This document discusses Listeria monocytogenes, which causes listeriosis. It is the only strain of Listeria that infects humans. It most commonly causes CNS listeriosis in neonates, elderly, and immunocompromised adults. Early diagnosis and treatment with ampicillin or penicillin plus gentamicin is important, as the mortality rate of CNS listeriosis is high. Survivors often experience neurologic sequelae.

1. SEMEY STATESEMEY STATE
MEDICAL UNIVERSITYMEDICAL UNIVERSITY
SIWSIW
TOPIC: LISTERIA , MORPHOLOGY,TOPIC: LISTERIA , MORPHOLOGY,
PHYSIOLOGY. ROLE IN A PATHOLOGYPHYSIOLOGY. ROLE IN A PATHOLOGY
OF WOMEN.OF WOMEN.
NAME: RATHER ALI MOHMADNAME: RATHER ALI MOHMAD

6. Listeria monocytogenesListeria monocytogenes
 The only strain of Listeria that infects humansThe only strain of Listeria that infects humans
 Aerobic and facultatively anaerobicAerobic and facultatively anaerobic
 Motile, beta hemolytic, non-spore-formingMotile, beta hemolytic, non-spore-forming
 Gram-positiveGram-positive rod, regular, shortrod, regular, short
 Occurs singly or in short chainsOccurs singly or in short chains

7. Common presenting syndromesCommon presenting syndromes
 BacteremiaBacteremia and sepsisand sepsis
 ChorioamnionitisChorioamnionitis
 CNS listeriosisCNS listeriosis (meningitis, meningoencephalitis,(meningitis, meningoencephalitis,
cerebritis, brainstem encephalitis, and brain orcerebritis, brainstem encephalitis, and brain or
spinal abscess)spinal abscess)
 EndocarditisEndocarditis
 Focal infectionsFocal infections
 Recurrent spontaneous abortionRecurrent spontaneous abortion
 granulomatosis infantisepticumgranulomatosis infantisepticum
 StillbirthStillbirth

9. EpidemiologyEpidemiology
 Additional predisposing factor:Additional predisposing factor:
 MalignancyMalignancy
 Transplantation (especially renal transplantation)Transplantation (especially renal transplantation)
 Corticosteroid therapyCorticosteroid therapy
 HIV/AIDSHIV/AIDS
 DMDM
 Autoimmune disorderAutoimmune disorder
 SplenomegalySplenomegaly
 AlcoholismAlcoholism
 HemochromatosisHemochromatosis

10. EpidemiologyEpidemiology
 Usually food-borne transmissionUsually food-borne transmission
 1% ~ 5% asymptomatic intestinal carrier1% ~ 5% asymptomatic intestinal carrier
 High risk:High risk:
 NeonatesNeonates
 Elderly and pregnant womenElderly and pregnant women

31. DiagnosisDiagnosis
 Imaging studies are negative in cases of CNSImaging studies are negative in cases of CNS
listeriosis without parenchymal CNSlisteriosis without parenchymal CNS
involvementinvolvement
 In cases of parenchymal CNS involvement,In cases of parenchymal CNS involvement, MRIMRI
(imaging study of choice) and CT reveal areas of(imaging study of choice) and CT reveal areas of
uptake without ring enhancement, involving theuptake without ring enhancement, involving the
brainstembrainstem,, cerebellumcerebellum, and, and cerebral cortexcerebral cortex
 MRI: T1WIMRI: T1WI  Enhencing lesionsEnhencing lesions
T2WIT2WI  High signalHigh signal

32. DiagnosisDiagnosis
 Gram stain of CSF is negative in 2/3 of cases ofGram stain of CSF is negative in 2/3 of cases of
meningitis/meningoencephalitis (SEN 0~40%)meningitis/meningoencephalitis (SEN 0~40%)
 Gram stain of CSF may be misleading in manyGram stain of CSF may be misleading in many
of the remaining cases (usually misinterpreted asof the remaining cases (usually misinterpreted as
gram(+) diplococci, Diphtheroids)gram(+) diplococci, Diphtheroids)
 CSF examinationCSF examination
 Lymphocyte >25%Lymphocyte >25%
 Elevated proteinElevated protein
 Reduced sugarReduced sugar poor prognosispoor prognosis

