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.

Late stillbirth due to listeriosis

Listeriosis is a sporadic infectious disease, which affects high-risk populations, such as the elderly, pregnant women, newborns, and immunocompromised patients. During pregnancy, listeriosis usually presents like a mild non-specific infection, but it may be responsible for fetal loss, preterm labor, early onset neonatal sepsis, and neonatal death. We report the case of a late stillbirth secondary to maternal chorioamnionitis. Listeria monocytogenes was isolated from the amniotic fluid and the fetal pleural fluid. The fetal autopsy revealed a disseminated inflammatory response with multi-organ involvement. This case illustrates the importance of the prevention and the diagnosis of listeriosis during gestation and may help us to understand the physiopathology of fetal loss due to listeriosis.

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.

Listeriose: uma doença de origem alimentar pouco conhecida no Brasil / Listeriosis: a foodborne disease not very well known in Brazil

Listeria monocytogenes é um micro-organismo patógeno que surgiu na década de 80, responsável pela doença de origem alimentar chamada listeriose. A listeriose afeta principalmente mulheres grávidas, recém-nascidos, idosos e pessoas imunodeprimidas. Essa doença pode ocasionar abortos, septicemias, meningites e até mesmo óbito nos casos mais graves. A bactéria Listeria apresenta doses infectantes muito baixas possibilitando que uma simples contaminação ou deficiência de processos que visam à eliminação desse micro-organismo ocasionem surtos. A alta taxa de mortalidade desperta atenção especial das autoridades governamentais responsáveis pelo controle sanitário e da comunidade científica da área de alimentos, mas no Brasil não há estatísticas oficiais de casos de listeriose, pois sua notificação não é obrigatória. Nesta revisão procurou-se trazer à luz informações sobre a listeriose, uma doença de origem alimentar ainda pouco conhecida, identificando os alimentos comumente envolvidos nos surtos, os fatores causais mais significativos, assim como as características e impactos sociais relacionados a essa doença. Foram descritos ainda sua etiologia, fatores de riscos, sinais e sintomas. A análise crítica e a divulgação dos principais aspectos relacionados das doenças transmitidas por alimentos pode ser um importante fator para a prevenção dessas doenças.

Vasculitis séptica por Listeria monocytogenes / Septic vasculitis caused by Listeria monocytogenes

Septic vasculitis is a medium and small-vessel vasculitis caused by direct action of pathogens, associated with bacteremia. It is an uncommon condition; clinical manifestations include purpura, ulcers and vesicles-pustules. Most cases of septic vasculitis are related to meningococcemia. There are no cases reported in medical literature associated to Listeria spp. We report a case of a 71 year-old man who presented sepsis by Listeria monocytogenes, and then evolved with purpuric skin lesions. Skin biopsy revealed a septic vasculitis.

La vasculitis séptica es una inflamación de los vasos sanguíneos de pequeño y mediano calibre causada por la acción directa de agentes patógenos en el contexto de una sepsis. Es una condición infrecuente y se manifiesta clínicamente por lesiones cutáneas como púrpura, vesículo-pústulas e incluso úlceras. La mayoría de los casos de vasculitis séptica se asocian a una meningococcemia. No se han reportado casos en la literatura médica de vasculitis séptica secundaria a Listeria spp. Se presenta el caso de un hombre de 71 años, con cuadro de sepsis por Listeria monocytogenes y que presentó lesiones purpúricas con una biopsia compatible con una vasculitis séptica.

Encefalitis del tallo cerebral y mielitis por Listeria monocytogenes / Brainstem encephalitis and myelitis due to Listeria monocytogenes : a case report and literature review

