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40 years!
Last updated:
8/15/2023
Years published: 1989, 1992, 1997, 2004, 2009, 2012, 2015, 2018, 2023
NORD gratefully acknowledges the Centers for Disease Control and Prevention’s Division of Foodborne, Waterborne and Environmental Diseases for assistance in the preparation of this report.
Listeriosis is a rare but serious infectious disease caused by the bacterium Listeria monocytogenes, which is predominantly transmitted to humans through the consumption of contaminated food. Clinical syndromes associated with listeriosis include febrile gastroenteritis, invasive disease (bacteremia, meningitis, meningoencephalitis) and pregnancy-associated infections causing spontaneous abortions, stillbirth, premature labor and neonatal disease. Approximately 20% of listeriosis cases are fatal. Listeriosis most often affects pregnant women and their newborns, adults aged 65 and older and individuals with weakened immune systems. Prompt recognition and treatment of the disease is necessary to avoid several serious complications.
Symptoms associated with listeriosis may vary widely, ranging from mild febrile gastroenteritis to invasive disease (which occurs when the bacteria spread beyond the gastrointestinal tract) causing severe illness. People who are not pregnant most often present with bacteremia (bacteria in the blood), meningitis (infection of the meninges, the membrane surrounding the brain and spinal cord) or meningoencephalitis (infection of the meninges and brain). Common presenting symptoms in patients with bacteremia, meningitis, or meningoencephalitis include fever, muscle aches, headache, stiff neck, malaise, ataxia (loss of balance), convulsions and mental status changes, such as confusion. Less common clinical syndromes include endocarditis (infection of the lining of the heart), pneumonia, osteomyelitis (infection of the bone), septic arthritis (infection of the joint), abscesses of the brain or liver, peritonitis (infection of the membranes lining the abdominal cavity) and endophthalmitis (infection of structures within the eye). Symptoms secondary to these conditions depend on the anatomical site of infection and may include abdominal pain, bone pain, respiratory distress, pneumonia and heart failure. Outbreak investigations have demonstrated that listeriosis can cause febrile gastroenteritis, a noninvasive syndrome, in healthy individuals. Patients with febrile gastroenteritis typically experience diarrhea, fever/chills, fatigue, headache, abdominal pain and nausea.
Listeriosis during pregnancy can result in fetal loss (spontaneous abortion and stillbirth), premature delivery and neonatal bacteremia or meningitis. Listeriosis may occur at any time during pregnancy; however, it is most often detected in the third trimester. Among pregnant women diagnosed with listeriosis, most reported only mild flu-like symptoms including fever, chills, myalgias (muscle aches), headaches, arthralgia (joint pain) and gastrointestinal symptoms. Some pregnant women do not recall having any symptoms before the diagnosis of listeriosis in their infant. In contrast to maternal illness, fetal and newborn infections are serious. Nearly one-quarter of pregnancy-associated cases result in fetal loss or death of the newborn. Infants with listeriosis (neonatal listeriosis) may present with fever, lethargy, irritability, diarrhea, poor feeding, vomiting, respiratory distress or a characteristic skin rash consisting of widely spread, small, pale nodules (granulomatosis infantiseptica). Neonatal listeriosis may be classified as early-onset or late-onset. Early-onset neonatal listeriosis, which occurs in the first 7 days of life, is most often associated with bacteremia or sepsis. Early-onset infections occur following maternal bacteremia with transplacental transmission before birth. Late-onset neonatal listeriosis is most often associated with meningitis. The mode of transmission is less clear in late-onset listeriosis; environmental sources may be involved in some cases, and outbreaks of hospital-acquired, neonatal listeriosis have been reported.
Listeriosis is caused by the bacterium Listeria monocytogenes. Nearly all cases of listeriosis (other than neonatal listeriosis) occur from eating contaminated food products, especially ready-to-eat, refrigerated foods. Unlike most foodborne bacterial pathogens, L. monocytogenes can grow at refrigeration temperatures. Listeria organisms are commonly found in the environment, including water, soil, mud and decaying vegetation. L. monocytogenes can be introduced into slaughterhouses and food manufacturing plants, which results in the contamination of food products such as meat or dairy products, raw produce and processed foods. Important sources of foodborne outbreaks include contaminated dairy products such as soft cheeses, unpasteurized or improperly pasteurized milk and ice cream, hot dogs and delicatessen meats and raw produce, including packaged salads, cantaloupe and sprouts.
Although L. monocytogenes exposures are common, the interaction of several factors is thought to play a role in the development of invasive disease. These factors include the number of bacteria a person consumes (dose), the virulence of the bacterial strain and the functioning of the patient’s immune system.
