bacteria "listeria monocytogenes". Several epidemics have been traced to ingestion of contaminated food products such as improperly pasteurized milk, cheese, unwashed vegetables, and raw meat. This common bacteria is found worldwide in soil, water, and dust, and in the meat of many wild and domestic animals. Fecal matter has been found to contain the bacteria, and it has been cultured in the human vagina in females and urethra in males. Infants have contracted the infection from infected mothers through the connecting membrane (placenta) or by the presence of the bacteria in the vagina at the time of delivery. Affected Population Listeriosis occurs most often in the summer months. It is found most commonly in patients whose immune system is suppressed, newborns, the elderly, and pregnant women. An epidemic in California in 1985 affected nearly 200 persons and was attributed to contaminated cheese manufactured in Mexico. According to the Centers for Disease Control in Atlanta, GA, approximately 1,850 cases occur and 425 deaths result from Listeriosis each year in the United States. Related Disorders Symptoms of the following disorders can be similar to those of Listeriosis. Comparisons may be useful for a differential diagnosis: Salmonellosis is an infectious food-borne bacterial disorder caused by any of the ten identified types of salmonella bacteria. This disorder occurs worldwide. In the United States the major reservoirs of infection include poultry, reptiles and insects. Infection can be transmitted from animal-to- animal or human-to-human by ingestion of contaminated food or water, or by bulk handling of food in slaughter houses or processing plants. Salmonella infections can occur in epidemics usually attributable to specific food- related sources. This disorder is the most common cause of outbreaks of food-borne bacterial infection. Symptoms of Salmonellosis include acute gastrointestinal inflammation (gastroenteritis), fever, or localized infection with or without blood poisoning (septicemia). Botulism is an infection caused by a bacillus known as clostridia botulinum that is transferred to humans through contaminated food. Improperly canned low-acid fruits and vegetables, fish and fish products, or relishes and chili peppers are responsible for the vast majority of cases, which statistically occur most often during the summer and fall. Restaurant- associated outbreaks have also occurred. (For more information on this disorder, choose "Botulism" as your search term in the Rare Disease Database.) The first symptoms of botulism can appear between six hours and eight days after ingestion of the contaminated food, although most cases begin after eighteen to thirty six hours. The severity of the illness is inversely proportional to the length of the incubation period. Initial symptoms are gastrointestinal including nausea, vomiting, abdominal cramps or diarrhea. In some cases, blurred or double vision, disturbance of muscles used for speaking (dysarthria), or difficulty in swallowing (dysphagia) may occur. Muscle weakness, and in severe cases, breathing difficulty can also develop. Fatigue, dizziness, sore throat, and unusual sensations (paresthesias) have also been reported. Rapid treatment is required to avoid severe complications. Wound botulism has been caused by the presence of the toxin in soil which enters the body through breaks in the skin, or the sharing of contaminated needles by drug abusers. In these cases, the gastrointestinal problems do not occur. Therapies: Standard Prevention is the most important way to combat the spread of Listeriosis. Cook all foods of animal origin thoroughly. Cooking kills the organism that causes the disease. Keep hot foods hot, above 145 degrees F. Wash fruits and vegetables thoroughly before eating if eating raw. Keep cooked and uncooked foods apart. Do not eat or drink raw (unpasteurized) milk or milk products. Keep away from soft cheeses. Keep all cooking utensils washed as well as keeping your hands clean. This advice is importrant for avoiding other types of food poisoning as well as Listeriosis. This information is most important for those persons of high risk groups such as pregnant women and persons who are immunosuppressed. The treatment of choice for Listeriosis usually includes the antibiotic drugs penicillin, penicillin G, or ampicillin with or without aminoglycosides (gentamicin, tobramycin, amikacin, or netilmicin). Alternative therapies include Trimethoprim/Sulfamethoxazole, tetracycline, erythromycin, chloramphenicol, or cephalothin. Penicillin in conjunction with ampicillin and the aminoglycosides may be more effective than penicillin alone. Other treatment is symptomatic and supportive. Therapies: Investigational Scientists are studying the factors that lead to Listeriosis in humans including the degree of infectiousness, the severity of the resulting disease as well as the high susceptibility of some individuals to contract the illness. When these factors are better understood, measures may be developed to prevent and better treat patients. Additionally, new tools called "DNA Probes" to help prevent outbreaks of Listeriosis are under investigation. DNA Probes can detect the presence of the Listeria monocytogenes bacteria in food samples usually in only two days, whereas conventional methods take much longer. New pasteurization procedures are also being studied which may be able to help control or prevent the presence of the Listeria monocytogenes bacteria in milk and milk products. This disease entry is based upon medical information available through June 1992. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Listeriosis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy & Infectious Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Rd. NE Atlanta, GA 30333 (404) 639-3534 Food & Drug Administration (FDA) Office of Consumer Affairs 5600 Fishers Lane (HFE-88) Rockville, MD 20857 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 1657-1658. PERINATAL LISTERIOSIS (EARLY-ONSET): CORRELATION OF ANTENATAL MANIFESTATIONS AND NEONATAL OUTCOME: M. Boucher, et al.; Obstet Gynecol (November 1986, issue 68(5)). Pp. 593-597. CLINICAL MANIFESTATIONS OF EPIDEMIC NEONATAL LISTERIOSIS: A.J. Teberg, et al.; Pediatr Infect Dis J (September 1987, issue 6(9)). Pp. 817-820. LISTERIA: BATTLING BACK AGAINST ONE 'TOUGH BUG': K.J. Skinner; FDA Consumer (July-August 1988). Pp. 12-15.