Listeria Monocytogenes Infection (Listeriosis)

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Background

Listeria monocytogenes, which causes listeriosis, is an important pathogen in pregnant patients, neonates, elderly individuals, and immunocompromised individuals, although it is an uncommon cause of illness in the general population. Patients with cancer, particularly those of blood, are also at high risk for listeriosis.[1] See the image below.



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Electron micrograph of an artificially colored Listeria bacterium in tissue.

It is typically a food-borne organism. Listeria is also 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] 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.[3]

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.

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. 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.

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

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. Annually, 2500 cases are reported, with higher incidence rates during the summer months.[4] 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.[5]

Nosocomial infection has been reported.

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 are commonly affected.

Neonates and elderly individuals are at risk.

History

L monocytogenes infection may be a self-limited gastrointestinal tract illness or a more severe CNS infection, bacteremia, or a localized infection such as monoarticular septic arthritis.

Physical

Examination depends on the organ system involved.

Listeriosis in pregnancy [6, 7]

Listeria may proliferate in the placenta and cause infection due to impaired cell-mediated immunity during pregnancy.

CNS infection is very rare during pregnancy, although it is observed frequently in other compromised hosts.

Fever, myalgias, arthralgias, back pain, and headache are classic symptoms of bacteremia. Symptoms may mimic those of a flulike illness. The infection may be mild and self-limited.

Listeriosis during pregnancy usually occurs during the third trimester, when cell-mediated immunity is at its lowest.

Preterm labor and/or delivery is common. Abortion, stillbirth, and intrauterine infection are possible.

Neonatal infection (granulomatosis infantisepticum)

Two forms are described.[6]

Early-onset sepsis, with Listeria acquired in utero via transplacental transmission, results in premature birth. Listeria can be isolated in the placenta, blood, meconium, nose, ears, and throat, among other sites, and manifests as abscesses and/or granulomas.

Late-onset meningitis is acquired through vaginal transmission, although it also has been reported with cesarean deliveries.

CNS infection [8]

Listeria has a predilection for the brain parenchyma, especially the brain stem, and the meninges.

Mental status changes are common.

Seizures, both focal and generalized, occur in at least 25% of patients.

Cranial nerve deficits may be present.

Strokelike syndromes with hemiplegia may occur.

Nuchal rigidity is less common.

Movement disorders may include tremor, myoclonus, and ataxia.

Patients may present with encephalitis, especially of the brainstem.[9]

Meningitis is possible.

Ventriculitis, particularly of the fourth ventricle, may develop.

Cervical myelitis has been reported.[10]

Brain abscess occurs in 10% of CNS infections, often located in the thalamus, pons, and medulla. This uncommon complication is associated with high mortality.[11]

Febrile gastroenteritis [2]

L monocytogenes can produce food-borne diarrheal disease, which is typically noninvasive.

The median incubation period is 1-2 days, with diarrhea lasting anywhere from 1-3 days.

The prevalence of diarrheal illness is high in individuals exposed to inocula of Listeria.

Patients present with fever, myalgias, and diarrhea and recover with supportive care.

Causes

Most infections are due to food-borne transmission.

A substantial minority of infections are transmitted by other modes. Transmission can occur transplacentally or via an infected birth canal. Isolated incidences of cross-infection in neonatal nurseries have been reported.

Nosocomial infection, while rare, has been reported.

Laboratory Studies

Blood cultures should be performed. Blood culture results are positive in 60-75% of patients with CNS infections.

Listeria demonstrates "tumbling motility" in wet mounts of cerebrospinal fluid (CSF). Listeria organisms are motile in wet mounts of CSF.

CSF Gram stain results are positive in less than 50% of patients. CSF analysis reveals pleocytosis, and CSF protein levels are moderately elevated. CSF glucose levels may be low, and if so, are associated with a poor prognosis.

Laboratory results that show diphtheroids should prompt heightened awareness for the possibility of Listeria infection, particularly in immunocompromised patients.

CSF cultures are positive less frequently than blood cultures.

A commercially available PCR test has been developed for CSF analysis.

Serologic testing is not reliable.

Synovial fluid and/or prosthetic joint material should be cultured in cases of septic arthritis.

Stool cultures are neither sensitive nor specific.

Imaging Studies

MRI is superior to CT scan for demonstrating CNS disease, especially in the brainstem.[12]

Transesophageal echocardiography should be performed if endocarditis is suspected.