La romboencefalitis por Listeria monocytogenes es una presentación poco común de la listeriosis del sistema nervioso central; sin embargo, es la presentación más común en personas inmunocompetentes. Aun más rara es la combinación de romboencefalitis con mielitis causada por L. monocytogenes ; no obstante, en este artículo se reporta un caso de encefalitis del tallo y mielitis grave en un paciente sin compromiso del sistema inmunitario. Se presenta un paciente de 21 años de edad, sin deficiencias del sistema inmunitario, que consumió productos lácteos no pasteurizados y, posteriormente, presentó un cuadro de cefalea, vómito, deterioro de su estado general y, finalmente, alteración del estado de conciencia y muerte. Consultó al Instituto Neurológico de Colombia y se hizo diagnóstico de encefalitis del tallo y mielitis por L. monocytogenes . Se discuten las diferencias entre el caso presentado y los reportados en la literatura científica. Ante un paciente con signos de compromiso del tallo cerebral, de posible origen infeccioso, es prudente iniciar tratamiento antibiótico para L. monocytogenes y, en caso de poca respuesta, escalar rápidamente en dicho tratamiento. También lo es extender el estudio radiológico hacia la columna vertebral, con el fin de descartar compromiso de la médula espinal.

Brainstem encephalitis caused by Listeria monocytogenes is an uncommon form of central nervous system listeriosis; however, it is the most common presentation in immunocompetent individuals. Here, we describe an even more rare combination of rhombencephalitis with severe myelitis caused by L. monocytogenes in an immunocompetent patient. We report the case of a 21-year-old immunocompetent patient who consumed unpasteurized dairy products and experienced headache and vomiting that progressed to an impaired general condition, altered consciousness and ultimately death. The patient had presented to the Neurological Institute of Colombia (INDEC in Spanish) for consultation and was diagnosed with brainstem encephalitis and myelitis caused by Listeria monocytogenes . The differences between this particular case and those reported in the literature will be discussed. It is advisable to initiate antibiotic treatment for Listeria monocytogenes if a patient shows signs of brainstem compromise of possible infectious origin and quickly intensify treatment if there is no or minimal response. It is also necessary to extend radiological assessment to include the spinal column to rule out spinal cord involvement.

Listeriosis in the far South of Brazil: neglected infection?

Listeriosis is an under-diagnosed and under-reported infection; however, listeriosis is not a compulsorily notifiable disease in Brazil. We provide an overview of the rates of listeriosis in the United States of America (USA), Europe, Latin America, and Brazil during the past decade. We also report a case of miscarriage caused by listeriosis in which there was no suspicion of this infection. This overview and the case we report serve as reminders of the often-neglected threat of listeriosis and its potential to cause miscarriage while highlighting the necessity of recognizing listeriosis as a compulsorily notifiable disease in Brazil.

A Case of Spontaneous Bacterial Peritonitis Caused by Listeria monocytogenes / 대한소화기학회지

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with ascites caused by advanced liver disease. While gram negative bacteria, such as Escherichia coli and Klebsiella pneumonia are the common pathogens, Listeria monocytogenes has been recognized as a very rare pathogen. Empirical treatment with third generation cephalosporins does not provide adequate antibiotics coverage against L. monocytogenes. Diagnosis is often delayed as it requires confirmation from ascitic fluid culture. Herein, we describe the first case of SBP caused by L. monocytogenes in a patient with advanced alcoholic liver cirrhosis in Korea. Clinicians should be aware of the atypical pathogens, especially in patients with inadequate response to empirical antibiotics.

Listeria monocytogenes: ocorrência em produtos lácteos e suas implicações em saúde pública / Listeria monocytogenes: occurrence in dairy products and its implications in public health

Listeria monocytogenes é o agente causador da listeriose, uma grave doença de origem alimentar que causa severas infecções em humanos com altas taxas de mortalidade. O leite e seus derivados estão entre os produtos alimentícios mais frequentemente envolvidos na transmissão de L. monocytogenes. A listeriose acomete, sobretudo, indivíduos imunodeprimidos, grávidas, recémnascidos e idosos, o que ressalta o caráter oportunista deste micro-organismo e sua importância para a saúde pública. No presente trabalho, faz-se uma revisão narrativa crítica sobre o risco à saúde humana decorrente da ingestão de leite e derivados contaminados por L. monocytogenes, bem como se discutem os fatores que determinam a contaminação por L. monocytogenes na cadeia de produção e distribuição de leite e derivados. São apresentados e avaliados os dados de ocorrência de L. monocytogenes em leite cru e em produtos lácteos no Brasil, tendo em vista seu potencial de envolvimento em casos de listeriose humana. Adicionalmente, são indicadas as principais áreas de pesquisa e atuação para prevenir a contaminação de L. monocytogenes em produtos lácteos.

