Is listeriosis a viral disease?

Symptoms associated with listeriosis may vary widely. Non-pregnant adults most often present with bacteremia (bacteria in the blood), meningitis (infection of the meninges, the membrane surrounding the brain and spinal cord), or meningoencephalitis (infection of the meninges and brain). Common presenting symptoms in patients with bacteremia, meningitis, or meningoencephalitis include fever, muscle aches, headache, stiff neck, malaise, ataxia (loss of balance), convulsions, and mental status changes, such as confusion. Less common clinical syndromes include endocarditis (infection of the lining of the heart), pneumonia, osteomyelitis (infection of the bone), septic arthritis (infection of the joint), abscesses of the brain or liver, peritonitis (infection of the membranes lining the abdominal cavity), and endopthalmitis (infection of structures within the eye). Symptoms secondary to these conditions depend on the anatomical site of infection and may include abdominal pain, bone pain, respiratory distress, pneumonia, and heart failure. Outbreak investigations have demonstrated that listeriosis can cause febrile gastroenteritis, a noninvasive syndrome, in healthy individuals. Patients with febrile gastroenteritis typically experience diarrhea, fever/chills, fatigue, headache, abdominal pain, and nausea.

Listeriosis during pregnancy can result in fetal loss (spontaneous abortion and stillbirth), premature delivery, and neonatal bacteremia or meningitis. Listeriosis may occur at any time during pregnancy; however, it is most often detected in the third trimester. Among pregnant women diagnosed with listeriosis, most reported only mild flu-like symptoms including fever, chills, muscle aches (myalgias), headaches, joint pain (arthralgia), and gastrointestinal symptoms. Some pregnant women do not recall having had any symptoms before the diagnosis of listeriosis in their infant. In contrast to maternal illness, fetal and newborn infections are serious. Nearly one-quarter of pregnancy-associated cases result in fetal loss or death of the newborn. Infants with listeriosis (neonatal listeriosis) may present with fever, lethargy, irritability, diarrhea, poor feeding, vomiting, respiratory distress, or a characteristic skin rash consisting of widely spread, small, pale nodules (granulomatosis infantiseptica). Neonatal listeriosis may be classified as early-onset or late-onset. Early-onset neonatal listeriosis, which occurs in the first 7 days of life, is most often associated with bacteremia or sepsis. Early-onset infections occur following maternal bacteremia with transplacental transmission before birth. Late-onset neonatal listeriosis is most often associated with meningitis. The mode of transmission is less clear in late-onset listeriosis; environmental sources may be involved in some cases, and outbreaks of hospital-acquired, neonatal listeriosis have been reported.

Listeriosis is caused by the bacterium L. monocytogenes. Nearly all cases of listeriosis (other than neonatal listeriosis) occur from eating contaminated food products, especially ready-to-eat, refrigerated foods. Unlike most foodborne bacterial pathogens, L. monocytogenes can grow at refrigeration temperatures. Listeria organisms are commonly found in the environment, including in water, soil, mud, and decaying vegetation. L. monocytogenes can be introduced into abattoirs and food manufacturing plants, which results in the contamination of food products such as meat or dairy products, raw produce, and processed foods. Numerous outbreaks have been traced to contaminated food products such as unpasteurized or improperly pasteurized milk, soft cheeses, and dairy products, hot dogs, turkey delicatessen meats, and cantaloupe.

Although L. monocytogenes exposures are common, the interaction of several factors is thought to play a role in the development of invasive disease. These factors include the number of bacteria a person consumes (dose), the virulence of the bacterial strain, and the functioning of the patients immune system.

Invasive listeriosis usually affects pregnant women and their unborn fetuses, newborn infants, older adults, and individuals with weakened immune systems (immunocompromised). Medical risk factors for invasive listeriosis include hematologic malignancy, organ transplantation, HIV infection or AIDS, alcoholism, and liver and kidney disease. In the United States, L. monocytogenes accounts for ~5% of all cases of bacterial meningitis in infants <2 months of age and ~10% of all cases of bacterial meningitis in people 65years of age. Invasive listeriosis occurs very infrequently in young, healthy adults. Overall rates of invasive listeriosis in the United States have remained relatively constant over the past decade (~3 cases per million population), as measured where active surveillance for listeriosis has been conducted.

Symptoms of the following disorders can be similar to those of listeriosis. Comparisons may be useful for a differential diagnosis:

The differential diagnosis of listeriosis includes all causes of meningitis or sepsis in newborn infants, such as group B streptococcus infection; all causes of meningitis and encephalitis in older adults and in individuals with weakened immune systems; and all causes of febrile illness during pregnancy, including viral syndromes.