Procedures

Lumbar puncture should be performed if CSF infection is suspected.

Medical Care

Intravenous antibiotics must be started immediately when the diagnosis is suspected or confirmed.

Diagnosis is established by culture of the organism from blood, CSF, or other sterile body fluid.

Person-to-person transmission does not occur; therefore, isolation precautions are not necessary.

Surgical Care

There have been case reports of L monocytogenes –associated bone and joint infections, but information is scarce. A 2012 retrospective study of 43 patients found that osteoarticular listeriosis primarily involves prosthetic joints and occurs in immunocompromised patients. In cases of periprosthetic joint infection, optimal therapy includes surgical removal of the prosthetic joint.[13]

Consultations

Listeriosis may be sporadic or may be part of a larger epidemic. The table below lists some of the most recent epidemics. Consultation with an infectious disease specialist or an epidemiologist is important when epidemic listeriosis is suspected.

Table. Epidemic Listeriosis



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See Table

Prevention

The following are measures that can be used to prevent listeriosis:

Medication Summary

Antibiotic therapy is the treatment of choice for listeriosis. Bacteremia should be treated for 2 weeks if the patient is immunocompetent. Longer courses may be required in the immunocompromised patient. Meningitis should be treated for 3 weeks; endocarditis, for 4-6 weeks; and brain abscess, for at least 6 weeks. Ampicillin is generally considered the preferred agent, but other agents may be acceptable. Gentamicin is added frequently for synergy, but it may be discontinued after 1 week of clinical improvement in order to decrease the chance of renal toxicity or ototoxicity.[22]

Glucocorticoids have not demonstrated benefit in Listeria meningitis.[23]

Ampicillin (Omnipen, Marcillin)

Clinical Context:  Ampicillin is the drug of choice. It interferes with bacterial cell wall synthesis during active multiplication, causing bactericidal activity against susceptible organisms.

Gentamicin

Clinical Context:  Gentamicin is an adjunctive therapy that can be used in conjunction with ampicillin. It is an aminoglycoside antibiotic that interferes with bacterial protein synthesis by binding to the 30S and 50S ribosomal subunits. Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in volume of distribution, as well as the body space into which the agent needs to distribute. Gentamicin may be given iIV/IM. Each regimen must be followed by at least a trough level drawn on the third or fourth dose, 0.5 hour before dosing; a peak level may be drawn 0.5 hour after a 30-minute infusion.

Trimethoprim-sulfamethoxazole (Bactrim)

Clinical Context:  This agent is indicated for patients unable to take penicillin antibiotics. It inhibits bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid, which results in inhibition of bacterial growth.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

What is listeria monocytogenes infection (listeriosis)?What is the pathophysiology of listeria monocytogenes infection (listeriosis)?What is the prevalence of listeria monocytogenes infection (listeriosis) in the US?What are the mortality rates for listeria monocytogenes infection (listeriosis)?What is the sexual predilection of listeria monocytogenes infection (listeriosis)?Which patient groups have the highest prevalence of listeria monocytogenes infection (listeriosis)?What are the signs and symptoms of listeria monocytogenes infection (listeriosis)?Which physical findings are characteristic of listeria monocytogenes infection (listeriosis) during pregnancy?Which physical findings are characteristic of listeria monocytogenes infection (listeriosis) in neonates?Which CNS findings are characteristic of listeria monocytogenes infection (listeriosis)?Which physical findings are characteristic of febrile gastroenteritis in listeria monocytogenes infection (listeriosis)?What causes listeria monocytogenes infection (listeriosis)?What are the differential diagnoses for Listeria Monocytogenes Infection (Listeriosis)?What is the role of lab testing in the diagnosis of listeria monocytogenes infection (listeriosis)?What is the role of imaging studies in the diagnosis of listeria monocytogenes infection (listeriosis)?What is the role of lumbar puncture in the diagnosis of listeria monocytogenes infection (listeriosis)?How is listeria monocytogenes infection (listeriosis) treated?What is the role of surgery in the treatment of listeria monocytogenes infection (listeriosis)?How common are listeria monocytogenes infection (listeriosis) epidemics?How is listeria monocytogenes infection (listeriosis) prevented?What is the role of antibiotic therapy in the treatment of listeria monocytogenes infection (listeriosis)?Which medications in the drug class Antibiotics are used in the treatment of Listeria Monocytogenes Infection (Listeriosis)?

Author

Karen B Weinstein, MD, FACP, Associate Professor, Department of Internal Medicine, Rush University Medical Center

Disclosure: Nothing to disclose.

