Listeriosis A32.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Cutaneous listeriosis

History
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Murray, 1926; the disease was named after the English surgeon Josef Baron Lister.

Definition
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Namely notifiable bacterial infectious disease with Listeria monocytogenes (direct pathogen detection from blood, cerebrospinal fluid and other substrates, as well as from smears from newborns) usually sporadic, occasionally epidemic. Basically, a distinction must be made between the different types of infection, as they present themselves under different clinical conditions.

Primary cutaneous listeriosis is a very rare zoonosis.

Pathogen
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facultatively pathogenic Listeria spp. (gram-positive, mobile, non-porous, catalase-positive, facultatively anaerobic rods). The most important human pathogenic species is Listeria monocytogenes, L. seeligeri or L. ivanovii are also rarely found in infected persons. About 10% of humans and animals are healthy intestinal carriers of Listeria monocytogenes. In immunocompetent people, infection does not occur.

Occurrence/Epidemiology
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Diseases are rare. In the Federal Republic of Germany: about 100-300 reported diseases/year.

Etiopathogenesis
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Smear infection on contact with sick animals, possibly through consumption of infected food, also by healthy germ carriers, in foetus diaplacental. Infected persons (even with asymptomatic courses) can excrete the pathogen via the stool for several months. In mothers of infected newborns, the pathogen is detectable in lochial secretions and urine about 7-14 days after delivery, rarely longer.

Manifestation
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Symptomatic disease mainly in patients with immune deficiency, e.g. newborns, old people, tumors, HIV infection, immunocompromised persons, transplanted persons, pregnant women.

No age or sex preference.

Localization
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In cutaneous inoculation listeriosis: hands and forearms

Clinical features
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Incubation period: 3-70 days

Listeriosis of the newborn: infection occurs transplacentally, during birth or postnatally by contact

Postnatal listeriosis: in immunocompetent patients usually asympotmatic without being noticed or with slight gastrointestinal complaints. In immunocompromised persons or persons with consuming diseases, severe invasive courses with fever, headache, dizziness, loin pain, meningitis and sepsis (granulomatosis infantiseptica). Skin may be involved by vasculitic exanthema. 30% of septic listeriosis (especially immunocompromised people are at risk) is lethal.

Cutaneous inoculation listeriosis: Inoculation of the pathogen by veterinarians and agricultural workers (favoured by eczematous skin changes - occupational listeriosis). At the inoculation site, localized (grouped), painless, non-itching papulo-vesicular or pustular efflorescences are formed, which can transform into small ulcers. Generally uncomplicated self-limed course.

Diagnosis
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Direct pathogen detection in throat swabs, skin lesions, meconium, perforations, stool. Antibody detection, intradermal test.

Differential diagnosis
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Complication(s)
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Listeria meningitis (lethality rate despite therapy approx. 30%).

Therapy
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  • Therapy of choice is ampicillin (e.g. Binotal) 6-12 g/day in 3-4 ED i.v. therapy over at least 3 weeks.
  • Alternatively Cotrimoxazol (e.g. Cotrimox Wolff): Dosage Trimethoprim/Sulfamethoxalzol: 20/100 mg/kg bw/day.
  • If necessary combinaton with gentamicin (e.g. Refobacin) 3-5 mg/kg bw/day i.v. or i.m. as 1 ED.

Notice! The duration of therapy should be at least 14 days due to the risk of recurrence.

Note(s)
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Named after the British surgeon Josef Baron Lister (1827-1912)

Literature
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  1. Asahata S et al (2015) Fournier's gangrene caused by Listeria monocytogenes as the primary organism. Can J Infect Dis Med Microbiol 26:44-46
  2. Braden CR (2003) Listeriosis. Pediatric Infect Dis J 22: 745-746
  3. Godshall CE et al (2013) Cutaneous listeriosis. J Clin Microbiol 51:3591-3596
  4. Paul ML et al (1994) Listeriosis - a review of eighty-four cases. Med J Aust 160: 489-493
  5. Perrin M et al (2003) Fatal case of Listeria innocua bacteremia. J Clin Microbiol 41: 5308-5309
  6. Vitas AI et al (2004) Occurrence of Listeria monocytogenes in fresh and processed foods in Navarra (Spain). Int J Food Microbiol 90: 349-356
  7. Vera-Kellet C et al (2014) Septic vasculitis caused by Listeria monocytogenes. Rev Chilena infectol 31:746-749
  8. Zelenik K et al (2014) Cutaneous listeriosis in a veterinarian with the evidence of zoonotic transmission--a case report. Zoonoses Public Health 61:238-241

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020