Listeriosis diseminada: a propósito de un caso

La listeriosis es una enfermedad infecto contagiosa, transmitida por los alimentos, prevenible, y potencialmente grave. Las formas clínicas de presentación pueden ser muy variadas, desde una gastroenterocolitis hasta sepsis grave y compromiso multisistémico. Se discute el caso de una mujer joven que se presenta con manifestaciones neuropsiquiátricas y sistémicas subagudas, en contexto febril en la que a través de hemocultivos se llega al diagnóstico de Listeriosis invasiva. Se destaca el compromiso profundo parenquimatoso a forma de abscesos múltiples, como presentación menos frecuente. Se realiza tratamiento médico, antibioticoterapia prolongada, con franca mejoría clínica imagenológica. El diagnóstico de esta enfermedad requiere un alto índice de sospecha, optimizar las herramientas diagnósticas para un correcto relevo bacteriológico y así poder instaurar precozmente la antibioticoterapia.

Listeriosis is an infectious, contagious, foodborne, preventable, and potentially serious disease. The clinical forms of presentation can be very varied, from gastroenterocolitis to severe sepsis and multisystem involvement. We discuss the case of a young woman with subacute neuropsychiatric and systemic manifestations, in a febrile context in which the diagnosis of invasive Listeriosis is reached through blood cultures. Deep parenchymal involvement in the form of multiple abscesses stands out as a less frequent presentation. Medical treatment, prolonged antibiotic therapy, with clear clinical imaging improvement is performed. The diagnosis of this disease requires a high index of suspicion, optimization of diagnostic tools for a correct bacteriological relief and thus early initiation of antibiotic therapy.

A listeriose é uma doença infecciosa, contagiosa, transmitida por alimentos, evitável e potencialmente grave. As formas clínicas de apresentação podem ser muito variadas, desde gastroenterocolite até sepse grave e envolvimento multissistêmico. Discutimos o caso de uma jovem que apresenta manifestações neuropsiquiátricas e sistêmicas subagudas, em um contexto febril em que o diagnóstico de Listeriose invasiva é alcançado por meio de hemoculturas. O envolvimento do parênquima profundo na forma de múltiplos abscessos destaca-se como uma apresentação menos frequente. Realiza-se tratamento médico, antibioticoterapia prolongada, com nítida melhora da imagem clínica. O diagnóstico desta doença requer um alto índice de suspeição, otimização das ferramentas diagnósticas para um correto alívio bacteriológico e, assim, início precoce da antibioticoterapia.

Analysis of 50 cases of bloodstream infection with Listeria monocytogenes / 中国热带医学

@#Abstract: Objective　To analyze the characteristics of bloodstream infection of Listeria monocytogenes and provide basis for the diagnosis and treatment of the disease. Methods　We retrospectively analyzed the cases of Listeria monomyrhosi bloodstream infection in Peking Union Medical College Hospital (PUMCH) from April 2012 to April 2022. The age, sex, onset time, underlying disease, symptoms, diagnosis, treatment and prognosis of the patients were analyzed, as well as the changes of white blood cells (WBC), neutrophils, lymphocytes, and C-reactive protein (CRP) before and after anti-infection treatment. Results　Fifty cases of Listeria monocytogenes bloodstream infection confirmed by blood culture were involved. The age of patients ranged from 0 to 82 (43.7±20.0) years old, among whom 20.0% were over 60 years old. The onset time of patients was the highest in spring (44.0%), followed by winter (24.0%), and relatively fewer in summer and autumn (14.0%-18.0%). The median diagnosis time was 3 days (1-60 days). After the etiological diagnosis, 45 patients (90.0%) had underlying diseases or pregnancy status, and 45 patients were adjusted to the target antibacterial treatment mainly with carbapenems (48.9%) and penicillins (44.4%). The level of WBC, neutrophils, lymphocytes, monocytes, and CRP after treatment were significantly lower than those pre-treatments (P<0.05). Among all patients, 36 cases (72.0%) were treated according to the Antimicrobial Treatment Guidelines for Fever Sanford, of which 26 cases (72.2%) were discharged from the hospital, two cases died, one case was transferred to other hospitals, and 7 cases had a poor prognosis. Conclusions　Autoimmune diseases, tumor diseases, pregnant patients are susceptible to Listeria monocytogenes infection. Penicillins are the first choice for effective empiric therapy. For the patients allergic to penicillins, trimethoprim/sulfamethoxazole or meropenem could be used.

