How long does listeriosis live in the external environment. Listeriosis - what is it? Symptoms and treatments

Listeria (Listeria monocytogenes, L. monocytogenes) are bacteria that cause the infectious disease listeriosis in animals, including domestic animals, birds and humans. Every year, thousands of cases of the disease are recorded in the world, the mortality rate among which is 20-30%, which significantly exceeds that of other foodborne diseases, including such as salmonellosis and botulism. Listeria represent great danger for pregnant women, newborns, the elderly and patients with sharply reduced immunity. They infect mononuclear phagocytes, which is why they are called Listeria monocytogenes.

Listeria live in water, soil, plants and food. The ability of bacteria to multiply in food at low temperatures (home refrigerator conditions) can cause food poisoning in humans. The first symptoms of listeriosis appear only a few weeks after the consumption of infected products - raw milk, products made from raw milk, meat and meat products, greens, vegetables and fruits contaminated with soil, where the excretions of sick animals have fallen.

Listeria enters the human body through the mucous membranes of the oral cavity and nose, conjunctiva, mucosa of the digestive tract, respiratory organs and damaged skin. The disease occurs in the form of localized or generalized forms. With the mass reproduction of Listeria monotsotogenes in the blood, patients develop sepsis.

Animals often develop septicemia, which leads to damage to the central nervous system, mastitis develops, and pregnancy often ends in abortion.

Many sources of infection, a variety of distribution routes and transmission factors, a variety of clinical manifestations, high mortality are the main signs of listeriosis in humans.

Rice. 1. In the photo of listeria (electron diffraction pattern, ultrathin section).

A bit of history

Listeria was first described in 1911 by S. Halfes as a new type of microorganism Bacterium hepatis.

D. Murray with co-authors (Cambridge University) in 1926 isolated the pathogen from patients guinea pigs and rabbits. Due to the ability to cause an increase in the number of the largest leukocytes - monocytes in the blood (up to 30 - 50%), the pathogen received the specific name monocytogenes.

A similar pathogen was isolated in Africa from rodents by J. Peary in 1927, from a person with tonsillitis by A. Niefeldt in 1929, from puerperas and newborns by K. Bern et al. in 1935.

In 1940, the bacterium was named Listeria monocytogenes in honor of Joseph Lister, an English surgeon, and the disease that it causes began to be called listeriosis.

More recently, listeriosis was perceived as a disease of animals. The disease has been reported in sheep, cattle, pigs and horses, causing death among them. Listeriosis has rarely been reported in humans. From 1960 to 1982, more than 10 thousand cases were already registered in the world. Then, thousands of cases began to be registered annually, the mortality rate among which was 20-30%, which significantly exceeds that of other food toxic infections, including such as salmonellosis and botulism.

Rice. 2. Photo of the English surgeon Joseph Lister (1827 - 1912), after whom the bacterium was named Listeria monocytogenes in 1940. and the disease it causes is called listeriosis.

Microbiology of listeria

The bacterium Listeria monocytogenes is a member of the type species of the genus Listeria, family Corinebacteriaceae.

Listeria monocytogenes is a small short movable rod or coccobacterium. Its dimensions are 0.3 - 0.5 x 0.8 - 2.0 microns. Bacteria are located singly, in pairs, less often in short chains.
Listeria have flagella that provide motility to bacteria. Some microbial cells quickly lose flagella, which deprives them of mobility.

Rice. 3. Listeria are located singly, in pairs, less often in short chains. Bacteria stain pink on Gram stain.

Rice. 4. In the photo, listeria outside and inside the cells. The rapid movement of Listeria in the human body is carried out with the help of "comet tails", which are formed as a result of the polymerization of protein actin (Act A). At one end of the bacteria, protein filaments form an "actin tail", at the other end protrusions are formed, with the help of which the host cells are introduced into the cytoplasm.

Rice. 5. Listeria in the human body move with the help of flagella only for a few days, then movement is carried out using the actin tail.

