Epidemiology and pathogenesis of Listeria monocytogenes infection
- Michael S Gelfand, MD
Michael S Gelfand, MD
- Professor of Medicine
- University of Tennessee College of Medicine
- Section Editors
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Listeria monocytogenes is an important bacterial pathogen in immunosuppressed patients, individuals at the extremes of age including neonates and older adults, pregnant women, and, occasionally, previously healthy individuals. Invasion of the central nervous system (meningitis or meningoencephalitis) and bacteremia are the principal clinical manifestations of listerial infection in these hosts. In contrast, normal hosts who ingest high numbers of Listeria may develop self-limited febrile gastroenteritis.
The epidemiology, microbiology, and pathogenesis of listerial infection will be reviewed here. The clinical manifestations, diagnosis, treatment, prognosis, and prevention of listerial infections are discussed separately. (See "Clinical manifestations and diagnosis of Listeria monocytogenes infection" and "Treatment, prognosis, and prevention of Listeria monocytogenes infection".)
L. monocytogenes is the only Listeria species that regularly infects humans, although rare cases of human infections with Listeria ivanovii (a pathogen of ruminants) and Listeria grayi have been reported [1,2]. Listeria is an aerobic and facultatively anaerobic, motile, beta-hemolytic, non–spore-forming, short, gram-positive rod that exhibits characteristic tumbling motility by light microscopy (movie 1 and picture 1) [3,4]. Listeria occurs singly or in short chains. On Gram stain, Listeria may resemble pneumococci (diplococci), enterococci, or diphtheroids (Corynebacteria) or be gram variable and be confused with Haemophilus species (picture 2) [3-5]. In particular, when a positive blood or cerebrospinal fluid culture is preliminarily identified as diphtheroids, the clinician should consider the possibility that the isolate represents Listeria .
Listeria produces a characteristic appearance on blood agar with small zones of clear beta-hemolysis around each colony (picture 3). Listeria grows well at refrigeration temperatures (4° to 10°C). Rarely, the "cold enrichment" technique and selective media are used when attempting to isolate Listeria from mixed cultures, such as stool .
Listeria is a facultative intracellular parasite. The primary habitat of Listeria is the soil and decaying vegetable matter. Most Listeria infections in adults are thought to result from oral ingestion and subsequent intestinal mucosal penetration and systemic infection.
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