Detection and genotyping of Listeria monocytogenes in artisanal soft cheeses from Ecuador

Abstract Listeria monocytogenes is one of the most important bacteria associated with food-borne diseases, soft cheese being an important L. monocytogenes vehicle. In Ecuador, softcheese is consumed in 84.3% of urban households. We determined the prevalence of L. mono-cytogenes and serogroups in 260 fresh artisanal soft cheese samples collected in 18 of 24Ecuadorian provinces. Listeria spp. detection was carried out by culture-dependent and inde-pendent methods; 14.23% of samples were positive for L. monocytogenes. Serogroup IVb wasfound in 83.78% of the food isolates. Serogroups IIb and IIa were present in 8.11% of our isolates.To our knowledge, this is the first report of L. monocytogenes serogroups associated with foodin Ecuador; we also found serogroup similarities between cheese isolates and clinical isolates.

Resumen Listeria monocytogenes es una de las bacterias más importantes asociadas conenfermedades transmitidas por alimentos, y el queso fresco es un importante vehículo de trans-misión de L. monocytogenes. En Ecuador, el consumo de quesos frescos se produce en el 84,3%de los hogares urbanos. Determinamos la prevalencia de L. monocytogenes y sus serogrupos en260 muestras de queso fresco artesanal recolectadas en 18 de las 24 provincias ecuatorianas.La detección de Listeria spp. se llevó a cabo mediante métodos independientes y dependientesde cultivo; el 14,23% de las muestras fueron positivas para L. monocytogenes.

Submaxilitis aguda bilateral asociada con listeriosis en un paciente inmunodeprimido / Acute bilateral submaxillitis associated to listeriosis in immunosuppressed patient

Acute bilateral submaxillitis is a rare event, except when it is caused by sialolithiasis. It has been described secondary to allergic, infectious, suppurative or viral processes, autoimmune such as Sjögren's syndrome, drugs such as thiopurines, nitrofurantoin, phenylbutazone, captopril, and after upper airway procedures such as upper endoscopy, orotracheal intubation bronchoscopy and ERCP (endoscopic retrograde cholangiopancreatography for choledocholithiasis). Treatment with tumour necrosis factor-alpha (TNF-alpha) antagonist drugs is associated with an increased risk of reactivation of intracellular bacterial infections, so that listeriosis has been described in pathologies that require such treatment, such as rheumatic, dermatological and intestinal diseases, which present other comorbidities or are immunocompromised. Listeriosis mainly causes bacteremia and meningitis, when symptomatic, and infects immunosuppressed persons, where it has a lethality despite 30% antibiotherapy. We present the clinical case of a male immunosuppressed patient, secondary to a treatment with azathioprine and prednisone followed by adalimumab, for indeterminate inflammatory bowel disease, superinfected by CMV, who after eating meat contaminated by Listeria monocytogenes, suffered a picture of listeriosis bacteremia, which improved with antibiotic treatment, followed by a transient acute bilateral submaxillitis, which subsided with symptomatic treatment (oral hydration). It is the only case described in the literature, in which an immunosuppressed patient treated with adalimumab, suffers from acute bilateral submaxillitis in the context of listeriosis, caused by the mumps virus.

La submaxilitis aguda bilateral es un evento raro, salvo cuando está causada por sialolitiasis. Se la ha descrito secundaria a procesos alérgicos, infecciosos, supurativos, virales o autoinmunes como el síndrome de Sjögren; a la administración de fármacos como tiopurinas, nitrofurantoina, fenilbutazona, captopril, y tras procedimientos sobre la vía aérea superior, como endoscopia digestiva alta, broncoscopia, intubación orotraqueal y colangiopancreatografía retrógrada endoscópica por coledocolitiasis (CPRE). El tratamiento con fármacos antagonistas del factor de necrosis tumoral alfa (TNF-alfa) se asocia con riesgo acentuado de reactivación de infecciones bacterianas intracelulares, de forma que se ha descrito la listeriosis en afecciones que requieren dicho tratamiento, como enfermedades reumáticas, dermatológicas y del intestino en sujetos que presentaban otras comorbilidades o estaban inmunocomprometidos. La listeriosis provoca bacteriemia y meningitis predominantemente, cuando es sintomática, e infecta a los sujetos inmunodeprimidos, en los que, a pesar de la antibioticoterapia, tiene una letalidad del 30%. Se presenta el caso clínico de un paciente varón, inmunodeprimido, secundario a tratamiento por azatioprina y prednisona seguido de adalimumab, por enfermedad inflamatoria intestinal indeterminada, sobreinfectada por citomegalovirus, que tras la ingesta de carne contaminada por Listeria monocytogenes, sufrió un cuadro de bacteriemia por listeriosis que mejoró con tratamiento con antibióticos, seguido de submaxilitis aguda bilateral transitoria, que cedió con tratamiento sintomático (hidratación oral). Es el único caso descrito en la literatura en el que un paciente inmunodeprimido tratado con adalimumab presenta submaxilitis aguda bilateral en el contexto de la listeriosis, provocada por el virus de la parotiditis.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Analysis on epidemiological characteristics of Listeriamonocytogenes in patients from Henan province between 2015 to 2020 / 中华检验医学杂志