Video. Movement of Listeria within host cells.

Rice. 6. Listeria monocytogenes located inside the cell.

Cultivation of Listeria monocytogenes

Listeria monocytogenes are unpretentious. They grow at room temperature on conventional nutrient media- slightly alkaline and neutral.

Rice. 7. When growing on meat-peptone agar, listeria colonies look like fatty mucous balls, transparent or with a whitish tinge, like dew drops on glass. In transmitted light, the colonies acquire a pearly hue. Colonies of virulent bacterial strains are S-shaped. Colonies of weakened and avirulent bacteria are R-shaped. There is O (RS) -form of colonies.

Rice. 8. Growth of Listeria colonies on chromogenic agar. This medium is used to isolate bacteria from food products. It contains a lecithin substrate, with the help of which the phospholipase enzyme is detected, which is present only in the colonies of Listeria monocytogenes. In the presence of this enzyme, bacterial colonies acquire a blue color, an opaque halo is absent.

Rice. 9. When growing on Oxford agar, L. monocytogenes hydrolyzes esculin to form a complex with iron, which is manifested by the formation of a precipitate in the form of a black halo around the colonies.

Rice. 10. With the growth of Listeria in meat-peptone broth, cloudiness with slight opalescence is formed. Turbidity of a viscous consistency is formed during the growth of an old culture. It sticks to the bottom of the tube. With rapid rotation, the sediment rises up in a "pigtail".

Listeria resistance

Listeria monocytogenes show high resistance in the external environment:

Inactivation of bacteria as a result of exposure to sunlight occurs within 2-15 days.
In a 2.5% solution of formalin and alkalis, listeria die after 20 minutes, in a solution of bleach (100 mg of active chlorine per 1 liter of liquid) - after an hour.
Freezing and drying listeria monocytogenes does not kill.
L. monocytogenes can withstand 6-20% salt concentration for a long time.
Bacteria are able to multiply at temperatures from 1 to 45°C. They are stored for a long time in water, soil, plants, food products, silage, straw, grain and animal carcasses, as well as in a home refrigerator.
In premises where livestock is kept, Listeria persists for up to 25 days in summer, up to 48 days in spring, and up to 130 days in autumn. On soil contaminated with manure, bacteria persist up to 20 days in summer, up to 33 days in spring, up to 52 days in autumn, up to 115 days in winter. In corpses buried in the ground, L. monocytogenes persist from 45 days to 4 months.
Bacteria die within 3 - 5 minutes when boiled, at a temperature of 70 ° C - after 25 - 30 minutes.

Listeria is sensitive to a variety of antibacterial drugs penicillin and tetracycline series, aminoglycosides, chloramphenicol, erythromycin, rifampicin and fluoroquinolones. Listeria is resistant to cephalosporins.

Rice. 11. Freezing Listeria does not kill.

Epidemiology

Listeriosis is a typical natural focal zoonotic infection. Distributed everywhere. Most often, outbreaks of listeriosis are recorded in temperate zones, where the soil is rich in organic fertilizers. Contributes to the spread of listeriosis widespread economic activity people: the introduction of advanced soil cultivation technology, the construction of livestock complexes, feed mills, centralized enterprises for the processing and sale of raw materials of animal origin, food warehouses and storage facilities.

Outbreaks of listeriosis are recorded both sporadic and group. Pregnant women, newborns, the elderly and the immunocompromised are at risk. Listeriosis is common among workers in poultry and livestock farms, primary processing shops at poultry and meat processing plants.

The disease is registered throughout the year, but more often in spring and summer.

