You are in: eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease Listeria InfectionArticle Last Updated: Sep 27, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University Terence Zach is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association Editors: Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Larry I Lutwick, MD, Director, Division of Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Professor, Department of Internal Medicine, State University of New York at Downstate; Robert W Tolan Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine; Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center Author and Editor Disclosure Synonyms and related keywords: listeria infection, listeriosis, neonatal listeriosis, meningitis, Listeria monocytogenes, L monocytogenes, Listeria, chorioamnionitis, premature labor, spontaneous abortion, early onset neonatal listeriosis, late-onset neonatal listeriosis, granulomatosis infantisepticum, hydrocephalus, mental retardation, neonatal sepsis INTRODUCTIONSection 2 of 10
  BackgroundListeriosis is an infection caused by the gram-positive motile bacterium Listeria monocytogenes. Listeriosis is relatively rare and occurs primarily in newborn infants, elderly patients, and patients who are immunocompromised. PathophysiologyL monocytogenes is a gram-positive, motile, rod-shaped bacterium that is ubiquitous in the environment. L monocytogenes can be isolated in soil, wood, and decaying matter in the natural environment; however, the principal route of acquisition of Listeria is through the ingestion of contaminated food products. Listeria has been isolated from prepared meat (eg, hot dogs, deli meat), dairy products, unwashed raw vegetables, and seafood. Soft cheeses and unpasteurized milk have been the most frequently incriminated dairy products. Ingestion of Listeria by pregnant women can result in nausea, vomiting, diarrhea, fever, malaise, back pain, and headache. Many pregnant women can carry Listeria asymptomatically in their GI tract or vagina. Maternal infection with Listeria can result in chorioamnionitis, premature labor, spontaneous abortion, or stillbirth. Fetal infection can occur via transplacental transmission. Vertical transmission can also occur from mother to infant via passage through an infected birth canal or ascending infection through ruptured amniotic membranes. Nosocomial outbreaks from one infected infant to others in the same nursery are rare but have been reported. Two clinical presentations of neonatal infections occur: early onset (<5 d) and late onset (>5 d). Early onset neonatal listeriosis is usually associated with sepsis or meningitis. Late-onset neonatal listeriosis frequently presents with purulent meningitis. Listeriosis often involves many organs with microabscesses or granulomas. A disseminated rash with small, pale, granulomatous nodules is histologically characteristic of granulomatosis infantisepticum. Beyond the neonatal period, most children with Listeria infections have an underlying immunodeficiency or are immunocompromised. Older children with Listeria infections frequently develop meningitis. FrequencyUnited StatesThe estimated annual incidence of listeriosis is approximately 2-3 cases per million population. In 2004, 753 new cases of listeriosis were reported in the InternationalThe estimated annual incidence of listeriosis is approximately 4 cases per million population in Mortality/MorbidityEarly onset neonatal listeriosis has a 20-30% mortality rate. Late-onset neonatal listeriosis has a 0-20% mortality rate. The mortality rate in older children is less than 10%. Hydrocephalus, mental retardation, and other CNS sequelae have been reported in survivors of Listeria meningitis. AgeListeria infections occur most often in newborns and elderly patients. Neonatal infections can be subdivided into early onset and late-onset disease.
CLINICALSection 3 of 10
HistoryConsider listeriosis in cases of neonatal sepsis or meningitis and in cases of sepsis or meningitis in children who are immunocompromised.
PhysicalListeriosis presents in the same manner as other more common neonatal pathogens, such as group B streptococci and Escherichia coli.