Objective:To analyze the serology and molecular typing of Listeriamonocytogenes isolated from patients in Henan, and to explore the epidemic situation of listeriosis, construct the molecular traceability database of patient isolates, so as to provide laboratory basis for listeriosis traceability. Methods:From January 2015 to July 2020, 71 positive Listeriamonocytogenes cases were monitored in 16 sentinel hospitals in Henan. Eighty samples of positive cases were collected for detection, and 71 positive strains were obtained for molecular typing. According to the Entry-exit Inspection and Quarantine Industry Standard of China (SN/T 2521-2010) and the instructions for the use of diagnostic serum of Listeriamonocytogenes, 80 strains of Listeriamonocytogenes were serotyped, and PFGE cluster analysis was performed according to the User Manual of National Foodborne Disease Molecular Traceability Network. Results:A total of 71 positive listeriosis cases were detected, of which 38 cases were perinatal cases and 33 cases were non-perinatal cases. Among the 80 positive cases of listeriosis, 58.75% (47/80) were from perinatal cases, 20.00% (16/80) were from non-perinatal cases with underlying diseases, the proportion of>1 month-≤5 years old,>5-≤60 years old and >60 years old was 7.50% (6/80), 12.50% (10/80) and 1.25% (1/80), respectively, in non-perinatal age group. There were 5 types of specimens, 73.75% (59/80) were blood, 15.00% (12/80) were cerebrospinal fluid, and 3.75% (3/80) were stool, intrauterine swab and sputum. 80 strains of Listeriamonocytogenes were classified into three serotypes, Type 1/2b, Type 1/2a and Type 4b accounted for 61.25% (49/80), 35.00% (28/80) and 3.75% (3/80) respectively. The 71 strains of Listeriamonocytogenes were digested by AscⅠ, and 58 bands were obtained. Each band type included 1-4 strains, and the similarity was 60.8%-100%. GX6A16HA0005, GX6A16HA0011, GX6A16HA0030, GX6A16HA0023, GX6A16HA0029 and GX6A16HA0054 were dominant bands, including 4, 4, 4, 3, 2 and 2 strains respectively. Four strains of GX6A16HA0005 from 2016, 2018 and 2020 were isolated. One strain from 2016 and one strain from 2018 were from Puyang City. Four strains of GX6A16HA0011 were isolated from samples of 2016, 2018 and 2020, including two strains of 2020 from Luoyang City. Four strains of GX6A16HA0030 were isolated from 2018 samples from Luoyang City, Shangqiu City and Zhengzhou City, respectively. Three strains of GX6A16HA0023 were isolated from 2017 and 2018 samples, of which one strain from 2017 and one strain from 2018 were from Luoyang City. Two strains of GX6A16HA0029 were isolated from 2018 samples, from Kaifeng City and Puyang City respectively. Two strains of GX6A16HA0054 were isolated from 2020 from Pingdingshan City and Anyang City, respectively. The PFGE patterns of 4 strains with different serotypes were the same. Conclusion:Listeriosis cases in Henan are mainly found in patients during the perinatal period, and in elderly, new-born, and low immunity population. The infection type is mainly invasive infection; the serotypes of epidemic strains are 1/2a, 1/2b and 4b, and the results of PFGE typing of strains are diverse. There is a consistent phenomenon of cross-year or different regions in the same year, different time zones in the same year and the same region; phenotyping and genotyping or different genotyping techniques should be combined in the traceability analysis.

Clinical characteristics of patients with listeriosis / 中南大学学报(医学版)

OBJECTIVES@#To investigate the clinical characteristics of patients with listeriosis and to provide a basis for diagnosis, treatment, prevention and control of hospital infection.@*METHODS@#A total of 10 inpatients, who suffered from the listeriosis in Xiangya Hospital, Central South University from January 2013 to June 2019, were retrospectively collected for this study. The characteristics of the patients' age, gander, basic information, case type, clinical manifestations, first consultation department, days of diagnosis, infection indicator, specimen type, results of drug sensitivity, treatment plan, hospital infection or not, outcome, follow-up data were analyzed.@*RESULTS@#Two cases were pregnant women and other were non-pregnant adults among 10 patients with listeriosis. Among them, there were 3 cases with hospital acquired infection. The age of patient onset was 27-71 years old, and the time from onset to diagnosis was 5-36 days. Five cases had fever, and other 5 cases had not fever. There were headache, fatigue, local pain, and other specialized symptoms in the 10 patients.The white blood cell count,the neutrophil ratio, the inflammatory index C-reactive protein, the procalcitonin were all increased, and the erythrocyte sedimentation was accelerated in the 10 patients.All the patients were sensitive to ampicillin, penicillin G, meropenem, and compound sinomine.@*CONCLUSIONS@#Listeriosis often affects the patients with low immunity, which often leads to misdiagnosis or missed diagnosis in clinic.So early prevention, early diagnosis, and early treatment can reduce mortality; it is important for departments of nosocomial infection management to manage patients' diet for avoiding outbreaks of listeriosis in hospital.