Listeria monocytogenes is the causative agent of listeriosis, a serious foodborne disease that promotes severe human infections with high mortality rates. Milk and byproducts are among the food products most often involved in the transmission of L. monocytogenes. Listeriosis mainly affects immunodepressed individuals, pregnant women, neonates and the elderly, thus emphasizing its opportunistic character and importance to public health. The present article presents a narrative and critical review concerning the risk to human health from the consumption of dairy products contaminated with L. monocytogenes. Also, a discussion is made on the factors that determine the contamination by L. monocytogenes in the production and distribution chain of milk and dairy products. The available data on the occurrence of L. monocytogenes in raw milk and dairy products in Brazil are also presented and evaluated, taking into consideration its potential for involvement in human listeriosis outbreaks. Additionally, this review indicates the main research and work areas needed for the prevention of L. monocytogenes contamination in dairy products.

Métodos diagnósticos para os patógenos alimentares: Campylobacter sp., Salmonella sp. e Listeria monocytogenes / Diagnostic methods for the food pathogens Campylobacter sp., Salmonella sp. and Listeria monocytogenes

Os métodos moleculares de detecção rápida e eficaz de lotes de aves infectados por bactérias como Salmonella sp. Campylobacter sp. e Listeria monocytogenes são importantes para reduzir a frequência da transmissão destes patógenos entre os lotes de aves e aos consumidores de produtos de origem animal. Recentemente, as técnicas de biologia molecular, em especial a reação em cadeia polimerase, que permite a amplificação específica de segmentos de DNA, têm possibilitado novos rumos na identificação de bactérias supracitadas, reduzindo o tempo de cultivo e ampliando a confiabilidade das provas diagnósticas. A utilização da biologia molecular por laboratórios de diagnóstico humano e animal, assim como em programas de controle de qualidade de alimentos e produtos de origem animal, já é realidade e tende a se expandir rapidamente. O objetivo deste artigo é fazer uma breve revisão dos testes diagnósticos convencionais e moleculares para identificar Campylobacter sp., Salmonella sp. e Listeria monocytogenes. Concluindo, o diagnóstico molecular é um campo em avanço científico e tecnológico, no qual novas técnicas moleculares estão em desenvolvimento para o diagnóstico de bactérias em alimentos.

The molecular methods for quick and efficient detection of chicken lots infected by bacteria such as Salmonella sp. Campylobacter sp. and Listeria monoytogenes is basic for the effort to reduce the frequency of the transmission between chicken lots and to the consumers of poultry products. Recently, the development of techniques involving molecular biology, especially polymerase chain reaction, which allows the specific enlargement of segments of DNA, has been making new procedures possible for the identification of the abovementioned bacteria, reducing the time necessary for the tests and enhancing the reliability of the resulting diagnoses. The use of molecular biology in laboratories for human and animal diagnosis, as well as in quality control programs for foods and products of animal origin is already a reality and has tended to expand quickly. The objective of this article is to present a brief review of the conventional diagnostic and molecular tests for the identification of Campylobacter sp., Salmonella sp. and Listeria monocytogenes. In conclusion, molecular diagnosis is a field undergoing scientific and technological advancement, in which new molecular techniques are under development for the diagnosis of bacteria in foods.

Listeriose na gravidez / Listeriosis in pregnancy

Relata-se o caso de uma gestante apresentando febre de origem indeterminada. O resultado da hemocultura identificou Listeria monocytogenes. Fez-se revisão da literaturareferente ao tema.

A case of pregnant patient with undetermined fever of origin is described. The result of blood culture demonstrated Lysteria monocytogenes. A review of the literature was made.