More recently, listeriosis was perceived as a disease of animals. The disease has been reported in sheep, cattle, pigs and horses, causing death among them. Listeriosis has rarely been reported in humans. Since 1960, thousands of sick people began to be registered annually, the mortality rate among which was 20-30%, which significantly exceeds that of other food toxic infections, including such as salmonellosis and botulism. In severe forms of listeriosis, mortality reaches 90 - 100%. In the United States, 1,600 people are diagnosed with listeriosis every year, 260 of whom die. In Russia, up to 80 cases of listeriosis are registered annually, which clearly does not reflect the true state of this problem.

An increase in the listeriosis disease is predicted, which is associated with the high adaptive ability of Listeria monocytogenes, the ability to reproduce in adverse environmental conditions. Of particular danger to humans are products that are prepared using unpasteurized milk (cheeses), meat and products made from it, including semi-finished products made from animal meat, fish and poultry. An increase in the number of people with immunodeficiencies leads to an increase in the disease.

Rice. 12. Listeriocarrier is found in a significant part of insects, including 8 species of ixodid ticks.

Listeria reservoir in nature

Listeriosis affects more than 91 species of wild animals and 12 species of domestic animals. Young and pregnant animals are especially susceptible to the disease.
Goats, sheep, pigs, rabbits, cattle, horses, geese, chickens, turkeys, ducks, pigeons, parrots and canaries are susceptible to the disease.
In nature, listeriosis is common among rodents (mainly murines): mice, rats, water rats, gerbils, jerboas, hares, etc.
Bacteria isolated from raccoons, foxes, gazelles, wild boars. Among the birds - capercaillie and partridge.

The disease is registered among fur-bearing animals - minks, chinchillas, foxes.

In hatcheries, listeriosis is recorded in trout. The bacteria are isolated from crayfish and frogs, shellfish and shrimp.
Listeria carriage is found in a significant part of insects, including 8 species of ixodid ticks, 5 species of fleas, 1 species of lice, 1 species of gamazate and argas mites, flies and gadflies, which play a certain role in the circulation of pathogens among wild animals. They become infected by the bites of sick animals and spread listeriosis to healthy animals.
Cases of listeriosis among monkeys, dogs and cats are noted.
A person suffers from listeriosis. Infection from a sick pregnant woman is transmitted to the fetus.

Rice. 13. In nature, listeriosis is common among rodents, which take part in the spread of infection by infecting soil, water and animal feed.

Transmission factors for listeriosis

The main source of listeriosis for humans are animals, as well as objects and natural substrates of the environment where listeria develops. Pets become infected with listeriosis by eating food and water contaminated with secretions from sick rodents or their carcasses. Bacteria from sick animals enter the external environment with secretions from the nasal cavity, genital organs, feces, urine and abortive fetus, seeding meat and dairy products. Listeria pollute the water wastewater, soil, plants, silage and straw.

Unboiled milk and products that are made from it - soft cheeses, butter, ice cream can be infected. The source of infection can be fruits and vegetables, including frozen ones, meat and semi-finished meat products, vacuum-packed sausages and sausages.

Listeria spreads in food processing plants, contaminating meat, meat products, including processed foods and equipment.

Rice. 14. In the photo of listeria.

Listeria transmission mechanisms

The mechanisms of infection with listeriosis in humans are diverse. The main one is fecal-oral. Less common are airborne, contact and transplacental routes of infection. Listeria enters the body of animals with contaminated water and food, infected with sick rodents or their corpses, less often - when bitten by ixodid ticks or other blood-sucking insects. Bacteria enter the human body through the mucous membranes of the mouth and nose, conjunctiva, mucosa of the digestive tract, respiratory organs and damaged skin.

Alimentary mechanism of infection

Of paramount importance for humans is the alimentary route of infection transmission. Infection occurs through the use of contaminated water and food:

unboiled milk and products made from unpasteurized milk (soft cheeses, butter);
meat and meat products, including semi-finished products, sausages, sausages, ham, etc. in vacuum packaging;
fresh vegetables (often lettuce and cabbage), including frozen ones grown on land fertilized with manure and feces;
seafood (shrimp, shellfish).

