### Microbiology A gram-positive rod, cold tolerant and it has tumbling motility. There are around 15 *[[Listeria]]* spp, *L*. *monocytogenes* is the main human pathogen. In pregnancy, there may be certain strains that are prone to causing infection. [^18] ### Epidemiologic Risks Found in most meats by way of the colon (every creature's last act is to evacuate its bowels and then into/onto its corpse aka dinner), it survives cold very well. Immunosuppression ([[AIDS]], lymphoma, CLL, steroids), including alcoholism and pregnancy, and age > 50 [^1] 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, [^2] sometimes leading to hospital outbreaks. > "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.: [^8] The solution? Deep fry everything. [^3] A growing problem in Latin style soft cheeses such as queso fresco and cotija. [^4] There have been 8 hospital outbreaks from > "sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each)." [^5] An outbreak in Canada was traced to chocolate milk, which is distributed in plastic bags. Looks like sacks of poop. [^6] And an outbreak traced to lettuce. [^7] And an outbreak in Italy from pork head cheese, which is not a cheese but gelatin filled with chunks of head meat. [^10] I will eat damn near anything, but this stuff looks designed to replace ipecac. [^9] Use of PPI's a risk, [^11] as it is for many GI infections. Stomach acid is an important first defense. 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." [^12] Biologics (like infliximab) are a disease risk, especially if on concomitant steroids or methotrexate. [^13] Biologics increase the risk for not only for PJP, but for *[[Listeria]]*, *Salmonella*, and *[[Legionella]]* and it has been suggested that all patients on biologics be on [[Trimethoprim-Sulfamethoxazole]] to prevent all of the above. [^14] Alemtuzumab, used for CLL, T cell lymphoma and MS, increases the risk of *[[Listeria]]*. [^15] Not all *[[Listeria]]* are the same: genotype ST6 has worse outcomes. [^16] ### Syndromes Bacteremia, [[Meningitis]], fatal fetal infection, bacteremia in pregnancy, febrile bloody gastroenteritis [^17], and rarely [[endocarditis]]. I had a case of prosthetic knee infection from eating raw cheese in S. America. See Weird PJI. ### Treatment See the note. [[Ampicillin]] PLUS [[gentamicin]] has been the standard for years; the use of [[gentamicin]] is not exactly proven [^19] The probably best way to treat is both [[ampicillin]] and [[Trimethoprim-Sulfamethoxazole]] , given that TMP has much better intracellular penetration. If penicillin allergic either desensitize OR try maximum dose [[Trimethoprim-Sulfamethoxazole]] . [[Vancomycin]] is a last-ditch treatment. [[Linezolid]] works in the test tube, and there are a smattering of successes such as a case of endophthalmitis. [^20] Dexamethasone may not be of use [^21] and in one study INCREASED mortality. [^22] Duration of therapy: 3 weeks. Less has more relapse. ### Notes 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 organism on a high power field at 100,000 CFU/ml. *[[Listeria]]* subverts the cellular actin system to push itself through the cytosol. [^23] This is way cool and you should check it out. MRI and CT of listeriosis have > "a combination of neuroradiological images, none being specific. Radiological signs of rhombencephalitis are uncommon, whereas, unexpectedly, hemorrhagic images are frequent ([PubMed](https://www.ncbi.nlm.nih.gov/pubmed/29796652))." [^24] ### Puswhisperers [[Ampicillin]] Allergy and [[Listeria]]](http://www.pusware.com/PW10/AmpAllergyListeria.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1139.mp3) [Didn't See That Coming. Yet Again.](http://www.pusware.com/PW6/DidntSeeThat.