Listeriose como diagnóstico de febre de origem desconhecida em gestantes / Listeriosis as a diagnosis of unknown fever in pregnant women

Listeriose é a denominação de um grupo geral de desordens de transmissão alimentar causadas pela Listeria monocytogenes. Pode simular diversas situações clínicas, dificultando a conduta do médico. Na gestação é pouco considerada, mas relevante enquanto etiologia de perdas gestacionais e posterior acometimento fetal. Geralmente é assintomática, mas pode-se levantar suspeita da doença em gestante febril com sintomas gripais e gastrointestinais, sendo que o diagnóstico definitivo somente é realizado através da cultura sanguínea. Este trabalho tem por objetivo apresentar um caso de listeriose gestacional destacando os principais aspectos desta infecção e orientando quanto ao diagnóstico e tratamento precoces, uma vez que a terapêutica antimicrobiana pode evitar perdas ou sequelas fetais

Listeriosis is the name of a general group of disorders caused by foodborne Listeria monocytogenes. It can simulate various clinical situations, hindering the conduct of the physician. During pregnancy listeriosis is little considered, but it is significant as the etiology of miscarriage and subsequent fetal disease. It is usually asymptomatic, but it can be suspected in pregnant woman with fever and gastrointestinal and flu symptoms, and a definitive diagnosis can only be made by blood culture. This paper aims to present a case of gestational listeriosis highlighting the main aspects of this infection and guiding to early diagnosis and treatment, since antimicrobial therapy may prevent fetal loss or fetal sequelae

Romboencefalitis por Listeria monocytogenes: Patología emergente en relación al brote epidémico. Presentación de tres casos clínicos / Listeria monocytogenes rhomboencephalitis: Report of three cases

An unusual number of cases of rhomb encephalitis have occurred in Chile because of the increased frequency of infections caused by Listeria monocytogenes. We report three females aged 36, 40 and 55 years, with the disease. All presented with a prodrome characterized by headache, nausea, vomiting and fever, followed by ataxia and unilateral palsies of the third, seventh and twelfth cranial nerves. One patient presented also a hemi-hypoesthesia. Magnetic resonance showed lesions in the posterior aspect of the brain stem, specifically in relation to the floor of the fourth ventricle. Blood cultures were positive for Listeria monocytogenes.

Infección del líquido pleural y ascítico por Listeria monocytogenes: caso clínico / Pleural and ascitic fluid infection by Listeria monocytogenes: report of one case

Ascitic and pleural fluids infection by Listeria monocytogenes is uncommon. The association of spontaneous bacterial peritonitis and empyema caused by this microorganism has been seldom reported. A 61 year-old male with an alcoholic cirrhosis and an upper right ¡obectomy for a lung cáncer, consulted because of an exacerbation of dyspnea, abdominal pain and fever. Listeria monocytogenes was isolated from ascitic and pleural fluids and from blood cultures. He was successfully treated with ampicillin and a chest tube for drainage.

Infecciones por Listeria monocytogenes en mujeres embarazadas: experiencia del Hospital Clínico de la Pontificia Universidad Católica de Chile / Listeria monocytogenes infection in pregnaney: experience of Pontificia Universidad Católica de Chile University Hospital

Listeria monocytogenes is Gram-positive facultative intracellular pathogen often foodborne and found elsewhere. It is an uncommon cause of illness in the general population. However, it is an important cause of severe infection in neonates, pregnant women, elderly and immunosuppressed patients. Listeriosis has unique preference for pregnant women. Maternal listeriosis is a diagnostic challenge, and intrauterine infection can lead to severe complications such as amnionitis, preterm labor, spontaneous abortion, stillbirth and neonatal sepsis. From 2001 to 2005, 16 patients with L. monocytogenes were identified in this hospital; four (25 percent) were pregnant women. Clinical and laboratory findings are described. There were 3 preterm deliveries and 1 spontaneous second trimester abortion. Three women with listeriosis had no predisposing factors other than pregnaney. One patient was on immunosupressive drugs for ulcerative colitis. Fever was the most common symptom. Infected neonates were most commonly diagnosed with early-onset listeriosis (two cases) or fetal demise (one case). Pregnaney can be the only risk factor for listeriosis. Listeriosis should be considered during the evaluation of febrile syndrome in pregnaney as this condition can be the only risk factor. Blood and amniotic fluid cultures are useful diagnostic tests. Perinatal complications remains high.