Group B streptococcus (group B strep) is a type of bacteria that causes infection among newborns, pregnant women, or women after childbirth, women after gynecologic surgery, and older men and women with other serious diseases. Group B strep remains the most common cause among newborns (neonates) of infection of the blood and of the brain. The responsible bacterium, usually Streptococcus agalactiae, may be found most often in the vagina and rectum of females and may be transmitted as the infant passes through the birth canal. Group B strep disease is said to be early onset if it is obvious within the first week of life. It is said to be late onset if the disease is evident after the first week of life and before the end of the first three months. (For more information on this disorder, choose Group B streptococcus as your search term in the Rare Disease Database.)

Bacterial meningitis is a central nervous system infection caused by certain types of bacteria. Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord. Inflammation can begin suddenly (acute) or develop gradually (subacute). Major symptoms may include fever, headache, and a stiff neck, sometimes with aching muscles. Nausea, vomiting and other symptoms may occur. Five types of bacteria are responsible for most cases of bacterial meningitis: Haemophilus influenzae, Streptococcus pneumoniae (pneumococcus), Group B streptococcus, Neisseria meningitidis (meningococcus), and Listeria monocytogenes (Listeria). (For more information on this disorder, choose meningitis as your search term in the Rare Disease Database.)

A diagnosis of invasive listeriosis is confirmed through laboratory tests called cultures, which confirm the presence of L. monocytogenes in the body by isolating the bacteria from a clinical specimen. Cultures of blood, amniotic fluid, cerebrospinal fluid, placenta, or specimens from any affected organ systems may be performed to determine whether the bacterium L. monocytogenes is present. Certain x-ray tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) might be used to detect abscesses that may form on internal organs, especially the brain or liver.

Treatment
Listeriosis is treated with antibiotics. The most commonly prescribed treatment is intravenous ampicillin. Many physicians also recommend treatment with the antibiotic gentamicin in combination with ampicillin. For affected individuals who cannot tolerate B-lactam antibiotics (such as ampicillin), trimethoprim-sulfamethoxazole is recommended. Other antibiotics are sometimes recommended. Antibiotic treatment of pregnant women with documented listeriosis may prevent infection of the fetus. L. monocytogenes is resistant to all third generation cephalosporins. Other treatment is symptomatic and supportive.

Prevention
Knowing what foods to avoid and how to safely prepare and store foods is the best way to reduce the risk of listeriosis. This information is most important for those persons in groups at higher risk for invasive listeriosis, especially pregnant women, older adults, and persons who have weakened immune systems.

Recommendations for persons at higher risk for listeriosis: Do not eat or drink raw (unpasteurized) milk or other dairy products. Do not eat soft cheeses such as Brie, feta, and Mexican-style cheeses, unless they are labeled as made from pasteurized milk. Additionally, be aware that Mexican-style soft cheeses and other Latin-style soft cheeses made from pasteurized milk have also caused listeriosis. Reheat leftovers, prepackaged foods, and deli meats until steaming hot. Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole, or unless it is a canned or shelf-stable product.

Recommendations for everyone: prevent listeriosis and other foodborne diseases, thoroughly cook all raw foods of animal origin, such as meat, because heat kills L. monocytogenes. Wash fruits and vegetables thoroughly if eating raw. Follow recommended sell by or best if used by labels on processed foods. Keep unwashed and uncooked foods separate from foods that have been already prepared for eating.

The following resource provides additional information:
https://www.cdc.gov/listeria/prevention.html

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For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

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Some current clinical trials also are posted on the following page on the NORD website:
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For information about clinical trials sponsored by private sources, contact:
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For information about clinical trials conducted in Europe, contact:
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TEXTBOOKS
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JOURNAL ARTICLES
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Silk BJ, Date KA, Jackson KA, et al. Invasive Listeriosis in the Foodborne Diseases Active Surveillance Network (FoodNet), 20042009: Further Targeted Prevention Needed for Higher-Risk Groups. Clin Infect Dis 2012;54: S396S404.

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Jackson KA, Biggerstaff M, Tobin-DAngelo, Sweat D, Klos R, Nosari J, Garrison O, Boothe E, Saathoff-Huber L, Hainstock L, Fagan RP. Multistate outbreak of Listeria monocytogenes associated with Mexican-style cheese made from pasteurized milk among pregnant, Hispanic women. J Food Prot. 2011;74(6):949-53.

Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A; Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.

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INTERNET
Centers for Disease Control and Prevention. Listeriosis. www.cdc.gov/listeria Updated June 29, 2017. Accessed August 20, 2018.

Zach T. Listeria Infection. Medscape. http://www.emedicine.com/ped/topic1319.htm Updated: Jan 09, 2018. Accessed August 20, 2018.

Weinstein KB. Listeria Monocytogenes. Medscape. http://emedicine.medscape.com/article/220684-overview Updated: Dec 01, 2017. Accessed August 20, 2018.

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