Nervous form of listeriosis in buffaloes / Listeriose nervosa em búfalos

ABSTRACT: Listeriosis is a disease that affects several animal species, including humans, and has three different forms of presentation: encephalic, reproductive, or septicemic. The nervous form is caused mainly by the bacterium Listeria monocytogenes. In Brazil, this disease has already been described in sheep, goats, and cattle. There are no reports of the disease in buffaloes in Brazil and worldwide. The objective of this study was to describe an outbreak of listeric meningoencephalitis in buffaloes in the state of Pará, Brazil. The outbreak occurred in a property located in the municipality of Bujaru, in the eastern Amazon, from May to July 2016. In a herd of 47 buffaloes, three animals (Cases 1, 2 and 3), aged <40 days, presented a neurological condition with locomotion difficulty characterized by paralysis of the four limbs, hypoesthesia, lateral recumbency, and death. Morbidity was 6.38% and lethality was 100%. At necropsy, no significant macroscopic lesions were found. Samples of the central nervous system were collected, fixed in 10% buffered formalin, and routinely processed for histopathological analysis. The main microscopic changes observed were unilateral microabscesses in the brainstem composed predominantly of mononuclear cells, with fewer polymorphonuclear cells, and perivascular cuffs composed mostly of mononuclear cells and few neutrophils. Samples of Cases 1 and 2 revealed Gram-positive bacteria in the areas of necrosis by the Gram's stain technique. Samples of Case 1 were positive in immunohistochemistry for L. monocytogenes. Diagnosis of the nervous form of listeriosis was based on epidemiological data, clinical profile, and immunostaining for Listeria monocytogenes. Results showed that listeriosis should be considered in the differential diagnosis in buffaloes with nervous signs.

RESUMO: A listeriose é uma doença que afeta várias espécies animais, incluindo o homem, e possui três formas diferentes de apresentação: nervosa, abortiva ou septicêmica. A forma nervosa é causada principalmente pela bactéria Listeria monocytogenes. No Brasil a doença já foi descrita em bovinos, ovinos e caprinos, mas não foram encontrados relatos desta doença em búfalos no Brasil e no mundo. O objetivo deste trabalho foi descrever um surto de listeriose nervosa em búfalos no estado do Pará, Brasil. O surto ocorreu de maio a julho de 2016, em uma propriedade localizada no município de Bujaru, na Amazônia Oriental. Três bubalinos de um total de 47 animais (Casos 1, 2 e 3), menores de 40 dias, apresentaram um quadro clínico neurológico caracterizado por dificuldade de locomoção, paralisia dos quatro membros, diminuição da sensibilidade cutânea, decúbito lateral e morte. A morbidade foi de 6,38% e a letalidade de 100%. Na necropsia não foram encontradas lesões macroscópicas significativas. Amostras do sistema nervoso central foram coletadas e fixadas em formalina tamponada a 10% e processadas rotineiramente para análise histopatológica. As principais alterações microscópicas observadas foram microabscessos unilaterais no tronco encefálico, compostos predominantemente por células mononucleares, com menor número de polimorfonucleares, e manguitos perivasculares compostos predominantemente por células mononucleares e poucos neutrófilos. Amostras dos Casos 1 e 2 revelaram bactérias Gram positivas nas áreas de necrose na técnica de Gram. Amostras do Caso 1 resultaram positivas na imuno-histoquímica para L. monocytogenes. O diagnóstico da forma nervosa da listeriose foi baseado nos dados epidemiológicos, no quadro clínico patológico e na imunomarcação para Listeria monocytogenes. Os resultados demostram que a listeriose deve ser considerada no diagnóstico diferencial em bubalinos com sinais nervosos.

Should arboviruses be the only diagnosis hypothesis in pregnant women in endemic areas presenting with a rash?

Abstract Listeria is an unusual pathogen that causes neonatal infection with high morbidity and mortality. We present the case of a premature newborn whose mother had a rash during pregnancy; the newborn had severe early sepsis because of Listeria monocytogenes and histopathologically suggestive findings of the placenta. Obstetricians and neonatologists should suspect listeriosis in cases with compatible epidemiological history, clinical features, and examination findings of the placenta.