Listeria tolerate well. low temperature home refrigerators, where they multiply intensively.

contact route of infection

Listeria monocytogenes can enter the human body through abrasions and cuts on the skin from rodents and animals, while cutting meat and processing skins. Sexual transmission has been described.

aerogenic route of infection

The aerogenic route of infection occurs when processing the wool of sick animals, leather, bristles, skins, fluff and feathers. Infection can occur by inhalation of dust contaminated by sick animals in stalls and barns, as well as from patients in hospitals.

Transmissible route of infection

The transmissible route of infection occurs when bitten by ticks and other insects.

Infection from person to person

Infection of a person from a person is recorded only in the case of listeriosis of pregnant women who infect the fetus transplacentally (through the placenta) or intranatally (during childbirth). Parturient women and infected newborns pose a danger to others within 12 days after birth. In maternity hospitals, the spread of nosocomial infection associated with Listeria was noted both in our country and abroad.

Listerian carrier

Asymptomatic listeria carriers are common in 2 to 20% of people. In 5-6% of cases, healthy people listeria are excreted from the feces.

Rice. 15. The source of listeria can be soft cheeses, meat and products from it.

Risk groups for listeriosis

Listeriosis rarely develops in healthy people. Most often, the disease develops in pregnant women, newborns, the elderly and those with immunodeficiency that developed on the background of AIDS, kidney disease, chemotherapy, cirrhosis of the liver, diabetes, removal of the spleen, in the treatment of immunosuppressants.

The risk group includes field growers, workers of poultry and livestock farms, veterinarians, workers of primary processing shops at poultry and meat processing plants.

A person can become infected with an infection from a variety of rodents, both wild and synanthropic. Infection can also occur in various objects of the external environment. The most favorable place for reproduction of Listeria is the silo, namely its layers on the surface. In animals, the period of contagiousness is very long, and a person infected with an infection becomes a source of perinatal and neonatal pathology. So, the pathogen is released in puerperas and newborns after childbirth for 10-12 days.

The infection can be transmitted in different ways: contact , fecal-oral , airborne , transplacental . However, most often the infection enters the body through the fecal-oral route. So, infection in animals occurs through water and feed contaminated with listeria, rodents also infect them, or infection occurs through their corpses. People become infected with Listeria mainly through contaminated water, as well as food that is of animal origin. The risk of infection is increased if food and water are not heat treated and if food is stored at inappropriately high temperatures before consumption. Listeria can enter the human body while eating fresh vegetables. There is also the possibility aerogenic contamination while working with animal raw materials: wool, leather, down, etc. By contact, the infection enters the body through abrasions And injured on the skin after particles of secretions of infected animals get on such lesions. There is also the possibility of transferring listeria from one person to another. But listeriosis poses the most serious danger to pregnant women due to the fact that the pathogen is transmitted from mother to child.

The disease most often manifests itself in older people, newborn children, as well as in patients with immunodeficiency . The disease is ubiquitous and has all the characteristics of a saprozoonotic infection. The incidence can be both spodarism and group. Among livestock workers, as well as at enterprises engaged in meat processing, listerosis has professional character. As a rule, manifestations of the disease are recorded in spring and summer.

Symptoms and forms of listeriosis

The infection enters the human body through mucous membranes of the gastrointestinal tract , eye , respiratory tract , through skin lesions . If Listeria enters the human body by lymphogenous and by hematogenous route, then the infected person develops a condition, and Listeria are fixed in lymph nodes , lungs , tonsils , liver , spleen and other organs. After that, the process of reproduction of bacteria begins. If subsequent inflammation occurs, the nodes increase, but suppuration does not appear. In the most severe stage, the disease has symptoms listeriosis sepsis . In this case, small multiple necrotic nodules, called listeriomas, appear in the internal organs and lymph nodes. In pregnant women, listeromas appear in the placenta, after which the fetus becomes infected. Those who have been ill with listeriosis develop a stable immunity to infection. The course of the disease may be sharp , subacute , chronic And abortive . It is customary to distinguish several clinical forms of listeriosis: anginal-septic , nervous , septic-granulomatous , oculo-glandular , mixed . Cases of asymptomatic carriage of listeriosis for a long period have also been recorded. The incubation period of this disease can last from several days to one and a half months.