Specialty Editors

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA, Infectious Disease Physician, Skagit Valley Hospital, Skagit Regional Health

Disclosure: Nothing to disclose.

References

  1. Mook P, O'Brien SJ, Gillespie IA. Concurrent conditions and human listeriosis, England, 1999-2009. Emerg Infect Dis. 2011 Jan. 17(1):38-43. [View Abstract]
  2. Ooi ST, Lorber B. Gastroenteritis due to Listeria monocytogenes. Clin Infect Dis. 2005 May 1. 40(9):1327-32. [View Abstract]
  3. Aureli P, Fiorucci GC, Caroli D, Marchiaro G, Novara O, Leone L, et al. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. N Engl J Med. 2000 Apr 27. 342(17):1236-41. [View Abstract]
  4. Pappas G, Panagopoulou P, Christou L, Akritidis N. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect Dis Clin North Am. 2006 Jun. 20(2):395-421, x. [View Abstract]
  5. Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis. 2011 Jan. 17 (1):7-15. [View Abstract]
  6. Mylonakis E, Paliou M, Hohmann EL, Calderwood SB, Wing EJ. Listeriosis during pregnancy: a case series and review of 222 cases. Medicine (Baltimore). 2002 Jul. 81(4):260-9. [View Abstract]
  7. Sheffield JS. Sepsis and septic shock in pregnancy. Crit Care Clin. 2004 Oct. 20(4):651-60; viii. [View Abstract]
  8. Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore). 1998 Sep. 77(5):313-36. [View Abstract]
  9. Armstrong RW, Fung PC. Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin Infect Dis. 1993 May. 16(5):689-702. [View Abstract]
  10. Josephson SA, Pillai DR, Phillips JJ, Chou D. Neurolisteriosis presenting as cervical myelitis in an immunocompetent patient. Neurology. 2006 Apr 11. 66(7):1122-3. [View Abstract]
  11. Dee RR, Lorber B. Brain abscess due to Listeria monocytogenes: case report and literature review. Rev Infect Dis. 1986 Nov-Dec. 8(6):968-77. [View Abstract]
  12. Faidas A, Shepard DL, Lim J, Nelson JE, Baddour LM. Magnetic resonance imaging in listerial brain stem encephalitis. Clin Infect Dis. 1993 Jan. 16(1):186-7. [View Abstract]
  13. Charlier C, Leclercq A, Cazenave B, Desplaces N, Travier L, Cantinelli T, et al. Listeria monocytogenes-Associated Joint and Bone Infections: A Study of 43 Consecutive Cases. Clin Infect Dis. 2012 Jan. 54(2):240-8. [View Abstract]
  14. Gottlieb SL, Newbern EC, Griffin PM, Graves LM, Hoekstra RM, Baker NL, et al. Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis. 2006 Jan 1. 42(1):29-36. [View Abstract]
  15. Ericsson H, Eklow A, Danielsson-Tham ML, Loncarevic S, Mentzing LO, et al. An outbreak of listeriosis suspected to have been caused by rainbow trout. J Clin Microbiol. 1997 Nov. 35(11):2904-7. [View Abstract]
  16. Büla CJ, Bille J, Glauser MP. An epidemic of food-borne listeriosis in western Switzerland: description of 57 cases involving adults. Clin Infect Dis. 1995 Jan. 20(1):66-72. [View Abstract]
  17. Dalton CB, Austin CC, Sobel J, Hayes PS, Bibb WF, Graves LM, et al. An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk. N Engl J Med. 1997 Jan 9. 336(2):100-5. [View Abstract]
  18. Goulet V, Rocourt J, Rebiere I, Jacquet C, Moyse C, Dehaumont P, et al. Listeriosis outbreak associated with the consumption of rillettes in France in 1993. J Infect Dis. 1998 Jan. 177(1):155-60. [View Abstract]
  19. Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C, et al. Epidemic listeriosis associated with Mexican-style cheese. N Engl J Med. 1988 Sep 29. 319(13):823-8. [View Abstract]
  20. Schlech WF 3rd, Lavigne PM, Bortolussi RA, Allen AC, Haldane EV, Wort AJ, et al. Epidemic listeriosis--evidence for transmission by food. N Engl J Med. 1983 Jan 27. 308(4):203-6. [View Abstract]
