Listeriosis

Last reviewed: December 2018

Last updated: November 2018

Summary

A gram-positive bacterial infection that affects neonates, pregnant women, adults over 45 to 50 years of age, and immunocompromised people.

Mainly a food-borne disease. Prevention consists of hand hygiene, cooking food well, and avoiding unwashed and leftover food.

Recent outbreaks have been reported in Australia, where the source was thought to be cantaloupe melons, and in Europe, where the source was reported to be frozen vegetables.

Bacteremia, sepsis, meningitis, encephalitis, brain abscess, endocarditis, and gastroenteritis are the most common clinical manifestations.

Cultures from clinically sterile sites and serologic tests are the keys for laboratory diagnosis.

Ampicillin is the preferred drug for initial treatment for systemic (nongastroenteritis) manifestations. Gastroenteritis alone is usually self-limited.

Definition

Listeriosis is a food-borne infection caused by a motile, nonspore-forming, gram-positive bacillus. Its incidence is relatively low in the general population. [1]

History and exam

Key diagnostic factors

headache
altered mental status

Full details

Other diagnostic factors

fever
diarrhea and abdominal pain
generalized malaise
flu-like symptoms in pregnancy
poor feeding (neonates)
meningismus
cranial nerve deficits
cerebellar signs
focal neurologic signs
seizures
hypotension
intrapartum fever
bleeding diathesis with hemorrhage
cardiac murmur

Full details

Risk factors

exposure to contaminated food
age >45-50 years
pregnancy
neonates
immunocompromised states
impaired stomach acidification

Full details

Diagnostic investigations

1st investigations to order

CBC
urine pregnancy test
blood cultures
brain MRI
brain CT
cerebrospinal fluid (CSF) analysis

Full details

Investigations to consider

prothrombin time (PT) and PTT
D-dimer
placenta and amniotic fluid culture
cervical swab culture
meconium Gram stain and culture
Listeria serology
food analysis
stool culture
other stool analyses
electroencephalogram
echocardiography

Full details

Emerging tests

polymerase chain reaction of blood

Full details

Treatment algorithm

ACUTE

systemic infection: not gastroenteritis or meningitis/meningoencephalitis

meningitis/meningoencephalitis

Contributors

Authors VIEW ALL 

Petros M. Karsaliakos, MD, FRCP, MSc

Honorary Clinical Senior Lecturer

Glasgow University

Consultant in Acute and General Medicine

Monklands Hospital

NHS Lanarkshire

Scotland

Disclosures

PMK declares that he has no competing interests.

Eleftherios Mylonakis, MD, PhD, FIDSA

Professor

Infectious Diseases Division

Massachusetts General Hospital and Harvard Medical School

Boston

Disclosures

EM is an author of several references cited in this topic. He has also received grant support from T2 Biosystems, Astellas Pharma, and Boehringer Ingelheim. In addition, he is a member of Astellas Pharma.

Peer reviewers VIEW ALL 

Josiah D. Rich, MD, MPH

Professor of Medicine and Community Health

Brown University

Providence

Disclosures

JDR declares that he has no competing interests.

Alistair Leonord, MBChB, BSc, MRCPath, MD, DTM&H

Professor

Infection and Immunity

Consultant Microbiologist

Bacteriology Dept

Southern General Hospital

Glasgow

Disclosures

AL declares that he has no competing interests.

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Listeriosis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

gastroenteritis

systemic infection: not gastroenteritis or meningitis/meningoencephalitis

meningitis/meningoencephalitis

Contributors

Authors VIEW ALL 

Petros M. Karsaliakos, MD, FRCP, MSc

Disclosures

Eleftherios Mylonakis, MD, PhD, FIDSA

Disclosures

Peer reviewers VIEW ALL 

Josiah D. Rich, MD, MPH

Disclosures

Alistair Leonord, MBChB, BSc, MRCPath, MD, DTM&H

Disclosures

Differentials

Guidelines

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