Clinical analysis of 26 cases of maternal or neonatal listeriosis / 中华围产医学杂志

Objective@#To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.@*Methods@#A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis.@*Results@#(1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole.@*Conclusions@#There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.

Clinical analysis of 26 cases of maternal or neonatal listeriosis / 中华围产医学杂志

Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.Methods A retrospective analysis of 26 cases of listeriosis,including their demographic and clinical features,was conducted,involving 16 pregnant women from Civil Aviation General Hospital,Xiamen Humanity Hospital,Tongzhou Maternal and Child Health Hospital of Beijing,Beijing Tiantan Hospital,Tangshan Maternal and Child Health Hospital,the Fourth Hospital of Tianshui City from October,2011 to May,2018,and 10 newborns from the Fourth Hospital of Tianshui City,Tangshan Maternal and Child Health Hospital,Zhengzhou Children's Hospital from February,2016 to April 2018.Descriptive methods were used for data analysis.Results (1) Among the 16 gravidas,one,five and 10 developed the infection in the 1st,2nd and 3rd trimester of pregnancy,respectively,and eight had pregnancy complications.Furthermore,all of them developed fever [(38.9± 0.5) ℃].Symptoms such as cough,nasal congestion,runny nose,sore throat,dizziness,headache and other flu-like symptoms were observed in six cases.Gastrointestinal symptoms and flu-like symptoms were presented in four.Fetal distress,tachycardia and decreased fetal movement occurred in 11 cases.Elevated C-reactive protein and white blood cell count were detected in 16 and 14,respectively.Eight underwent placental pathological examination which shown various degrees of pathological changes,including neutrophil infiltration,acute chorioamnionitis and inflammatory necrosis.The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes.Only two delivered at term,while the others (14/16) ended in miscarriage,premature delivery or stillbirth.(2) Among the 10 newborns with listeriosis,there were eight early-onset infections and two late-onset infections.All of them were febrile [(38.6±0.6)℃].Six had cyanosis,groaning,foaming and three concave sign;five showed shortness of breath;meningitis and skin rash were found in one,respectively.All had elevated white blood cell and C-reactive protein.Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment.Four were treated with cephalosporins alone,one of which died after the treatment was withdrawn.One was cured by initial treatment with meropenem alone,while eight recovered after adjustment of treatment with ampicillin,penicillin,meropenem,vancomycin alone,or meropenem combined with ampicillin or vancomycin.(3) The isolates that were susceptible to penicillin,ampicillin and meropenem accounted for 96.1％ (25/26) all together and 88.5％ (23/26) were susceptible to compound sulfamethoxazole.Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis.Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.

Contamination and pathogenicity analysis of listeria monocytogenes in restaurant in Heilongjiang Province / 中华预防医学杂志

Objective@#To study the contamination, serotype, pulsed field gel electrophoresis (PFGE) and drug resistance of listeria monocytogenes (L.monocytogenes) in the process of restaurant kitchens in Heilongjiang Province.@*Methods@#Seventeen typical restaurants were selected from three cities in Heilongjiang Province in 2016, and 590 kitchen samples were collected and tested according to the national standard method. The serotype, pulsed field gel electrophoresis (PFGE) and drug resistance of isolated strains were analyzed.@*Results@#L. monocytogenes was found in 104 of 590 of the samples analysed (17.63%). The isolates belong to six serotypes (1/2 a, 1/2 b, 1/2c, 3a, 3 b, 4 b) and self-condensing bacteria, and 57.38% (70 strains) of the strains belong to serotype 1/2b. Two highly pathogenic serotype 4b was detected for human listeria disease. The results of PFGE analysis show that the bacteria have cross-contamination in the environment, tools, equipment, food and personnel. The drug resistance results showed that 2 strains were resistant to tetracycline, 1 strain was resistant to erythromycin, 13 strains were intermediate to tetracycline, and 2 strains were resistant to tetracycline and erythromycin.@*Conclusion@#There is a certain degree of L. monocytogenes cross-contamination in the catering kitchen in Heilongjiang Province. And an important serotype 4b that can cause human Listeria disease was detected.

