Listeriosis

What is listeriosis?

Listeriosis is a bacterial infection caused by bacteria Listeria monocytogenes. Listeriosis is typically a foodborne illness and generally affects people with impaired immunity. Your presentation can vary from febrile stomach flu to potentially fatal invader disease, including septicemia, central nervous system infection and perinatal infection [1].

Listeriosis can also occur infrequently cutaneous rashes.

Who gets listeriosis?

Most reported cases of listeriosis are sporadic, but there have been several outbreaks. [1].

Clinical listeriosis occurs primarily in high-risk groups, including [2]:

• Pregnant women and fetuses
• Neonates
• Older people (generally considered ≥ 65 years)
• Immunocompromised patients due to medical conditions, such as AIDS (or the human immunodeficiency virus (HIV) infection), and hematological malignancy
• Patients on immunosuppressive therapies, including long-term corticosteroids and post-organ medication transplant

• Veterinarians and farmers helping calving animals, who are also at increased risk of primary cutaneous listeriosis [3].

What Causes Listeriosis?

L. monocytogenes is a anaerobic Gram-positive bacilli found in vegetation, soil, and animals. Consumption of contaminated food is believed to be the main route of transmission. the bacterium it can survive acidic, salty and cold food processing techniques and can continue to multiply even with adequate refrigeration [1]. the incubation The period of listeriosis is variable and outbreaks have occurred 3 to 70 days after exposure to contaminated food products. [4]. The median incubation period is approximately 3 weeks.

The following foods are considered high-risk products. [4]:

• Unpasteurized dairy products
• Soft cheese
• Crown
• Raw or smoked seafood
• Cold prepackaged salads
• Deli foods that have not been reheated properly
• Sprouted seeds and raw mushrooms.

L. monocytogenes It can also be transmitted from mother to baby, through the placenta or vaginal infection. [1].

Rarely, L. monocytogenes it can also be transmitted from animals to humans [1].

Most cases of cutaneous listeriosis in adults are the result of inoculation of the skin [3]. This is most often seen in veterinarians or farmers who come into contact with birth animals, products related to animal conceptions and births, or soil that carries the bacteria. Cutaneous listeriosis can also be the result of invasive diseases that spread through the bloodstream of people with impaired immunity [3].

What are the clinical features of listeriosis?

In immunocompetent individuals, noninvasive listeriosis usually manifests as febrile gastroenteritis with self-limiting nausea, vomiting, and diarrhea. [2].

• In older patients with impaired immunity, invasive listeriosis most often presents as sepsis or infection of the central nervous system with fever and neurological signs.
• Listerial bacteremia or septic listerial emboli endocarditis can lead to located infections including hepatitis, cholecystitis (inflammation gallbladder wall), peritonitis (inflammation of the linings of the abdominal organs), splenic abscess, pericarditis, pleurisy (inflammation of the outer lining of the lung), endophthalmitis (inflammation of the eye sockets) and osteomyelitis.

• Cellulitis, lymphadenitisand conjunctivitis direct inoculation with listeriosis have all been described [2].

Maternal T cell immunity is most affected during the third trimester and this is when listeriosis generally occurs in pregnancy [1].

• Mothers tend to develop flu-like symptoms, but they can be asymptomatic [5].
• Perinatal infection can lead to miscarriage, fetal death, premature delivery, neonatal sepsis or meningitis.
• Neonatal listeriosis can be classified as early onset, which occurs within the first week of life and is most often associated with sepsis or late onset, which is commonly associated with meningitis. [5].
• Infantile granulomatosis is a serious form of generalized neonatal infection, which can cause granulomatous lesions involving multiple organs, including the skin [5].

Clinical characteristics of cutaneous listeriosis.

Cutaneous listeriosis usually presents as purpuric, papulopustular, or vesiculopustular eruptions that are painless and notpruritus [3].

• Cellulitis with abscess formation has been described less frequently. [6].

• The rashes generally occur on exposed areas, such as the hands and forearms [3].
• The mean time from exposure to the start of eruption It's 2 days.
• Many patients experience systemic symptoms, of which fever is the most common.
• Associated regional adenopathy (enlargement of an organ) and lymphangitis has been reported [7].
• In newborns, the rash is usually more extended. Granulomatosis infantisepticum presents with a erythematous generalized, small, pale skin rash papules [8].

How is listeriosis diagnosed?

Listeriosis is diagnosed by isolating L. monocytogenes from a site that is normally sterile, such as the patient's blood, cerebrospinal fluid (the fluid between the brain and the spine cable), gastric lavage (results of a stomach pump), amniotic fluid (the fluid that surrounds the fetus in the womb), meconium (the first fecal material from a fetus), placenta, or fetal tissue samples [1]. The bacteria can also be isolated from a skin. biopsy.

• Listeria can be present asymptomatically like normal vaginal and intestinal flora; therefore, samples of these are not useful in diagnosis [9].
• Microscopy and culture or Polymerase chain reaction (PCR) can be used for detection.
• Molecular The subtype can help determine the association between case isolates and any product that tests positive for L. monocytogenes [4].
• Serology listeriosis tests are not very specific or sensitive [1].

Histopathology can demonstrate:

• Mild spongiosis and lymphocytic exocytosis or pustules with subcorneal intraepidermal collections of neutrophils [10].
• Mixed acute and chronic inflammatory infiltrate at dermis including prominent macrophages with intracellular and free coccobacilli (a short, oval rod) on Gram stain or hematoxylin and eosin (H&E) stain.
• Granulomas in granulomatosis infantisepticum [8].

An elevated white blood cell count is usually found on the complete blood test.

The images can show abscesses in the patient's internal organs, such as the liver and brain.

Which is the differential diagnosis for cutaneous listeriosis?

Listeriosis occurs like many other infectious diseases that cause fever and constitutional symptoms. The differential diagnosis for cutaneous listeriosis is broad and can include:

• Folliculitis
• Contact dermatitis

• Localized herpetic infection.

Differences to consider based on histopathology include intracellular infections microorganisms, as granuloma inguinal, rhinoscleroma, and leishmaniasis [10].

What is the treatment for listeriosis?

Listeriosis is treated with antibiotics.

Penicillin alone or with gentamicin is considered the drug of choice for the treatment of listeriosis. Vancomycin, meropenem, and linezolid have also been used with success in case reports. [1,11,12,13]. In patients allergic to penicillin, trimethoprim-sulfamethoxazole or erythromycin can be used. [1]. L. monocytogenes It is resistant to cephalosporins.

The duration of treatment varies depending on the age of the patient and the location and severity of the disease.

There is limited evidence on the role of antibiotics in primary cutaneous listeriosis, but it has been proposed that a 5- to 7-day course of oral amoxicillin or trimethoprim-sulfamethoxazole may be justified. [3].

Listeriosis should be reported to the relevant local authorities. [4]. If contaminated products are involved, they may need to be removed.

How can listeriosis be prevented?

Immunization for listeriosis is not currently available.

• The risk of exposure to listeriosis can be minimized through hygienic food preparation and storage.
• Pregnant women and immunocompromised people are recommended to avoid high-risk food products.
• Wearing protective gear, such as gloves, when working with livestock or gardening can help prevent cutaneous listeriosis.

What is the result of listeriosis?

Listeriosis is usually a self-limited disease in immunocompetent individuals; however, mortality rates in invasive diseases can reach 20% [14]. One third of listeriosis cases in pregnancy result in miscarriage or stillbirth [1].

Primary cutaneous listeriosis generally resolves without long-term consequences [3].