Background
Listeria monocytogenes, which causes listeriosis, is an important pathogen in pregnant patients, [1] neonates, elderly individuals, and immunocompromised individuals, although it is an uncommon cause of illness in the general population. [2, 3] Patients with cancer, particularly those of blood, also are at high risk for listeriosis. [4]
Electron micrograph of an artificially colored Listeria bacterium in tissue.
It typically is a food-borne organism. [5] Listeria infection ranks as the third leading cause of mortality from foodborne illnesses in the United States, and there are 1,600 cases of Listeria infection and 260 fatalities due to the infection each year. [3]
Listeria also is a common veterinary pathogen, being associated with abortion and encephalitis in sheep and cattle. It can be isolated from soil, water, and decaying vegetation.
The most common clinical manifestation is diarrhea. A mild presentation of fever, nausea, vomiting, and diarrhea may resemble a gastrointestinal illness. [2, 6]
The microorganism has gained recognition because of its association with epidemic gastroenteritis. In 1997, an outbreak of noninvasive gastroenteritis occurred in 2 schools in northern Italy, involving more than 1500 children and adults. [7]
Bacteremia and meningitis are more serious manifestations of disease that can affect individuals at high risk. Unless recognized and treated, Listeria infections can result in significant morbidity and mortality. [2]
Pathophysiology
L monocytogenes is a motile, non–spore-forming, gram-positive bacillus that has aerobic and facultatively anaerobic characteristics. It grows best at neutral to slightly alkaline pH and is capable of growth at a wide range of temperatures, from 1-45°C. [2, 5] It is beta-hemolytic and has a blue-green sheen on blood-free agar. It exhibits characteristic tumbling motility when viewed with light microscopy and is difficult to isolate in mixed cultures. It may be mistaken for streptococci or contaminants such as corynebacteria.
Most infections occur after oral ingestion, with access to the systemic circulation after intestinal penetration. Protection against Listeria is mediated via lymphokine activation of T cells on macrophages and by interleukin-18.
Healthy individuals may experience minor gastrointestinal symptoms when infected with Listeria. However, immunocompromised individuals are at risk for more severe infections, such as bacteraemia and meningitis, whereas pregnant people may experience miscarriage and stillbirth. Vulnerable populations, such as the elderly and pregnant women, have a mortality rate of 20-30% when infected with Listeria. [5]
CNS infection may manifest as meningitis, meningoencephalitis, or abscess. Endocarditis is another possible presentation. Localized infection may manifest as septic arthritis, osteomyelitis, and, rarely, pneumonia.
Epidemiology
The number of cases of Listeria infection is small, but the fatality rate is high. [5]
Frequency
United States
The frequency of L monocytogenes infection is 2.9 cases per million population, with higher incidences in elderly individuals and pregnant women. It presents with higher incidence rates during the summer months. [8] Pregnant women account for 27% of all cases, and most occur during the third trimester. Seventy percent of all nonperinatal infections occur in immunocompromised patients. Corticosteroid therapy is the most important predisposing association in patients who are not pregnant. Other risk factors include advanced age, recent chemotherapy, diabetes mellitus, end-stage renal disease, liver disease, and organ transplantation. [9]
Nosocomial infection has been reported.
Listeria infection ranks as the third leading cause of mortality from foodborne illnesses in the United States. There are 1,600 cases of Listeria infection and 260 fatalities due to the infection in the United States each year. [3]
International
Incidence rates range from 0.1 to 10 cases per 1 million individuals per year, varying across countries and regions globally.
Mortality/Morbidity
The overall mortality rate of L monocytogenes infection is 15-20%. Listeria accounts for 19% of all deaths due to food-borne infection.
Of all pregnancy-related cases, 22% resulted in fetal loss or neonatal death, but mothers usually survive.
Sex
With the exception of pregnant women, no sex predilection is recognized.
Age
Women of childbearing age commonly are affected.
Neonates and elderly individuals are at risk.
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Electron micrograph of an artificially colored Listeria bacterium in tissue.
Tables
Year |
Location |
Source |
| 2024 | United States | Delicatessen meats, cheese and produce |
| 2024 | United States | Queso fresco and cotija cheese |
| 2022 | United States | Ice cream |
2021 |
United States |
Pre-packaged salads |
2017 |
South Africa |
Processed meat product (polony) |
2014 |
United States |
Prepackaged caramel apples |
2011 |
United States |
Cantaloupe |
2007 |
Massachusetts |
Milk |
2003 |
United Kingdom | Sandwiches |
| 2002 [16] | United States (nationwide) | Delicatessen turkey breast |