Listeria monocytogenes es un bacilo grampositivo, intracelular facultativo, que se encuentra ampliamente difundido en la naturaleza, frecuentemente en alimentos. Las infecciones afectan principalmente a pacientes inmunocomprometidos, ancianos, mujeres embarazadas y neonatos. La infección intrauterina puede producir importantes complicaciones como corioamnionitis, parto de pre-término, aborto espontáneo de primer o segundo trimestre, mortinatos y sepsis neonatal. En el período 2001-2005, 16 pacientes con infección por L. monocytogenes fueron identificados en nuestro hospital. Cuatro de ellos (25 por ciento) se presentaron en mujeres embarazadas; se describen sus características clínicas y de laboratorio. Hubo tres partos de pre-término y un aborto espontáneo de segundo trimestre. En tres de las cuatro pacientes, el único factor de riesgo fue el embarazo. Una paciente recibía terapia inmunosupresora por una colitis ulcerosa. Fiebre fue el síntoma más frecuente. El compromiso feto-neonatal se manifestó por listeriosis neonatal precoz (dos casos) y mortinato (un caso). El embarazo puede ser el único factor predisponente a desarrollar listeriosis. Ésta debe considerarse en la evaluación del síndrome febril de una mujer embarazada. Los cultivos de sangre y líquido amniótico son útiles para su diagnóstico. La tasa de complicaciones perinatales permanece elevada.

Listeria monocytogenes: informe de un aumento de casos en mujeres embarazadas y revisión de la literatura / Listeria monocytogenes: report of a rise in pregnant women and literature review

Listeria monocytogenes, rare pathogen in the general population, causes serious infections in patients at the extreme ages of life, pregnant woman, and those with immunosuppression. The clinical manifestations are essential to suspect the disease in patients at risk, allowing an early prescription of antimicrobial therapy, before the results of the cultures are available. Clinical course and prognosis depends on how early treatment is started and, in pregnant women, the gestational age. In Clínica Alemana, at Santiago, we detected a 15 fold rate rise of neonatal listeriosis between year 2007 and 2008. Ten cases were diagnosed between January and July 2008 and the seven cases occurring in pregnant women are reported here. All these patients were in their first pregnancy, which could be associated with similar lifestyle and food habits. Considering this new epidemiological scenario, it is important to educate the population, and to conduct an epidemiological study in order to determine the national situation of Listeria monocytogenes infection.

Listeria monocytogenes, es un patógeno poco frecuente en la población general, causante de infecciones graves en pacientes en edades extremas de la vida, mujeres embarazadas e inmunodeprimidos. La sospecha de la enfermedad en pacientes de riesgo se basa principalmente en el cuadro clínico, lo que permite iniciar un tratamiento empírico antes de contar con los resultados de los cultivos. La evolución y pronóstico dependen de la precocidad con que se inicia la terapia y de la edad gestacional. En Clínica Alemana de Santiago detectamos un aumento de 15 veces en la tasa de listeriosis comparando el año 2007 con el 2008. Entre enero y julio 2008, se diagnosticaron 10 casos, de los cuales siete fueron en primigestas, lo que podría tener relación con un hábito alimentario y características de vida similar. Es fundamental, a la vista de esta nueva realidad epidemiológica, educar a la población en hábitos alimentarios y de higiene, como también realizar un estudio epidemiológico que determine la situación nacional de infección por L. monocytogenes.

Bacteriemia primaria por Listeria monocytogenes en paciente con cirrosis hepática: Caso clínico / Primary Listeria monocytogenes infection in a cirrhotic woman: Report of one case

L. monocytogenes infections are infrequent. Sepsis in pregnant women and newborns and central nervous system infections in the elderly are the most common clinical manifestations. We report a 61 years old woman with diabetes Mellitus and a Child B hepatic cirrhosis, admitted for persistent fever. Blood cultures were positive for Listeria monocytogenes. Cerebrospinal fluid was normal and sterile. She was treated with ampicillin and amikacin with a good response. Control blood cultures were negative. She was discharged 14 days after in good conditions.