Listeriosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Clinical syndromes caused by Listeria monocytogenes include: infection in pregnancy, neonatal infection, bacteremia, central nervous system infection (meningitis, encephalitis, rhombencephalitis, brain abscess, spinal cord infection), endocarditis, localized infection, and febrile gastroenteritis.

Classification

Clinical syndromes of listeriosis include:

• Infection in pregnancy: Listeria can proliferate asymptomatically in the vagina and uterus. If the mother becomes symptomatic, it is usually in the third trimester. Symptoms include fever, myalgias, arthralgias and headache. Abortion, stillbirth, and preterm labor are complications of genitourinary infection.

• Neonatal infection (granulomatosis infantisepticum): There are two forms. One, an early-onset sepsis, with Listeria acquired in utero, results in premature birth. Listeria can be isolated in the placenta, blood, meconium, nose, ears, and throat. Another, late-onset meningitis is acquired through vaginal transmission, although it also has been reported with caesarean deliveries.

• Central nervous system infection: Listeria has a predilection for the brain parenchyma, especially the brain stem, and the meninges. Mental status changes are common. Seizures occur in at least 25% of patients. Cranial nerve palsies, encephalitis, meningitis, meningoencephalitis, spinal cord infection, or brain abscess may occur.

• Gastroenteritis: Listeria monocytogenes can produce food-borne diarrheal disease, which typically is noninvasive. The median incubation period is 1-2 days, with diarrhea lasting anywhere from 1-3 days. Patients present with fever, muscle aches, nausea, diarrhea, headache, stiff neck, confusion, loss of balance, or convulsions.

• Bacteremia: Symptoms of listerial bacteremia include a prodromal illness with fever, myalgia, nausea, or diarrhea. Bacteremia can be transient and undetected in healthy subjects.

• Endocarditis: Listerial endocarditis occurs in about 7.5% of adult listeriosis and affects both native and prosthetic valves. Endocarditis caused by Listeria monocytogenes may be suggestive of underlying gastrointestinal tract pathology, including malignancy.

• Localized infection: Localized infections are rare and may result from direct inoculation or bacteremic spread.