Listeria

Reviewed and revised 4 July 2014

OVERVIEW

  • Listeria monocytogenes is non-endospore forming, regular, non-branching gram positive bacilli that grows in aerobic and anaerobic conditions
  • Listeriosis may resemble influenza or gastroenteritis but can be fatal and often occurs in outbreaks affecting the immunocompromised especially
  • accounts for 20-65% of all deaths in the USA from foodborne illness

TRANSMISSION

  • most common routes of transmission:
    – via food source
    – vertical transmission from mother to child
  • found widely in the environment in soil, decaying vegetation and water
  • outbreaks often related to contamination of cheese, cabbage, milk, deli meats and centralised production of ready-to-eat foods
  • can be found in faecal flora of mammals including humans and spread by contact
  • can grow at refrigerator temperatures (4°C to 10°C) and is resistant to freezing; killed by pasteurisation

RISK FACTORS

For severe forms of listeriosis

  • >60 years-old
  • pregnancy
  • newborms
  • immunocompromised
    • organ transplantation
    • immunosuppressant drugs e.g. corticosteroids, TNFR antagonists
    • cancer
    • diabetes mellitus
    • chronic renal failure
    • alcoholism
    • debilitation

CLINICAL FEATURES

  • onset 2-70 days post-exposure to contaminated food
  • Initial symptoms of infection include nonspecific flu-like symptoms, nausea, vomiting, cramps, diarrhea and fever
  • self-limiting illness in most healthy adults
  • may progress to severe illness: septic shock, ARDS, and/or meningoencephalitis
  • joint infections and endocarditis are rare
  • pregnant women may have mild-moderate severity infection, but have an increased risk of miscarriage and preterm labour
  • newborns may present with sepsis in the first 24 hours (early onset Listeriosis) or may present with delayed irritability and poor feeding (late onset)

INVESTIGATIONS

  • gram stain: gram positive bacilli (non-branching)
  • blood cultures
  • stool cultures if diarrhoea

MANAGEMENT

Resuscitation

  • attend to ABCs

Antibiotics

  • First line: penicillin G or amoxycillin
  • Alternatives: cotrimoxazole, meropenem, Linezolid-Rifampicin

Supportive care and monitoring

Consults

  • infectious diseases
  • obstetrics / neonatology

Prevention

Notifiable disease

PROGNOSIS

  • 10 to 50% mortality (highest in newborns)

References and Links

Journal articles

  • Bortolussi R. Listeriosis: a primer. CMAJ. 2008 Oct 7;179(8):795-7. PMC2553879

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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