  21. Evans JR, Allen AC, Stinson DA, Bortolussi R, Peddle LJ. Perinatal listeriosis: report of an outbreak. Pediatr Infect Dis. 1985 May-Jun. 4(3):237-41. [View Abstract]
  22. Lorber B. Listeriosis. Clin Infect Dis. 1997 Jan. 24(1):1-9; quiz 10-1. [View Abstract]
  23. Koopmans MM, Brouwer MC, Bijlsma MW, Bovenkerk S, Keijzers W, van der Ende A, et al. 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. [View Abstract]
  24. Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, MI: Physicians Press; 2008.
  25. Armstrong D, Cohen J, eds. Listeria Monocytogenes. Infectious Diseases. London, UK: Mosby; 1999. 8.15.1-8.15.20.
  26. Berenguer J, Solera J, Diaz MD, Moreno S, Lopez-Herce JA, Bouza E. Listeriosis in patients infected with human immunodeficiency virus. Rev Infect Dis. 1991 Jan-Feb. 13(1):115-9. [View Abstract]
  27. Blatt SP, Zajac RA. Treatment of Listeria bacteremia with vancomycin. Rev Infect Dis. 1991 Jan-Feb. 13(1):181-2. [View Abstract]
  28. Broome CV. Listeriosis: Can we prevent it?. ASM News. 1993. 59:444-6.
  29. Calubiran OV, Horiuchi J, Klein NC, Cunha BA. Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis. Heart Lung. 1990 Jan. 19(1):21-3. [View Abstract]
  30. Chang J, Powles R, Mehta J, Paton N, Treleaven J, Jameson B. Listeriosis in bone marrow transplant recipients: incidence, clinical features, and treatment. Clin Infect Dis. 1995 Nov. 21(5):1289-90. [View Abstract]
  31. Charpentier E, Gerbaud G, Jacquet C, Rocourt J, Courvalin P. Incidence of antibiotic resistance in Listeria species. J Infect Dis. 1995 Jul. 172(1):277-81. [View Abstract]
  32. Cherubin CE, Appleman MD, Heseltine PN, Khayr W, Stratton CW. Epidemiological spectrum and current treatment of listeriosis. Rev Infect Dis. 1991 Nov-Dec. 13(6):1108-14. [View Abstract]
  33. Cunha BA. Central nervous system infections in the compromised host: a diagnostic approach. Infect Dis Clin North Am. 2001 Jun. 15(2):567-90. [View Abstract]
  34. Cunha BA, Fatehpuria R, Eisenstein LE. Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: the differential diagnostic importance of cerebrospinal fluid lactic acid levels. Heart Lung. 2007 May-Jun. 36(3):226-31. [View Abstract]
  35. Cunha BA, Filozov A, Remé P. Listeria monocytogenes encephalitis mimicking West Nile encephalitis. Heart Lung. 2004 Jan-Feb. 33(1):61-4. [View Abstract]
  36. Decker CF, Simon GL, DiGioia RA, Tuazon CU. Listeria monocytogenes infections in patients with AIDS: report of five cases and review. Rev Infect Dis. 1991 May-Jun. 13(3):413-7. [View Abstract]
  37. Farber JM, Peterkin PI. Listeria monocytogenes, a food-borne pathogen. Microbiol Rev. 1991 Sep. 55(3):476-511. [View Abstract]
  38. Gellin BG, Broome CV, Bibb WF, Weaver RE, Gaventa S, Mascola L. The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group. Am J Epidemiol. 1991 Feb 15. 133(4):392-401. [View Abstract]
  39. Gorbach SL, Bartlett JB, Blacklow NR, eds. Listeria Monocytogenes. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders; 1998. 1750-5.
  40. Gross E, Slauson S. Update on emerging infections: news from the Centers for Disease Control and Prevention. Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003. Ann Emerg Med. 2004 Nov. 44(5):532-6. [View Abstract]
  41. Hof H, Nichterlein T, Kretschmar M. Management of listeriosis. Clin Microbiol Rev. 1997 Apr. 10(2):345-57. [View Abstract]
  42. John JF. Listeria Monocytogenes. Vinken PJ, Bruyn GW, eds. Handbook of ClinicalNeurology. New York, NY: Elsevier Science; 1988. Vol 8: 89-101.
  43. Klein NC, Schoch PE, Cunha BA. Listeria. Infect Control Hosp Epidemiol. 1991 May. 12(5):311-4. [View Abstract]
  44. Latcha S, Cunha BA. Listeria monocytogenes meningoencephalitis: the diagnostic importance of the CSF lactic acid. Heart Lung. 1994 Mar-Apr. 23(2):177-9. [View Abstract]
