Listeriosis, cutaneous A32.9

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

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.

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.

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

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.

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.

In cutaneous inoculation listeriosis: hands and forearms

Incubation period: 3-70 days

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

Postnatal listeriosis: in immunocompetent individuals, usually unnoticed asympotmatic or with mild gatrointestinal symptoms. In immunocompromised or those with consumptive disease, severe invasive courses with fever, headache, drowsiness, lumbar pain, meningitis and sepsis (granulomatosis infantiseptica). Skin may be involved in the setting of bacteremia due to vasculitic exanthema. 30% of septic listeriosis (mainly immunocompromised persons are at risk) are lethal.

Cutaneous inoculation listeriosis: Inoculation of the pathogen in veterinarians and agricultural workers (favoured by eczematous skin changes - occupational listeriosis). At the site of inoculation, formation of localized (grouped), painless, non-pruritic papulo-vesiculous, or pustular efflorescences, which may transform into small ulcers. I.A. uncomplicated self-limiting course.

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

• 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.

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

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