The most common form of this disease is anginal-septic. In this case, the main clinical sign is catarrhal or follicular . As a rule, in this case, the course of the disease is favorable, the patient recovers in about a week. If ulcerative-filmous listeriosis angina occurs, then the patient's body temperature rises sharply, reaching up to 39 ° C, sore throat , cough And . The tonsils are loose and enlarged, membranous plaques are observed on them or ulcers covered with films, regional lymph nodes increase and become painful. A blood test indicates that the patient has an increase, leukocytosis , the number of mononuclear cells increases significantly. Subject to a favorable course, the disease lasts up to 12-14 days.

In the nervous form of the disease, it manifests itself listeria, meningoencephalitis or brain abscess . In the first period, neurological forms in the patient's blood are noted monocytosis , later found leukocytosis And granulocytosis . With this form, various forms and are possible. The ocular glandular form of the disease is quite rare. As a rule, it is the result of infection with a pathogen from animals. This form is characterized blurred vision , high body temperature , conjunctiva , swelling of the eyelids , constriction of the eye , parotid and cervical lymph nodes. This form of the disease is a long period– 1-3 months.

Fetuses and newborns are characterized by a septic-granulomatous form of listeriosis. In pregnant women, the disease can occur without symptoms at all, or in an atypical or erased form. If the infection of the fetus occurs in the early stages of pregnancy, then it may die or have developmental abnormalities.

In newborns, listeriosis is severe. Yes, it arises fever , circulatory disorders And breathing , work problems hearts , may appear slimy stool , vomit . If it develops purulent meningitis , then death is likely. Listeriosis in newborns is difficult to recognize due to its similarity to other infectious diseases. The onset of listeriosis in infants is accompanied by characteristic symptoms. The child is later diagnosed small focal bronchopneumonia or purulent pleurisy . Some patients also have jaundice , liver enlargement , meningeal symptoms . After treatment, about a fifth of children who have recovered have disorders in the work of the peripheral nervous system and central nervous system. In chronic listeriosis, the clinical manifestations are quite hidden, and if the disease worsens, then there is a fever with catarrhal symptoms, dyspeptic disorders.

Diagnosis of listeriosis

Due to the presence of clinical polymorphism of listeriosis, it is quite difficult to establish such a diagnosis. It is important to carefully study the symptoms and differentiate the disease from angina of coccal etiology , infectious mononucleosis , acute respiratory viral infections th, blood diseases And, purulent meningitis . Dl different forms This disease is characterized by damage to the system mononuclear phagocytes which is taken into account in the diagnostic process. If there is a suspicion of listeriosis, especially the anginal-septic form of the disease, then in peripheral blood in stock a large number of. To make a diagnosis, depending on the form of the disease, it is necessary to conduct a bacteriological examination of blood, mucus taken from the nasopharynx and pharynx, which separates the conjunctiva, cerebrospinal fluid, placenta, amniotic fluid, punctates of the lymph nodes.

Complications of listeriosis

In the presence of an anginal-septic form of the disease, it may develop as alternative drugs. The prescribed antibiotics should be taken during the febrile period. If the oculo-glandular form of listeriosis is diagnosed, apply 1% , 20% sodium sulfacyl solution () .

The doctors

Medications

Prevention of listeriosis

In order to prevent the spread of this infection, a complex of veterinary, sanitary and hygienic measures is being taken. As a preventive measure, deratization is used, measures to protect water sources and enterprises working in the field of public catering from rodents. In places that are recognized as unfavorable for listeriosis, animals are examined without exception and those that can potentially become sources of infection are isolated. To protect pregnant women from infection with this disease, they are not recommended to eat soft cheeses such as Roquefort, Camembert, cheese and all products of the so-called fast food because of their insufficient heat treatment.