CausesL monocytogenes is acquired via the ingestion of contaminated food products. Newborns acquire Listeria transplacentally, by ascending infection via ruptured amniotic membranes or upon exposure during vaginal delivery. DIFFERENTIALSSection 4 of 10
Bacteremia Congenital Pneumonia Fever in the Young Infant Meningitis, Bacterial Neonatal Sepsis Pneumonia
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| Drug Name | Ampicillin (Marcillin, Omnipen, Polycillin, Principen) |
|---|---|
| Description | DOC. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity. Usual neonatal dosage for treatment of septicemia or meningitis depends on gestational and postnatal age. Higher doses are used with severe infections or meningitis. |
| Adult Dose | 1-3 g IV q3-4h; not to exceed 12 g/d |
| Pediatric Dose | Ampicillin dosing based on 25-100 mg/kg/dose slow IV push (higher doses typically used for meningitis) Gestational age <29 weeks Postnatal age of 0-28 days: Dose frequency = q12h Postnatal age of >28 days: Dose frequency = q8h Gestational age 30-36 weeks Postnatal age of 0-14 days: Dose frequency = q12h Postnatal age of >14 days: Dose frequency = q8h Gestational age 37-44 weeks Postnatal age of 0-7 days: Dose frequency = q12h Postnatal age of > 7 days: Dose frequency = q8h Gestational age >44 weeks All postnatal ages: Dose frequency = q6h |
| Contraindications | Documented hypersensitivity |
| Interactions | Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives |
| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals |
| Precautions | Renal, hepatic, and hematologic systems should be evaluated periodically in older children and adults on ampicillin; very large doses may result in CNS excitation or seizure activity |
| Drug Name | Gentamicin (Garamycin, Gentacidin) |
|---|---|
| Description | Useful in combination with ampicillin against listeria. |
| Adult Dose | 3-5 mg/kg/d IV/IM q8h |
| Pediatric Dose | Usual neonatal maintenance dosage for treatment of septicemia or meningitis depends on gestational and postnatal age Gentamicin neonatal dosing scheme: Loading dose of 4 mg/kg can be given Maintenance dose: 2.5-3 mg/kg/dose IV infused over 30 min Gestational age <29 weeks Postnatal age of 0-28 days: Dose frequency = q24h Postnatal age of >28 days: Dose frequency = q24h (consider using 3 mg/kg/dose) Gestational age 30-36 weeks Postnatal age of 0-14 days: Dose frequency = q24h (consider using 3 mg/kg/dose) Postnatal age of >14 days: Dose frequency = q24h Gestational age >37 weeks Postnatal age of 0-7 days: Dose frequency = q12h Postnatal age of > 7 days: Dose frequency = q8h |
| Contraindications | Documented hypersensitivity; non–dialysis-dependent renal insufficiency |
| Interactions | Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; aminoglycosides enhance effects of neuromuscular blocking agents thus prolonged respiratory depression may occur Coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly) |
| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus |
| Precautions | Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment |
| Drug Name | Sulfamethoxazole and Trimethoprim (Bactrim, Cotrim, Septra) |
|---|---|
| Description | Second-line DOC for non-neonatal penicillin-allergic patients. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. |
| Adult Dose | 15-20 mg/kg/d (based on trimethoprim component) PO/IV divided qid |
| Pediatric Dose | <2 months: Do not administer >2 months: 8-12 mg/kg/d (based on trimethoprim component) IV divided qid |
| Contraindications | Documented hypersensitivity; megaloblastic anemia caused by folate deficiency; age <2 months |
| Interactions | May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine |
| Pregnancy | C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus |
| Precautions | Do not use in pregnancy near term (risk of kernicterus); discontinue at first appearance of rash or sign of adverse reaction; frequently obtain CBC counts; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholism, elderly persons, patients receiving anticonvulsant therapy, or patients with malabsorption syndrome); hemolysis may occur in G-6-PD deficiency; patients with AIDS may not tolerate or respond to trimethoprim-sulfamethoxazole; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation |
| Drug Name | Penicillin G (Pfizerpen) |
|---|---|
| Description | Can be used as an alternative to ampicillin. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity. |
| Adult Dose | 15-20 million U/d IV divided q4-6h |
| Pediatric Dose | 250,000-400,000 U/kg/d IV divided q4-6h |
| Contraindications | Documented hypersensitivity |
| Interactions | Probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin |
| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals |
| Precautions | Caution in impaired renal function |
Prognosis is guarded and depends on whether meningitis or shock is present. Hydrocephalus, mental retardation, and other CNS sequelae have been reported following meningitis.
Failure to diagnose L monocytogenes infections may result in medicolegal action.
Article Last Updated: Sep 27, 2007
