Infectious Disease Compendium

Listeria monocytogenes

Microbiology

Gram positive rod, cold tolerant and tumbling motility. There are around 15 Listeria spp, L. monocytogenes is the main human pathogen.

Epidemiologic Risks

Found in most meats by way of the colon (every creatures last act is to evacuate its bowels and then into/onto its corpse aka dinner), it survives cold. Immunosuppression (AIDS, lymphoma, CLL, steroids), including alcoholism and pregnancy, and age > 50 (PubMed) are important risks as well as eating unpasteurized milk and milk products (like, you know, cheese, including an outbreak from the horribly named headcheese), deli meats, hot dawgs and occasionally fresh vegetables just for any of you vegans (CDC), sometimes leading to hospital outbreaks. The solution? Deep fry everything.

A growing problem in Latin style soft cheeses (queso fresco and cotija)(PubMed).

There have been 8 hospital outbreaks from "sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each) (PubMed)."

"Compared with persons < 65 years with no underlying conditions, those with chronic lymphocytic leukemia had a .1000-fold increased risk of acquiring listeriosis, and those with liver cancer; myeloproliferative disorder; multiple myeloma; acute leukemia; giant cell arteritis; dialysis; esophageal, stomach, pancreas, lung, and brain cancer; cirrhosis; organ transplantation; and pregnancy had a 100–1000-fold increased risk of listeriosis (PubMed)."

Use of ppi's a risk. (PubMed).

Inflammatory bowel disease also a risk: "12.2 bacteremias/100 000 IBD patient-years, compared with 1.6 bacteremias/100 000 person-years, with an odds ratio of 7.4 (PubMed)."

Biologics (like infliximab) are a disease risk, especially if on concomitant steroids or methotrexate (PubMed). Biologics increase the risk for PJP, but for Listeria, Salmonella, and Legionella and it has been suggested that all patients on biologics be on TMP/Sulfa to prevent all of the above (PubMed).

Alemtuzumab, used for CLL, T cell lymphoma and MS, increases the risk of Listeria (PubMed).

Not all Listeria are the same: genotype ST6 has worse outcomes (PubMed).

Syndromes

Bacteremia, meningitis, fatal fetal infection, bacteremia in pregnancy, febrile gastroenteritis (PubMed), rarely endocarditis.

I had a case of prothetic knee infection from eating raw cheese in S. America (Medscape).

In pregnancy there may be certain strains that are prone to causing infection (PubMed).

Treatment

See the note. Ampicillin PLUS gentamicin has been the standard for years; the use of gentamicin is not exactly proven (PubMed). If penicillin allergic either desensitize OR try high dose TMP/Sulfa (4mg/kg q6). Vancomycin is a last ditch treatment. Linezolid works in the test tube, and there are a smattering of successes.

Dexamethasone may not be of use (PubMed) and in one study INCREASED mortality (PubMed).

Duration of therapy: 3 weeks. Less has more relapse

Notes

The probably best way to treat is both ampicillin and TMP/Sulfa.

It can be slow to grow, I have had blood and/or csf cultures pop positive at day 4.

Because it is slow to grow, the csf gram stain may be negative. You will see a single organsim on a high power field at 100,000 cfu/ml.

Listeria subverts the cellular actin system to push itself through the cytosol (PubMed).

Curious Cases

Relevant links to my Medscape blog

Ampicillin Allergy and Listeria

Didn’t See That Coming. Yet Again.

Weird PJI. Part One

Didn't Even Consider It

Didn’t See That Coming. Yet Again.

Total Recall

Fetid Dingos’ Kidneys

That's A Curbside ?!?

Last update: 05/05/18