  45. Lorber B. Listeria Monocytogenes. Mandell GL, Bennett GE, Dolin R, eds. Principles and Practices of Infectious Diseases. 6th ed. Pennsylvania, PA: Churchill and Livingstone; 2005. 2478.
  46. Pigrau C, Almirante B, Pahissa A, Gasser I, Martinez Vasquez JM. Clinical presentation and outcome in cases of listeriosis. Clin Infect Dis. 1993 Jul. 17(1):143-4. [View Abstract]
  47. Pinner RW, Schuchat A, Swaminathan B, Hayes PS, Deaver KA, Weaver RE, et al. Role of foods in sporadic listeriosis. II. Microbiologic and epidemiologic investigation. The Listeria Study Group. JAMA. 1992 Apr 15. 267(15):2046-50. [View Abstract]
  48. Riedo FX, Pinner RW, Tosca ML, Cartter ML, Graves LM, Reeves MW, et al. A point-source foodborne listeriosis outbreak: documented incubation period and possible mild illness. J Infect Dis. 1994 Sep. 170(3):693-6. [View Abstract]
  49. Schneider JI. Rapid infectious killers. Emerg Med Clin North Am. 2004 Nov. 22(4):1099-115. [View Abstract]
  50. Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med. 1997 Oct 2. 337(14):970-6. [View Abstract]
  51. Skogberg K, Syrjanen J, Jahkola M, Renkonen OV, Paavonen J, Ahonen J, et al. Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy. Clin Infect Dis. 1992 Apr. 14(4):815-21. [View Abstract]
  52. Spitzer PG, Hammer SM, Karchmer AW. Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev Infect Dis. 1986 May-Jun. 8(3):427-30. [View Abstract]
  53. Swaminathan B, Rocourt J, Bille J. Listeria. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995. 341-8.
  54. Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. 1999 Jun. 66(6):375-80. [View Abstract]
  55. Tappero JW, Schuchat A, Deaver KA. Reduction in the incidence of human listeriosis in the United States. Effectiveness of prevention efforts? The Listeriosis Study Group. JAMA. 1995 Apr 12. 273(14):1118-22. [View Abstract]
  56. Uldry PA, Kuntzer T, Bogousslavsky J, Regli F, Miklossy J, Bille J, et al. Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases. J Neurol. 1993. 240(4):235-42. [View Abstract]
  57. Walsh RD, Gurevich I, Cunha BA. Listeria: A potential cause of febrile transfusion reactions. J Hosp Infect. 1993. 18:81-82.
  58. Lomonaco S, Nucera D, Filipello V. The evolution and epidemiology of Listeria monocytogenes in Europe and the United States. Infect Genet Evol. 2015 Oct. 35:172-83. [View Abstract]
  59. Nyarko EB, Donnelly CW. Listeria monocytogenes: Strain Heterogeneity, Methods, and Challenges of Subtyping. J Food Sci. 2015 Dec. 80 (12):M2868-78. [View Abstract]
  60. Leazer R, Perkins AM, Shomaker K, Fine B. A Meta-analysis of the Rates of Listeria monocytogenes and Enterococcus in Febrile Infants. Hosp Pediatr. 2016 Apr. 6 (4):187-95. [View Abstract]
  61. Calame DG, Mueller-Ortiz SL, Wetsel RA. Innate and adaptive immunologic functions of complement in the host response to Listeria monocytogenes infection. Immunobiology. 2016 Dec. 221 (12):1407-1417. [View Abstract]

Electron micrograph of an artificially colored Listeria bacterium in tissue.

Electron micrograph of an artificially colored Listeria bacterium in tissue.

Year Location Source
2017South AfricaProcessed meat product (polony)
2014United StatesPrepackaged caramel apples
2011United StatesCantaloupe
2007MassachusettsMilk
2003United KingdomSandwiches
2002[14] United States (nationwide)Delicatessen turkey breast
August 1998 to January 1999Multiple states in the United StatesHot dogs, deli meats
1997[3] ItalyCorn
1997[15] SwedenRainbow trout
1995[16] SwitzerlandSoft cheese
1994[17] IllinoisChocolate milk
1992[18] FranceRillettes (pork product)
1985[19] CaliforniaMexican-style soft cheese
1983[20] New EnglandUnpasteurized milk
1981[21] CanadaColeslaw