List of sources

Lobzin Yu.V. Textbook on infectious diseases. - St. Petersburg - 2000.
Tartakovsky I.S., Maleev V.V., Ermolaeva S.A. Listeria: role in infectious pathology human and laboratory diagnostics. Moscow: Medicine for everyone, 2002.
Bakulov I.A., Vasiliev D.A. Listeriosis as a food infection: Uch. allowance. Ulyanovsk, 1991.

Listeriosis is an infectious disease of humans and animals, caused by listeria, characterized by many sources of the infectious agent, a variety of ways and factors of its transmission, polymorphism of clinical manifestations, and high mortality.

According to ICD 10, it is registered under the code A32. In the view of many doctors, listeriosis is a new, rare, recently discovered disease. Meanwhile, the first reliable information about him appeared more than 80 years ago. In 1926, Murray et al. described an outbreak in rabbits and guinea pigs at a Cambridge University nursery caused by a previously unknown bacterium that caused a monocytic blood reaction in animals. After 3 years, the same microbe was first isolated from a sick person, and in 1940 it was named Listeria monocytogenes in honor of the English surgeon Lister, who proposed the antiseptic method. Since then, the disease has become known as listeriosis. Until recently, listeriosis was dealt with mainly by veterinary specialists, because. the disease affects many animals, including agricultural ones (sheep, cattle, pigs, horses, etc.), causing their death.

Prior to 1960, human listeriosis was uncommon; in 1960-1982 more than 10 thousand cases have already been reported in the world, and thousands of cases are registered annually in the future. At the end of the last and the beginning of the current century, large outbreaks of listeriosis in humans were described in countries Western Europe(France, UK, Switzerland, Finland) and North America(USA, Canada) with the number of cases from a few dozen to 300; they are associated with the use of animal products (soft cheeses, semi-finished meat products, vacuum-packed sausages, sausages, butter, etc.), vegetable ( vegetable salads, cabbage) origin, as well as seafood (shellfish, shrimp). The authors of relevant publications always draw attention to the high mortality rate among the sick. Listeriosis is now regarded as one of the most important food infections. In this regard, the epidemic situation around the world continues to worsen; This is due to a number of reasons, including some biological features listeria.

The most important factor pathogenicity of listeria is listeriolysin O, which has hemolytic activity and determining the virulence of the microbe; less significant ones include phosphatidylinazitol, internalin A, internalin B, ActA protein, etc. .

Epidemiology. Previously, listeriosis was considered a typical zoonosis, in which the source of the infectious agent is various animals, but now it is referred to as sapronoses, and the main source and reservoir of the pathogen are recognized as environmental objects, natural substrates in which Listeria can reproduce, primarily soil. Listeria is also isolated from plants, silage, dust, ponds and sewage.

The main route of human infection with listeriosis is food, carried out by using various foods (see above) without prior heat treatment. increased danger represent soft cheeses, as well as products fast food("fast food") - sausages "hot dog", hamburgers, etc. It is also possible contact way infection (from infected animals and rodents), aerogenic (indoors when processing skins, wool, as well as in hospitals), transmissible (with insect bites, in particular ticks). Special meaning has the ability to transfer Listeria from a pregnant woman to her fetus, either during pregnancy (transplacental) or through contact of the newborn with birth canal puerperas (intrapartum). Listeria can be the cause of nosocomial infection, in particular, in maternity hospitals, the resulting outbreaks are described both in domestic and foreign literature. In the human population, asymptomatic carriage of Listeria is 2-20%, listeria is isolated from the feces of healthy people in 5-6%.

There is no data in the literature on the possibility of infection from a person with listeriosis or a bacteriocarrier. The exception is pregnant women who can transmit the infection to the fetus.

