Listeriosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Listeriosis can present in different ways depending on the type of infection, such as: fever, headacheand muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms. Other less common symptoms may include: stiff neck, confusion and convulsions. It has an incubation period which can range from a median of 24 hours, in Listeria gastroenteritis, to a median of 35 days, in Listeria invasive disease. Manifestations of listeriosis are host-dependent. Among older adults and immunocompromised persons the most common clinical presentations are septicemia and meningitis. Pregnant women may experience a mild, flu-like illness followed by fetal loss or bacteremia and meningitis in their newborns. Immunocompetent persons may experience acute febrile gastroenteritis or no symptoms.
History
Symptoms
Although some patients may be transitory carriers of listeriosis, others become symptomatic. Depending on the affected systems, symptoms might include:
Febrile Gastroenteritis
Infection in Pregnancy
Sepsis of Unknown Origin
Bacteremia
CNS Infection
1. Meningoencephalitis Occurs more frequently in neonates after 3 days of age and in immunocompromised and elderly patients. The clinical presentation can range from mild fever and mental status changes, to a more aggressive course with coma. There may also be an encephalic component present, which will present with focal neurological signs, such as:
- Cranial nerve abnormalities
- Ataxia
- Tremors
- Hemiplegia
- Deafness
- Seizures
2. Cerebritis/ Encephalitis Results from direct hematogenous invasion of cerebral parenchyma, with or without meningeal involvement, probably representing an early localised infection of the parenchyma, which might eventually progress into brain abscess. Cerebritis may occur alongside meningitis in the same patient. In these cases, the clinical picture is dominated by altered consciousness or cognitive disfunction, but may also manifest as[1]:
3. Rhombencephalitis Rare manifestation of CNS infection, which affects more commonly healthy individuals through the ingestion of Listeria contaminated food, often in outbreaks. Rhombencephalitis often follows a biphasic course, beginning with:
Which lasts for about 4 days, and is followed by an abrupt onset of:
- Asymetrical cranial nerve palsies
- Ataxia
- Tremor
- Decreased consciousness
- Seizures
- Hemiparesis and/or hemisensory deficits
- Respiratory failure
Mortality is high and the survivors tend to experience serious sequelae.
4. Brain abscess Most cases occur in patients at risk for infection. The subcortical abscesses tend to be located in the thalamus, the pons and/or medulla, sites which are rarely affected by other bacteria.[2].
5. Spinal cord infection Rare cases of spinal cord involvement have been reported. However, if spinal symptoms develop, in the setting of acute bacterial meningitis of uncertain etiology, L. monocytogenes should be considered"[3]. Despite the fact of Listeria being the most common infectious cause of rhombencephalitis, it must be distinguished from other infectious etiologies, such as:
- Herpes simplex encephalities
- Tuberculosis
- Toxoplasmosis
- Cryptococcosis
- Lyme disease
- Epstein-Barr virus
- Brucellosis
- JC virus
There are also noninfectious conditions which may cause brainstem and/or cerebral lesions, such as:
The diagnosis of rhombencephalitis can be delayed by the fact that CSF analysis often reveals only mild abnormalities, but may be demonstrated by Magnetic resonance.
Endocarditis
Listerial endocarditis affects the population at risk for streptococcus viridans endocarditis, producing native and prosthetic valve disease and having an elevated rate of septic complications. Listerial endocarditis alone, may be an indicator of a GI tract abnormality, such as cancer[4].
References
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.