Invasive listeriosis usually affects pregnant women and their newborns, adults aged 65 and older and individuals with weakened immune systems (immunocompromised). Medical risk factors for invasive listeriosis include hematologic malignancy, organ transplantation, HIV infection or AIDS, alcoholism and liver and kidney disease. In the United States, L. monocytogenes accounts for ~5% of all cases of bacterial meningitis in infants <2 months of age and ~10% of all cases of bacterial meningitis in people ≥65 years of age. Invasive listeriosis occurs very infrequently in young, healthy adults. Overall rates of invasive listeriosis in the United States have remained relatively constant over the past decade (~3 cases per million population), as measured where active surveillance for listeriosis has been conducted.
A diagnosis of invasive listeriosis is confirmed through laboratory tests called cultures, which confirm the presence of L. monocytogenes in the body by isolating the bacteria from a clinical specimen. Cultures of blood, amniotic fluid, cerebrospinal fluid, placenta, or specimens from any affected organ systems may be performed to determine whether the bacterium L. monocytogenes is present. Certain x-ray tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) might be used to detect abscesses that may form on internal organs, especially the brain or liver.
Treatment
Listeriosis is treated with antibiotics. The most prescribed treatment is intravenous ampicillin. Many physicians also recommend treatment with the antibiotic gentamicin in combination with ampicillin. For affected individuals who cannot tolerate B-lactam antibiotics (such as ampicillin), trimethoprim-sulfamethoxazole is recommended. Other antibiotics are sometimes recommended. Antibiotic treatment of pregnant women with documented listeriosis may prevent infection of the fetus. L. monocytogenes is resistant to all third generation cephalosporins. Other treatment is symptomatic and supportive.
Prevention
Knowing what foods to avoid and how to safely prepare and store foods is the best way to reduce the risk of listeriosis. This information is most important for those persons in groups at higher risk for invasive listeriosis, especially pregnant women, older adults and persons who have weakened immune systems.
Recommendations for persons at higher risk for listeriosis: Do not eat or drink raw (unpasteurized) milk or other unpasteurized dairy products. Do not eat soft cheeses such as Brie, feta, and queso fresco, unless they are labeled as made from pasteurized milk. Additionally, be aware that soft cheeses, such as queso fresco, that were made from pasteurized milk but contaminated during cheese making have also caused listeriosis. Reheat leftovers, prepackaged foods, and deli meats until steaming hot. Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole or unless it is a canned or shelf-stable product.
Recommendations for everyone to prevent listeriosis and other foodborne diseases: thoroughly cook all raw foods of animal origin, such as meat, because heat kills L. monocytogenes. Wash fruits and vegetables thoroughly if eating raw. Follow recommended “sell by” or “best if used by” labels on processed foods. Wash hands before preparing food and after handling raw meat, poultry and eggs; clean surfaces and utensils used to prepare uncooked foods; and keep unwashed and uncooked foods separate from foods that have been already prepared for eating.
The following resource provides additional information:
https://www.cdc.gov/listeria/prevention.html
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/for-patients-and-families/information-resources/info-clinical-trials-and-research-studies/
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
TEXTBOOKS
Collins JP, Griffin PM. Listeria monocytogenes Infections. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison’s Principles of Internal Medicine, 21e. McGraw Hill; 2022. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095§ionid=263549003 Accessed August 14, 2023.
Painter J, Slutsker L. Listeriosis in Humans. In: Ryser ET ME, ed. Listeria, Listeriosis, and Food Safety 3rd ed. Boca Raton, FL: Taylor and Francis Group, 2007:85-110.
Braden CR. Listeriosis. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:290.
Slutsker L, Evans MC, Schuchat A. Listeriosis. In: Scheld WM, Craig WA, Hughes JM, eds. Emerging Infections. Washington DC: ASM Press, 2000:83-106.
JOURNAL ARTICLES
Conrad AR, Tubach S, Cantu V, et al. Listeria monocytogenes illness and deaths associated with ongoing contamination of a multiregional brand of ice cream products, United States, 2010-2015. Clin Infect Dis. 2023;76(1):89-95. doi:10.1093/cid/ciac550
McCollum JT, Cronquist AB, Silk BJ, Jackson KA, O’Connor KA, Cosgrove S, Gossack JP, Parachini SS, Jain NS, Ettestad P, Ibraheem M, Cantu V, Joshi M, DuVernoy T, Fogg NW Jr, Gorny JR, Mogen KM, Spires C, Teitell P, Joseph LA, Tarr CL, Imanishi M, Neil KP, Tauxe RV, Mahon BE. Multistate outbreak of listeriosis associated with cantaloupe. N Engl J Med. 2013 Sep 5;369(10):944-53.
Ibraheem M, Vance S, Jackson KA, Ettestad P, Smelser C, Silk B. Vision Loss following Intraocular Listeriosis Associated with Contaminated Cantaloupe. Case Rep Ophthalmol. 2013 Jun 1;4(2):7-11.