Clinical analysis of three cases of listerial rhombencephalitis / 中华神经科杂志

Objective To describe the features of clinical,imaging and cerebral spinal fluid (CSF) of listerial rhombencephalitis to improve the understanding of this disease in clinical practice.Methods All the clinical data of three cases of listerial rhombencephalitis from April to August 2017 in Qilu Hospital were collected and analyzed retrospectively.Results All the three cases were healthy adult women before,with a rapidly progressive course,beginning with fever (38.2-40 ℃),headache accompanied by nausea and vomiting,followed by cranial paralysis,dysphagia and paralysis of the limbs on the 2nd to 5th day of onset,and developed to acute respiratory failure and unconsciousness on the 5th to 8th day of onset.All the three patients were diagnosed with CSF culture positive for Listera monocytogenes on the 3rd to 5th day after admission.The initial CSF lactic acid increased significantly,representing 12.3,12.0 and 10.0 mmol/L respectively;CSF white blood cells were 416× 106/L,760× 106/L and 793× 106/L,respectively,and the protein levels were 0.76 g/L,0.57 g/L and 1.47 g/L,respectively.Brain images showed brain stem was involved in all the three patients,therein cases 1 and 3 with cerebellar hemisphere involved,case 2 with upper cervical spinal cord involved,and case 1 with supratentorial hydrocephalus involved.After treatment with sensitive antibiotics,case 1 recovered,case 2 died,and case 3 lived with dysphagia.Conclusions Listerial rhombencephalitis should be suspected when a patient started with fever and headache,rapidly progressed to cranial nerve paralysis,brainstem symptoms,and acute respiratory failure,especially when the brain imaging suggested brainstem involved with increased white blood cells and apparently elevated lactic acid level of CSF.The earlier the sensitive antibiotics initiated,the better the patients' prognosis.

Detection of Listeria spp. in cattle and environment of pasture-based dairy farms / Detecção de Listeria spp. em gados leiteiros no meio ambiente com base na pastagem

The aim of the study was to detect Listeria spp., particularly Listeria monocytogenes, in cattle and environment of pasture based dairy farms in Paysandú, Uruguay. A two-stage sampling was conducted, 10 farms were selected by probability proportional to size. A single visit was made to each farm. Samples from bovine faeces, feedstuffs, bulk tank milk, drinking water and soil from the entry and exit pens of the milking parlour were collected for bacteriological studies. PCR assays were used to confirm species and determine the serotype profile of L. monocytogenes isolates. AscI-pulsed-field gel electrophoresis was done to genetically compare them. Listeria spp. were isolated from eight of ten dairy farms, whereas L. monocytogenes in three of them. Serotype distribution in L. monocytogenes was as follows: 1/2a, three isolates; 4b, one isolate. L. monocytogenes or L. innocua excreted from clinically healthy milking cows was detected via faeces. In feedstuffs, only one L. monocytogenes 1/2a isolate from a pasture was obtained. The strain was identical by PFGE to an isolate 1/2a obtained from a pool of milking cow feces that grazed on this farm. No isolation of Listeria spp. was retrieved from the bulk tank milk or drinking water from any of the farms. Listeria innocua was detected in 13 feedstuffs and seven samples of soil from the entry and exit pens of the milking parlour. This is a first local study that confirms the presence of Listeria spp. including L. monocytogenes in healthy cattle and environment of pasture-based dairy farms. These results suggest the potential role that healthy cattle and their sub-products would play as a source of these agents for humans and/or others animals. More detailed studies that include genetic comparison of human and animal isolates are required in order to clearly establish the epidemiological relationship.(AU)

O objetivo deste trabalho foi detectar a presença de bactérias do gênero Listeria e particularmente Listeria monocytogenes, em bovinos leiteiros no ambiente de Paysandú, Uruguai. Foi realizada uma amostragem em duas etapas, dez estabelecimentos foram selecionados por probabilidade proporcional ao tamanho. Foi realizada uma única visita a cada propriedade. Foram coletadas amostras para cultura bacteriológica de matéria fecal bovina, além de alimentos, leite do tanque de resfriamento, água e solo na entrada e saída da sala de ordenha. Com os isolados de L. monocytogenes foi realizado PCR para a confirmação da espécie e determinação do perfil do serotipo. AscI-elctroforese em gel de campo pulsado foi realizado para compará-los geneticamente. Listeria spp. foram isoladas de oito de dez estabelecimentos, enquanto L. monocytogenes foram detectadas em três deles. A distribuição dos serotipos nos isolados de L. monocytogenes recuperados foi: 1/2a três isolados, 4b um isolado. Foram detectadas vacas leiteras clinicamente sadias ​​que excretaram L. monocytogenes ou L. innocua nas fezes. Dos alimentos do gado houve só um isolamento de L. monocytogenes 1/2a em uma pastagem. Esta estirpe foi idêntica no PFGE a um isolado 1/2a obtido de uma "piscina" de fezes de vacas leiteiras do mesmo estabelecimento. Não houve isolamento de Listeria no leite do tanque de resfriamento ou na água de nenhum dos estabelecimentos. Listeria innocua foi detectada em 13 alimentos para o gado e sete amostras de solo na entrada e saída da sala de ordenha. Este parece ser o primeiro estudo local que confirma a presença de Listeria spp. incluindo L. monocytogenes em vacas leiteiras sadias e no meio ambiente de propriedades leiteiras com base alimentícia na pastagem. Esses resultados sugerem o potencial de vacas sadias e seus subprodutos como possível fonte desses agentes para humanos e/ou outros animais. São necessários estudos mais detalhados que incluem a comparação genética de isolados humanos e de animais para estabelecer claramente seu relacionamento epidemiológico.(AU)

Septicemic listeriosis: An emerging food-borne illness in India?