35. TreatmentTreatment
 For severe infections:For severe infections:
 AmpicillinAmpicillin (200 mg/kg/d i.v. divided in six doses)(200 mg/kg/d i.v. divided in six doses)
oror PenicillinPenicillin (300,000 mg/kg/d i.v. divided in six doses)(300,000 mg/kg/d i.v. divided in six doses)
 Combined withCombined with gentamicingentamicin (1(1––2 mg/kg every 8 hours,2 mg/kg every 8 hours,
adjusted with renal function and followed by levels)adjusted with renal function and followed by levels)
 Penicillin-allergic patients:Penicillin-allergic patients:
 Trimethoprim-sulfamethoxazoleTrimethoprim-sulfamethoxazole (20 mg/kg per day of the(20 mg/kg per day of the
Trimethoprim component IV in four divided doses)Trimethoprim component IV in four divided doses)
 Combination of ampicillin and trimethoprim-Combination of ampicillin and trimethoprim-
sulfamethoxazole might be more effectivesulfamethoxazole might be more effective

36. TreatmentTreatment
 Other choices:Other choices:
 Imipenem and meropenem have excellent in vitroImipenem and meropenem have excellent in vitro
activity against Listeriaactivity against Listeria
 Vancomycin is an alternative, but failures have beenVancomycin is an alternative, but failures have been
reportedreported
 Erythromycin and Tetracyclines have in vitro activityErythromycin and Tetracyclines have in vitro activity
against Listeria, but not recommendedagainst Listeria, but not recommended
 Cephalosporins are inactive in vitro andCephalosporins are inactive in vitro and
ineffective clinicallyineffective clinically

37. Duration of TherapyDuration of Therapy
 The optimal duration of antibiotic therapy is unknownThe optimal duration of antibiotic therapy is unknown
 Two weeks may be sufficient for bacteremia inTwo weeks may be sufficient for bacteremia in
immunocompetent patientsimmunocompetent patients
 At leastAt least six to eight weekssix to eight weeks for CNS listeriosis infor CNS listeriosis in
immunocompromised patientsimmunocompromised patients
 The response to therapy is monitored by cultures ofThe response to therapy is monitored by cultures of
blood and or CSFblood and or CSF
 Treatment is continued until the CSF culture is negativeTreatment is continued until the CSF culture is negative
and repeat MRI of the brain is normaland repeat MRI of the brain is normal
 The patients are then monitored for relapseThe patients are then monitored for relapse

38. PrognosisPrognosis
 Early diagnosis and initiation of appropriate therapyEarly diagnosis and initiation of appropriate therapy areare
importantimportant
 100% mortality rate in untreated patients100% mortality rate in untreated patients
 The mortality rate of meningoencephalitis is among theThe mortality rate of meningoencephalitis is among the
highest among all causes of bacterial meningitishighest among all causes of bacterial meningitis
(13~43%)(13~43%)
 Mortality is higher among immunocompromisedMortality is higher among immunocompromised
patients and those who develop seizurespatients and those who develop seizures
 The mortality rate of cerebritis, CNS abscess, andThe mortality rate of cerebritis, CNS abscess, and
endocarditis due toendocarditis due to ListeriaListeria is even higheris even higher (~50%)(~50%)
 61%61% of survivors in each group had persistentof survivors in each group had persistent
neurologic sequelaeneurologic sequelae

39. SummarySummary
 Most CNS listeriosis occurs in noenates, elderlyMost CNS listeriosis occurs in noenates, elderly
and immunocompromised adultsand immunocompromised adults
 Early diagnosis and initiation of appropriateEarly diagnosis and initiation of appropriate
therapy are importanttherapy are important
 First choice of drugs: Ampicillin or PenicillinFirst choice of drugs: Ampicillin or Penicillin
plus Gentamicinplus Gentamicin
 The mortality rate of CNS listeriosis is highThe mortality rate of CNS listeriosis is high
 Neurologic sequelae are common among theNeurologic sequelae are common among the
survivorssurvivors

41. Thanks for your attentionThanks for your attention