Menon M, Graves L, McCombs K, Hise K, Silk BJ, Kuehnert M, Lynch M. Listeria monocytogenes in donated platelets–a potential transfusion transmitted pathogen intercepted through screening. Transfusion 2013; [Epub ahead of print].
Hoelzer K, Chen Y, Dennis S, Evans P, Pouillot R, Silk BJ, Walls I. New data, strategies, and insights for Listeria monocytogenes dose-response models: summary of an interagency workshop, 2011. Risk Analysis 2013; [Epub ahead of print].
Gaul LK, Farag NH, Shim T, Kingsley MA, Silk BJ, Hyytia-Trees E. Hospital-acquired listeriosis outbreak caused by contaminated diced celery–Texas, 2010. Clin Infect Dis 2013 Jan;56(1):20-6.
Cartwright EJ, Jackson KA, Johnson SD, Graves LM, Silk BJ, Mahon BE. Listeriosis outbreaks and associated food vehicles, United States, 1998–2008. Emerg Infect Dis [Internet] 2013 Jan.
Laksanalamai P, Joseph LA, Silk BJ, Burall LS, L Tarr C, Gerner-Smidt P, Datta AR. Genomic Characterization of Listeria monocytogenes Strains Involved in a Multistate Listeriosis Outbreak Associated with Cantaloupe in US. PLoS One 2012;7(7):e42448. Epub 2012 Jul 31.
Silk BJ, Date KA, Jackson KA, et al. Invasive Listeriosis in the Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2009: Further Targeted Prevention Needed for Higher-Risk Groups. Clin Infect Dis 2012;54: S396–S404.
Pouillot R, Hoelzer K, Jackson KA, Henao O, Silk BJ. Relative Risk of Listeriosis in Foodborne Diseases Active Surveillance Network (FoodNet) Sites According to Age, Pregnancy, and Ethnicity. Clin Infect Dis 2012; 54: S405–S410.
Jackson KA, Biggerstaff M, Tobin-D’Angelo, Sweat D, Klos R, Nosari J, Garrison O, Boothe E, Saathoff-Huber L, Hainstock L, Fagan RP. Multistate outbreak of Listeria monocytogenes associated with Mexican-style cheese made from pasteurized milk among pregnant, Hispanic women. J Food Prot. 2011;74(6):949-53.
Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS,
Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A; Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.
Jackson KA, Iwamoto M, Swerdlow D. Pregnancy-associated listeriosis. Epidemiol Infect 2010;138(10):1503-9.
Swaminathan B, Gerner-Smidt P. The Epidemiology of Human Listeriosis. Microbes Infect. 2007;9(10):1236-43.
Voetsch AC, Angulo FJ, Jones TF, et al. Reduction in the incidence of invasive listeriosis in Foodborne Diseases Active Surveillance Network Sites, 1996-2003. Clin Infect Dis 2007;44:513-20.
Gottlieb SL, Newbern C, Griffin PM, et al. Multistate outbreak of listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis 2006;42:29-36.
Arias Miranda IM, et al., Listeriosis in the adult. Revision of 10 cases. An Med Interna. 2004;21:75-8.
Roberts AJ, Wiedemann M. Pathogen, host and environmental factors contributing to the pathogenesis of listeriosis. Cell Mol Life Sci. 2003;60:904-18.
Benshushan A, et al., Listeria infection during pregnancy: a 10 year experience. Isr Med Assoc J. 2002;4:776-80.
Pierre V, et al., Prevention of Listeria infections. Bull Acad Natl Med. 2000;184:295-302.
Schlech WF. Foodborne listeriosis. Clin Infect Dis 2000;31;770-5.
Schlech III WF. Listeria gastroenteritis – new pathogen. N Engl J Med. 1997;336:130-2
Dalton CB, et al., An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk. N Engl J Med. 1997;366:100-5.
Schuchat A, Swaminathan B, Broome CV. Epidemiology of Human Listeriosis. Clin Micro Rev 1991;4;169-83.
Linnan MJ, Mascola L, Dong Lou X, et al. Epidemic listeriosis associated with Mexican-style cheese. N Engl J of Med 1988;319:823-8.
Teberg AJ, et al., Clinical manifestations of epidemic neonatal listeriosis. Pediatr Infect Dis J. 1987;6:817-20.
Boucher M, et al., Perinatal listeriosis (early-onset): correlation of antenatal manifestations and neonatal outcome. Obstet Gynecol. 1986;68:593-7.
INTERNET
Centers for Disease Control and Prevention. Listeria (Listeriosis). August 10, 2023. www.cdc.gov/listeria Accessed August 14, 2023.
Zach T. Listeria Infection. Medscape. Dec 1, 2022. https://www.emedicine.com/ped/topic1319.htm Accessed August 14, 2023.
Weinstein KB. Listeria Monocytogenes. Medscape. August 10, 2022. https://emedicine.medscape.com/article/220684-overview Accessed August 14, 2023.
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