Listeriosis

Cerebral Abscess Caused by Listeria monocytogenes: Case Report and Literature Review

BACKGROUND

 Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon.

CASE PRESENTATION

 We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes.

CONCLUSIONS

 This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.

Incidence of Listeria monocytogenes in fresh foods in Barcelona (Spain)

From September 1989 to March 1990, a study of Listeria spp. was carried out on 311 samples of raw foodstuffs from markets and other establishments in the city of Barcelona. These foodstuffs included vegetables (103 samples), minced meats from pork, beef and poultry (168 samples) and bivalve molluscs (40 samples). L. monocytogenes was isolated in 7.8% of the vegetable samples, 17.3% of the minced meats and in 7.5% of bivalve molluscs. The most frequent serovars were 1/2 and 4. Other species isolated were L. innocua, L. welschimeri and L. seeligeri.

Listeria monocytogenes, a food-borne pathogen

The gram-positive bacterium Listeria monocytogenes is an ubiquitous, intracellular pathogen which has been implicated within the past decade as the causative organism in several outbreaks of foodborne disease. Listeriosis, with a mortality rate of about 24%, is found mainly among pregnant women, their fetuses, and immunocompromised persons, with symptoms of abortion, neonatal death, septicemia, and meningitis. Epidemiological investigations can make use of strain-typing procedures such as DNA restriction enzyme analysis or electrophoretic enzyme typing. The organism has a multifactorial virulence system, with the thiol-activated hemolysin, listeriolysin O, being identified as playing a crucial role in the organism's ability to multiply within host phagocytic cells and to spread from cell to cell. The organism occurs widely in food, with the highest incidences being found in meat, poultry, and seafood products. Improved methods for detecting and enumerating the organism in foodstuffs are now available, including those based on the use of monoclonal antibodies, DNA probes, or the polymerase chain reaction. As knowledge of the molecular and applied biology of L. monocytogenes increases, progress can be made in the prevention and control of human infection.

Growth of Listeria monocytogenes Scott A, serotype 4 and competitive spoilage organisms in raw chicken packaged under modified atmospheres and in air

The development of Listeria monocytogenes Scott A, serotype 4 and aerobic plate counts on minced raw chicken were determined independently at 4, 10 and 27 degrees C. Samples were packaged in flexible film under two modified atmospheres (one containing oxygen and one containing no oxygen) or air. The anaerobic modified atmosphere (75:25, CO2:N2) resulted in the failure of both the aerobic plate counts and L. monocytogenes to grow at all temperatures. Both the L. monocytogenes and aerobic plate counts grew in air at all temperatures. The aerobic modified atmosphere (72.5:22.5:5, CO2:N2:O2), which more closely duplicates commercial practice, inhibited the increase in aerobic plate counts by more than 4 log10 cfu/g compared to air at 4 degrees C. However, the L. monocytogenes was not affected by this atmosphere and increased in numbers by nearly 6 log10 cfu/g at 4 degrees C in 21 days. Regression analysis of the log10 growth and 95% confidence intervals showed that the differences between aerobic plate counts and L. monocytogenes in modified atmosphere were large. The ability of L. monocytogenes to grow in the aerobic modified atmosphere was not affected by level of the L. monocytogenes inoculum nor by the initial level of aerobic plate counts. These data show that modified atmosphere packaging of raw chicken (and probably other meats) can substantially inhibit the aerobic spoilage flora while allowing pathogenic L. monocytogenes to increase.

Comparison of lithium chloride-phenylethanol-moxalactam and modified Vogel Johnson agars for detection of Listeria spp. in retail-level meats, poultry, and seafood

The effectiveness of Modified Vogel Johnson agar and lithium chloride-phenylethanol-moxalactam agar for detection of Listeria spp. in foods was compared by using the media to analyze retail-level meat, poultry, and seafood both by direct plating and in conjunction with a three-tube most-probable-number enrichment. The most-probable-number protocol detected Listeria species, including Listeria monocytogenes, in a substantial portion of the fresh meat and seafood samples. In most instances the Listeria levels were less than 2 CFU/g, which precluded detection by direct plating. Modified Vogel Johnson agar performed as well as did lithium chloride-phenylethanol-moxalactam agar and was considerably easier to use because of its ability to differentiate Listeria spp. from other microorganisms.

Behavior of Listeria monocytogenes in the presence of sodium propionate

Survival or growth of Listeria monocytogenes in Tryptose Broth supplemented with 0, 0.05, 0.1, 0.15, 0.2, 0.25 or 0.3% sodium propionate was determined when the pH of the medium was 5.0 or 5.6 and incubation was at 4, 13, 21 and 35 degrees C. The pathogen grew in all controls, propionate-free broth, except at 4 degrees C and pH 5.0. At pH 5.6 and 4, 13, 21 and 35 degrees C the bacterium grew in the presence of all propionate concentrations used in this study. The higher concentrations permitted only minimal growth with smallest ultimate populations and longest generation times. Reducing the pH to 5.0 served to minimize growth further at 13, 21 and 35 degrees C than that observed at the same temperatures but at pH 5.6. The extent of growth was directly proportional to the propionate concentrations; at high concentrations, propionate caused a gradual decrease in populations and/or prolonged the lag phase. At 35 degrees C, a concentration of 0.25% did not allow growth, whereas 0.3% caused inactivation of the pathogen after 80 h of incubation. At 4 degrees C and pH 5.0, all concentrations of sodium propionate caused a gradual decrease in populations during the incubation period.

Carriage of Listeria monocytogenes and related species in pregnant and non-pregnant women in Aberdeen, Scotland

The faecal, cervico-vaginal and oropharyngeal carriage of Listeria species in 54 healthy pregnant women and 60 healthy non-pregnant women was investigated. Samples were cold-enriched at 4 degrees C and subcultured on selective media containing acriflavin, nalidixic acid and potassium thiocyanate. Listeria monocytogenes was isolated from the faeces of one pregnant woman (2%) and two non-pregnant women (3.4%). Listeria innocua was isolated from the faeces of one pregnant woman (2%) and one non-pregnant woman (1.7%). Listeria seeligeri was isolated from the faeces of one non-pregnant woman (1.7%). Listeria species were not isolated from cervico-vaginal or oropharyngeal samples. The results indicate that pregnancy does not affect the naturally low carriage rate of Listeria species.

Congenital listeriosis causing early neonatal death

Images

Listeriosis

The incidence, clinical picture, natural history, epidemiology and sequelae of perinatal listeriosis are discussed along with treatment and diagnosis.