In Russia, the official registration of listeriosis began in 1992; since then, from 40 to 100 patients are detected annually in the country. Obviously, these figures do not reflect the true incidence and will increase as doctors of different specialties become familiar with the variants of clinical manifestations and subject to improvement of laboratory diagnostics.

The current and predicted future increase in the incidence of listeriosis is due to several reasons, namely, the high adaptive ability of Listeria, their ability to multiply in abiotic environment, including in food products during their production (ripening of cheese, preparation of meat, fish and chicken semi-finished products for " fast food"") and storage; increase in the human population of the proportion of people with various immunodeficiencies most susceptible to this infection; predominance food way infections.

Clinic. Duration incubation period ranges from 1-2 days to 2-4 weeks, occasionally up to 1.5-2 months.

The clinical manifestations of listeriosis are diverse, depending on the way the microbe enters the human body, reactions immune system and a number of other cofactors (age, gender, comorbidities, etc.).

The main forms of listeriosis are: glandular; gastroenteric; nervous; septic; bacteriocarrier.

Separately, listeriosis of pregnant women and newborns is distinguished.

Depending on the duration of the disease, there are acute (1-3 months), subacute (3-6 months) and chronic (longer than 6 months) listeriosis.

The glandular form proceeds in two variants: anginal-glandular and oculo-glandular. The first of them is characterized by an increase in body temperature, intoxication, tonsillitis (ulcerative necrotic or membranous), an increase and soreness of the submandibular, less often cervical and axillary lymph nodes. It is also possible to enlarge the liver and spleen. The feverish period is 5-7 days. The hemogram shows monocytosis ("monocytic angina"). The disease resembles infectious mononucleosis.

For the oculomotor variant, one-sided is typical. purulent conjunctivitis; there is a pronounced swelling of the eyelids, narrowing of the palpebral fissure. Nodular rashes are revealed on the transitional fold of the conjunctiva. Decreased visual acuity; increase and become painful parotid and submandibular The lymph nodes from the respective side.

The gastroenteric form is characterized by an acute onset, a rapid increase in body temperature to high numbers, severe intoxication (chills, headache, arthralgia and myalgia). A few hours later, gastrointestinal symptoms join in the form of nausea, repeated mild vomiting, cramping abdominal pain, rapid liquid stool, sometimes with an admixture of mucus. Characterized by bloating, pain on palpation, especially pronounced in the right iliac region. The duration of the fever is 5-7 or more days. This form of listeriosis is clinically similar to many acute intestinal infections and cannot be identified without laboratory confirmation. The high mortality rate characteristic of this form (20% and above) is due either to the development of infectious-toxic shock (ITS) or to the transition to more severe, nervous, septic forms.

The nervous form is one of the most common, occurs most often (according to previous ideas) in children under three years of age and in adults over 45-50 years old, usually manifests itself in the form of meningitis or meningoencephalitis. The frequency of listeriosis meningitis is about 1-5% of all bacterial meningitis, but among some categories, in particular patients with oncological diseases, is the most common form of meningitis.

We have our own observations of 53 patients with listeriosis, 32 of whom were diagnosed with meningitis; the majority were young and middle-aged people without concomitant and background diseases that could cause immunosuppression.

Listeriosis meningitis does not differ clinically from bacterial meningitis of other etiologies. by the most frequent symptoms are high body temperature, impaired consciousness and increasing in intensity headache. However, in some cases, the temperature is subfebrile or does not rise at all. Compared with other bacterial meningitis, listeriosis is less likely to have meningeal signs (including stiff neck), cerebrospinal fluid(CSF) less often has a neutrophilic composition and high content squirrel . Thus, among the 32 adult patients with listeriosis meningitis observed by us, lymphocytes predominated in the CSF in 5 patients. This fact deserves special attention clinicians, because CSF lymphocytic pleocytosis usually suggests a viral etiology of meningitis and does not prescribe antibiotic therapy, which is definitely indicated for meningitis of listeriosis etiology. One of the notable features of the described meningitis are severe complications: hydrocephalus, rhombencephalitis, encephalopolyneuritis, dementia, etc. In addition to the head, damage is possible spinal cord in the form of intramedullary abscesses, cysts, arachnoiditis, myelitis, etc.