Listeriosis is a food borne illness of significant public health concern, caused by consumption of food contaminated by gram negative bacilli, Listeria monocytogenes. Clinical listeriosis is relatively rare and it has varying spectrum of presentation, ranging from severe sepsis in immune-compromised individuals, febrile gastroenteritis and meningo-encephalitis in infants and adults. This disease is under reported in developing nations due to the lack of awareness and inadequate laboratory facilities to promptly isolate and identify the organism. We report a case of sporadic food-borne listeriosis, in an otherwise healthy individual presenting with meningo-encephalitis. Prompt identification and appropriate antibiotic therapy led to a favorable outcome.

Challenging management of chorioamnionitis with placental listeriosis: lessons from 2 cases

Listeriosis is a rare foodborne infection caused by Listeria monocytogenes. It is 12–20 times more prevalent in pregnant women compared to the general population, with a 20–40% mortality rate in neonates. Early treatment with appropriate antimicrobial agents is critical for pregnancy outcomes; however, the infection is difficult to control because the nonspecific clinical manifestations and rarity of the disease often preclude early diagnosis. We encountered 2 cases of pregnancy-associated listeriosis that occurred at 29 and 37 weeks of gestation. Both neonates were delivered by emergent cesarean section due to fetal condition, and one of the preterm infants died immediately after birth. Pregnancy-associated listeriosis should be considered in the management of unexplained fever or inflammatory conditions in pregnant women.

Panorama de la infección por Listeria monocytogenes / Overview of Listeria monocytogenes infection

Resumen La listeriosis es una infección infrecuente pero potencialmente grave, causada por Listeria monocytogenes. La principal vía de transmisión es por el consumo de alimentos contaminados, afecta generalmente a personas mayores, mujeres embarazadas y hospederos inmunosuprimidos, aunque también se ven casos en adultos y niños inmunocompetentes. Listeria monocytogenes es un bacilo grampositivo corto, anaerobio facultativo, no formador de esporas, móvil, que provoca una zona angosta de hemólisis en agar sangre. Es un patógeno intracelular facultativo, por lo que presenta una compleja patogenia. Esta bacteria tiene la habilidad de atravesar la barrera intestinal, la placenta y la barrera hemato-encefálica produciendo cuadros de gastroenteritis, infecciones materno-fetales y meningoencefalitis. Se diagnostica, generalmente, a partir de un cultivo positivo de un sitio estéril. El tratamiento de elección incluye el uso de ampicilina intravenosa sola o en combinación con gentamicina.

Listeriosis is an uncommon but potentially serious infection caused by Listeria monocytogenes. The main route of transmission is through the consumption of contaminated food. It generally affects elderly people, pregnant women and immunosuppressed hosts, although cases are also seen in immunocompetent adults and children. Listeria monocytogenes is a short, anaerobic, non-spore-forming gram-positive bacillus that causes a narrow zone of hemolysis in blood agar. It is a facultative intracellular pathogen, and therefore it shows a complex pathogenesis. This bacterium has the ability to cross the intestinal barrier, the placenta and the blood-brain barrier producing gastroenteritis, maternal-fetal infections and meningoencephalitis. It is most commonly diagnosed from a positive culture of a sterile site. The treatment of choice includes the use of intravenous ampicillin alone or in combination with gentamicin.

Clinical characteristics and antimicrobial susceptibility of neonatal Listeria septicemia / 中华围产医学杂志