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop793.mp3) [Weird PJI. Part One](http://www.pusware.com/PW9/WeirdPJI.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1112.mp3) [Didn't Even Consider It](http://www.pusware.com/PW4/DidntConsiderIt.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop570.mp3) [Total Recall](http://www.pusware.com/PW6/TotalRecall.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop820.mp3) [Fetid Dingos' Kidneys](http://www.pusware.com/PW7/FetidDigoes.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop898.mp3) [That's A Curbside ?!?](http://www.pusware.com/PW9/ThatsACurbside.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1122.mp3) [Late [[Sepsis and Bacteremia]] or Something Else?](http://boards.medscape.com/[email protected]@.2a847920) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1387.mp3) ### Rationalizations [^1]: Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-acquired [[Listeria]] monocytogenes [[Meningitis]] in adults. Clin Infect Dis. 2006 Nov 15;43(10):1233-8. doi: 10.1086/508462. Epub 2006 Oct 10. PMID: 17051485. [^2]: Cartwright EJ, Jackson KA, Johnson SD, et al. Listeriosis Outbreaks and Associated Food Vehicles, United States, 1998–2008. _Emerging Infectious Diseases_. 2013;19(1):1-9. doi:10.3201/eid1901.120393. [^3]: https://www.wikihow.com/Cook-Deep-Fried-Beer [^4]: Jackson K, Gould L, Hunter JC, et al. Listeriosis Outbreaks Associated with Soft Cheeses, United States, 1998–2014. _Emerging Infectious Diseases_. 2018;24(6):1116-1118. doi:10.3201/eid2406.171051. [^5]: Silk BJ, McCoy MH, Iwamoto M, Griffin PM. Foodborne listeriosis acquired in hospitals. Clin Infect Dis. 2014 Aug 15;59(4):532-40. doi: 10.1093/cid/ciu365. Epub 2014 May 20. PMID: 24846635. [^6]: Hanson H, Whitfield Y, Lee C, et al. [[Listeria]] monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada. _Emerging Infectious Diseases_. 2019;25(3):581-584. doi:10.3201/eid2503.180742. [^7]: Associated with Packaged Leafy Green Salads, United States and Canada, 2015–2016. _Emerging Infectious Diseases_. 2019;25(8):1461-1468. doi:10.3201/eid2508.180761. [^8]: Goulet V, Hebert M, Hedberg C, Laurent E, Vaillant V, De Valk H, Desenclos JC. Incidence of listeriosis and related mortality among groups at risk of acquiring listeriosis. Clin Infect Dis. 2012 Mar 1;54(5):652-60. doi: 10.1093/cid/cir902. Epub 2011 Dec 9. PMID: 22157172. [^9]: https://en.wikipedia.org/wiki/Head_cheese [^10]: Duranti A, Sabbatucci M, Blasi G, Acciari VA, Ancora M, Bella A, Busani L, Centorame P, Cammà C, Conti F, De Medici D, Di Domenico M, Di Marzio V, Filippini G, Fiore A, Fisichella S, Gattuso A, Gianfranceschi M, Graziani C, Guidi F, Marcacci M, Marfoglia C, Neri D, Orsini M, Ottaviani D, Petruzzelli A, Pezzotti P, Rizzo C, Ruolo A, Scavia G, Scuota S, Tagliavento G, Tibaldi A, Tonucci F, Torresi M, Migliorati G, Pomilio F. A severe outbreak of listeriosis in central Italy with a rare pulsotype associated with processed pork products. J Med Microbiol. 2018 Sep;67(9):1351-1360. doi: 10.1099/jmm.0.000785. Epub 2018 Jul 19. PMID: 30024370. [^11]: Anne Kvistholm Jensen, Jacob Simonsen, Steen Ethelberg, Use of Proton Pump Inhibitors and the Risk of Listeriosis: A Nationwide Registry-based Case-Control Study, _Clinical Infectious Diseases_, Volume 64, Issue 7, 1 April 2017, Pages 845–851, [https://doi.org/10.1093/cid/ciw860](https://doi.org/10.1093/cid/ciw860) [^12]: Miranda-Bautista J, Padilla-Suárez C, Bouza E, Muñoz P, Menchén L, Marín-Jiménez I. [[Listeria]] monocytogenes infection in inflammatory bowel disease patients: case series and review of the literature. Eur J Gastroenterol Hepatol. 