Listeriosis

Epidemiology

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Risk Factors

  • Anti-TNF Therapy (see [[Anti-TNF Therapy]])
    • Case series of 15 patients
    • Murine studies implicate TNF╬▒ in the immune response to Listeria
    • Relative Risk: infliximab >etanercept (no cases reported with adalimumab)
    • Clinical Presentation: meningitis, bacteremia, septic arthritis (no reports of Listeria pneumonia)
      [Slifman NR, Gershon SK, Lee JH, et al. Listeria monocytogenes infection as a complication of treatment with tumor necrosis factor alpha- neutralizing agents. Arthritis Rheum 2003; 48:319-324]
  • Lymphoma (see [[Lymphoma]])

Etiology

  • Listeria monocytogenes infection
    • Gram-positive rods:

Diagnosis

  • FOB:
  • Thoracentesis: may have empyema
    • pH: decreased
    • Chemistry: exudate
    • GS: gram-positive rods
    • Culture: Listeria usually can be cultured out by usual methods
  • CXR/Chest CT Pattern
    • Infiltrates:
    • Pleural Effusion:

Clinical Presentations

  • Pneumonia (see [[Pneumonia]])
    • Dyspnea:
    • Cough:
  • Pleural Effusion (see [[Pleural Effusion-Exudate]])

Treatment

  • High-Dose PCN: treatment of choice
  • Cephalosporins and Macrolides have limited activity against Listeria monocytogenes

References

  • Rothe J, Lesslauer W, Lotscher H, et al. Mice lacking the tumour necrosis factor receptor 1 are resistant to TNF-mediated toxicity but highly susceptible to infection by Listeria monocytogenes. Nature 1993; 364:798-802
  • Slifman NR, Gershon SK, Lee JH, et al. Listeria monocytogenes infection as a complication of treatment with tumor necrosis factor alpha- neutralizing agents. Arthritis Rheum 2003; 48:319-324