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$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
     [phone]

     NIH/National Institute of Allergy & Infectious Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Rd.  NE
     Atlanta, GA  30333
     [phone]

     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.