Objective To investigate the clinical features and antimicrobial susceptibility of neonatal Listeria septicemia.Methods Eleven cases of neonatal Listeria septicemia that were treated in the Huzhou Maternity and Children Health Hospital from March 2013 to March 2017 were enrolled in this study.Clinical data including the results of bacterial culture,antimicrobial susceptibility test and antibiotic treatment were collected and retrospectively analyzed.Moreover,maternal history of Listeria monocytogenes (LM) infection before delivery was retrieved.Results All of the 11 mothers had fever before delivery and nine of them showed different grades of amniotic fluid contamination during delivery.Clinical symptoms of the 11 neonates included dyspnea (11 cases),fever (ten cases),apnea (nine cases),slow response and feeding difficulty (nine cases),convulsion (six cases),vomiting and abdominal distension (two cases),pulmonary hemorrhage (one case),progressive jaundice (one case) and systemic skin bleeding point (one case).All cases showed abnormal results of blood routine test and increased calcitonin and C-reactive protein.Ten cases received cercbrospinal fluid examination,seven of which were abnormal.Altogether 17 strains of LM were isolated from various specimens.These strains were all sensitive to piperacillin-tazobactam,ampicillin-sulbactam,meropenem,vancomycin,cotrimoxazole,ciprofloxacin and gentamycin,but resistant to oxacillin.Strains those were sensitive to penicillin,ampicillin,erythromycin and clindamycin accounted for 10/17,11/17,9/17 and 8/17,respectively.The 11 neonates were treated with piperacillin-tazobactam,meropenem or vancomycin.All of them improved (11/11)and ten were cured (10/11).All cases were followed up through phone calls at one week and one month after discharge.Two were lost to follow-up,while thc others were all in good condition.Conclusions Neonatal Listeria septicemia is usually a severe disease characterized by rapid progression and mainly presented with dyspnea and fever,besides there is a high possibility of purulent meningitis.Some LM strains are resistant to single-agent penicillin antibiotics.However,antibiotics such as piperacillin-tazobactam,meropenem and vancomycin are effective in the treatment of neonatal Listeria septicemia.

Listeria monocytogenes bacteremia in third trimester of pregnancy:case report with literature review / 中华全科医师杂志

One case of Listeria monocytogenes bacteremia in third trimester of pregnancy admitted in Zhongnan Hospital was reported .And 25 cases of maternal listeriosis were retrieved from domestic literature search up to March 2017.The clinical features of 26 cases were analyzed .The newly reported case was a 27-year-old primigravida at 37 weeks 5 days of gestation presenting with fever for 23 days. Listeria monocytogenes was identified in blood culture .She was treated with intravenous piperacillin sodium and tazobactam sodium for 3 weeks and recovered .At 39 weeks 4 days of gestation, she gave birth of a male baby by vaginal delivery .The newborn baby was healthy with negative Listeria monocytogene in blood culture.The age of onset of all 26 cases was (30.2 ±4.7)years.There were 1, 13 and 12 patients with listeriosis diagnosed in the first, second and third trimester of pregnancy , respectively.The median time from onset to symptom presentation was 2 days.Clinical manifestations included fever (92%,24/26), leukocytosis (75%,18/24), abdominal pain (27%,7/26), fetal movement decrease or lose (23%,6/26) and vaginal bleeding (15%,4/26).Listeria monocytogenes were isolated from blood (11 cases), uterus swab (7 cases), amniotic fluid (2 cases) and so on.High proportion of adverse pregnancy outcomes occurred (88%,22/25).All gravidae recovered well after the termination of pregnancy .The empirical antibiotics did not cover those sensitive to listeria in all patients .Patients with maternal listeriosis often presented with acute fever and a high incidence of adverse pregnancy outcomes , however, empirical antibiotics can hardly cover Listeria monocytogene.Thus, clinicians should improve awareness of listeriosis to avoid missed diagnosis and misdiagnosis .

Clinical analysis of Listeria sepsis in newborns / 中国小儿急救医学

Objective To explore the clinical features and discuss the diagnosis and treatment of neonatal sepsis caused by Lesteria. Methods We collected 22 newborn cases of Listeriosis admitted in neonatal intensive care unit from January 2014 to March 2018. The diagnosis of Listerosis was confirmed by blood culture. The clinical features, assistant examination results, drug sensitivity test and therapeutic effect were analyzed. The prognosis of Listeria sepsis was traced. Results Clinical features included dyspnea (15 cases),fever (3 cases),convulsion(3 cases). Ten cases complicated purulent meningitis,3 cases com-plicated pneumonia and 2 cases complicated shock,1 case complicated with neonatal necrotizing enterocolitis. Laboratory findings showed that white blood cell count ( >25 × 109/L) increased in 7 cases,decreased ( <5 × 109/L) in 5 cases,and C-reactive protein elevated in 21 cases. Head MRI showed intracranial hemorrhage (6 cases),neonatal white matter injury (5 cases) and hydrocephalus (1 case). Drug sensitivity test showed that Lesteria were sensitive to sulfamethoxazole, penicillin and ampicillin. Ten cases were cured, 6 cases improved,and 6 cases died. Conclusion Neonatal Listeria sepsis is a serious infectious disease. It is very important to recognize its early symptoms. Early detection of pathogens and targeted treatment can help improve prognosis and reduce mortality.