Listeriosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia. Early clinical manifestations (usually fever) typically develop early within 24 hours of transmission. If left untreated, patients typically progress within 1-90 days to develop Listeria-associated complications, including bacteremia, abscess formation, pneumonia, ARDS, acute kidney injury, and CNS impairment. Among healthy children and young adults, the prognosis of listeriosis is generally good. Prognosis is poorer among high-risk populations, who are more likely to develop complications and death even with prompt management.

• Following transmission, the majority of healthy patients do not develop clinical manifestations or may develop a mild, transient bacteremia.^[1]
• The median incubation period for listeriosis-associated gastroenteritis is approximately 24 hours (range from 6 hours to 10 days).
• Systemic manifestations of listeriosis may be slow-occurring, and the duration from transmission to development of systemic manifestations widely varies between 1 day to 90 days following transmission.^[2][3][4]

• Listeria-associated gastroenteritis typically occurs 24 hours following ingestion of contaminated food.
• Patients typically manifest with fever, nausea, vomiting, and watery diarrhea.
• Listeria-associated gastroenteritis is usually self-limited and lasts for a mean of 2 days among healthy individuals.
• In high-risk patients, systemic manifestations of Listeria may occur, and patients are at higher risk of developing Listeria-associated complications.^[1]

• Among pregnant women, listeriosis typically manifests during the third trimester of gestation.^[1]
• Pregnant women typically first present with mild flu-like symptoms, such as fever and chills, that are difficult to diagnose.
• As the disease progresses, pregnant women typically develop Listeria-associated bacteremia (typically without CNS involvement)
• If left untreated, listeriosis among pregnant women typically results in fetal sequelae, including fetal death, premature birth, or neonatal sepsis.^[1]

• Neonates may be infected either in-utero infection, which manifests with neonatal sepsis or during delivery, which manifests with neonatal meningitis.
• Both infections are usually rapid-occurring, and infected neonates appear sick-looking with greyish-bluish discoloration at birth.
• If left untreated, neonates may develop granulomatosis infantiseptica, a severe in-utero infection, and death.^[1]

• L. monocytogenes has tropism for the brain stem and meninges.
• Patients with Listeria-associated CNS infection typically develop fever followed by altered mental status, seizures, cranial nerve palsy, hemiplegia, and ataxia.^[1]
• Patients may either develop rhombencephalitis, cerebritis, spinal cord infection, meningitis alone, encephalitis alone, or both (meningoencephalitis).
• Patients with Listeria-associated rhombencephalitis typically experience a bi-phasic course. First, patients develop worsening headache, fever, vomiting for a 3-5 days, followed by an abrupt-onset of neurological impairment (cranial nerve palsy, ataxia, altered mental status, seizures).^[1]
• If left untreated, brain abscesses may develop. The location of the brain abscesses is typically in the thalamus, pons, and/or medulla.
• The majority of patients with advanced CNS disease develop long-term sequelae.

Listerial endocarditis may affect either native or prosthetic valves.

• If left untreated, the majority of patients with Listeria-associated endocarditis progress to develop bacteremia.^[1]

• Compared with the general population, high-risk patients are more likely to develop invasive disease and Listeria-associated complications.^[5]
• Complications of invasive disease include the following:^[1][6]
• Disseminated intravascular coagulation
• ARDS
• Rhabdomyolysis
• Acute kidney injury
• Septicemia^[7]
• Meningitis^[7]
• Encephalitis^[8]
• Corneal ulcer^[9]
• Pneumonia^[10]
• Intrauterine or cervical infection in pregnant women, may result in:^[11]

• Spontaneous abortion (2nd/3rd trimester)
• Stillbirth
• Preterm birth
• Granulomatosis infantiseptica: pyogenic granulomas distributed over the whole body, and the newborn may suffer from physical retardation

The prognosis of listeriosis depends on the health status of the host:^[12]

• Healthy children and young adults have a good prognosis and are at low-risk of developing Listeria-associated complications and long-term sequelae.
• High-risk populations, including pregnant women, neonates, elderly, and immunosuppressed individuals, have a poorer prognosis with a high death rate (even when treatment is administered promptly).

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