2014 Nov;26(11):1247-52. doi: 10.1097/MEG.0000000000000188. PMID: 25171025. [^13]: Bodro M, Paterson DL. Listeriosis in patients receiving biologic therapies. Eur J Clin Microbiol Infect Dis. 2013 Sep;32(9):1225-30. doi: 10.1007/s10096-013-1873-1. Epub 2013 Apr 9. PMID: 23568606. [^14]: Bodro M, Paterson DL. Has the time come for routine [[Trimethoprim-Sulfamethoxazole]] prophylaxis in patients taking biologic therapies? Clin Infect Dis. 2013 Jun;56(11):1621-8. doi: 10.1093/cid/cit071. Epub 2013 Feb 7. PMID: 23392396. [^15]: Holmøy T, von der Lippe H, Leegaard TM. [[Listeria]] monocytogenes infection associated with alemtuzumab - - a case for better preventive strategies. BMC Neurol. 2017 Apr 4;17(1):65. doi: 10.1186/s12883-017-0848-8. PMID: 28376817; PMCID: PMC5381036. [^16]: Koopmans MM, Brouwer MC, Bijlsma MW, Bovenkerk S, Keijzers W, van der Ende A, van de Beek D. [[Listeria]] monocytogenes sequence type 6 and increased rate of unfavorable outcome in [[Meningitis]]: epidemiologic cohort study. Clin Infect Dis. 2013 Jul;57(2):247-53. doi: 10.1093/cid/cit250. Epub 2013 Apr 16. PMID: 23592828. [^17]: Say Tat Ooi, Bennett Lorber, Gastroenteritis Due to _Listeria monocytogenes_, _Clinical Infectious Diseases_, Volume 40, Issue 9, 1 May 2005, Pages 1327–1332, [https://doi.org/10.1086/429324](https://doi.org/10.1086/429324) [^18]: Elinav H, Hershko-Klement A, Valinsky L, Jaffe J, Wiseman A, Shimon H, Braun E, Paitan Y, Block C, Sorek R, Nir-Paz R; Israeli [[Listeria]] Study Group. Pregnancy-associated listeriosis: clinical characteristics and geospatial analysis of a 10-year period in Israel. Clin Infect Dis. 2014 Oct;59(7):953-61. doi: 10.1093/cid/ciu504. Epub 2014 Jun 27. PMID: 24973315. [^19]: Mitjà O, Pigrau C, Ruiz I, Vidal X, Almirante B, Planes AM, Molina I, Rodríguez D, Pahissa A. Predictors of mortality and impact of aminoglycosides on outcome in listeriosis in a retrospective cohort study. J Antimicrob Chemother. 2009 Aug;64(2):416-23. doi: 10.1093/jac/dkp180. Epub 2009 May 25. PMID: 19468027. [^20]: Romain Lécuyer, David Boutoille, Lydie Khatchatourian, Jean-Baptiste Ducloyer, Sophie Gibaud, François Raffi, Benjamin Gaborit, _Listeria_ Endophthalmitis Cured With [[Linezolid]] in an Immunocompetent Farmer Woman: Hazard of a Sweep of a Cow’s Tail, _Open Forum Infectious Diseases_, Volume 6, Issue 11, November 2019, ofz459, [https://doi.org/10.1093/ofid/ofz459](https://doi.org/10.1093/ofid/ofz459) [^21]: Koopmans MM, Brouwer MC, Bijlsma MW, Bovenkerk S, Keijzers W, van der Ende A, van de Beek D. [[Listeria]] monocytogenes sequence type 6 and increased rate of unfavorable outcome in [[Meningitis]]: epidemiologic cohort study. Clin Infect Dis. 2013 Jul;57(2):247-53. doi: 10.1093/cid/cit250. Epub 2013 Apr 16. PMID: 23592828. [^22]: Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, Lopes A, Maury MM, Moura A, Goffinet F, Dieye HB, Thouvenot P, Ungeheuer MN, Tourdjman M, Goulet V, de Valk H, Lortholary O, Ravaud P, Lecuit M; MONALISA study group. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017 May;17(5):510-519. doi: 10.1016/S1473-3099(16)30521-7. Epub 2017 Jan 28. Erratum in: Lancet Infect Dis. 2017 Sep;17(9):897. PMID: 28139432. [^23]: Lambrechts A, Gevaert K, Cossart P, Vandekerckhove J, Van Troys M. [[Listeria]] comet tails: the actin-based motility machinery at work. Trends Cell Biol. 2008 May;18(5):220-7. doi: 10.1016/j.tcb.2008.03.001. Epub 2008 Apr 7. PMID: 18396046. [^24]: Charlier C, Poirée S, Delavaud C, Khoury G, Richaud C, Leclercq A, Hélénon O, Lecuit M; MONALISA Study Group. Imaging of Human Neurolisteriosis: A Prospective Study of 71 Cases. Clin Infect Dis. 2018 Oct 15;67(9):1419-1426. doi: 10.1093/cid/ciy449. PMID: 29796652.