The course of the nervous form is usually severe, mortality reaches 30% and above, relapses occur in about 7% of cases.

Listeriosis meningitis (meningoencephalitis), tonsillitis, conjunctivitis can be both independent forms of listeriosis, and one of the manifestations of the septic form or precede it.

The septic form is characterized by recurring chills, fever with sharp fluctuations in body temperature, intoxication (headache, weakness, loss of appetite, muscle aches, etc.), enlargement of the liver and spleen. Perhaps the appearance of a large-spotted rash on the skin, mainly around large joints; on the face, the rash can be in the form of a "butterfly". Often there is hepatitis with jaundice, there may be polyserositis, pneumonia. The hemogram revealed anemia, thrombocytopenia. The development of the septic form is sometimes gradual or subacute, the first signs of the disease in these cases are either catarrhal symptoms(sore or sore throat, pain in the eyes), or dyspeptic (nausea, vomiting, stool disorders).

Severe septic form of listeriosis is more common in newborns, people with severe immunodeficiencies, patients with liver cirrhosis, chronic alcoholism; lethality reaches 60%. The cause of death may be ITSH, massive bleeding due to the development of disseminated intravascular coagulation (DIC), acute respiratory and acute renal failure.

With all the forms of listeriosis described above, leukocytosis (up to hyperleukocytosis), stab shift, and sometimes monocytosis are noted in the blood. However, contrary to the name of the microbe, pronounced monocytosis in the hemogram is not often recorded: in 30-40% according to the literature, in isolated cases according to our observations.

In addition to those listed, such rare forms of listeriosis as endocarditis, dermatitis, arthritis, osteomyelitis, abscesses of various organs, parotitis, urethritis, prostatitis, etc. are described.

Listeriosis hepatitis can be in a septic form, in some cases it is accompanied by jaundice. It is exceptionally rare that hepatitis with severe hyperenzymemia, signs of hepatocellular insufficiency, symptoms of acute hepatic encephalopathy (AHE) dominates in the clinic of listeriosis. We observed a case of listeriosis sepsis with a fatal outcome in a 19-year-old patient without any signs of immunodeficiency. IN clinical picture fulminant hepatitis syndrome prevailed. Similar descriptions are given in the literature.

Listeriosis of pregnancy. Level reduction cellular immunity during pregnancy causes an increased susceptibility to listeriosis infection. In the United States, listeriosis of pregnant women accounts for more than a quarter of total number diseases of this infection and more than half of the cases in people aged 10-40 years.

Listeriosis can develop at any stage of pregnancy, although most cases occur in the latter half. Acute listeriosis in pregnant women is either generally asymptomatic or mild, with erased polymorphic symptoms, therefore correct diagnosis is often established retrospectively after the death of the fetus or newborn. A pregnant woman may have fever, muscle pain, catarrhal phenomena from the upper respiratory tract, conjunctivitis; in these cases suggest influenza or SARS. Some patients have symptoms of gastroenteritis, while others have inflammation. urinary tract. Nervous system damage is the most common clinical form listeriosis - in pregnant women, oddly enough, is extremely rare.

Maternal listeriosis can lead to transplacental infection of the fetus, and the development intrauterine infection can be quite intense, in connection with which the sick mother and fetus seem to exchange infection: first, the mother infects her fetus, then the fetus re-infects the mother, causing her to have a secondary wave of the disease, in the form of fever unclear etiology. In connection with this feature, listeriosis is sometimes called a "ping-pong" infection.

characteristic clinical feature listeriosis pregnant is a critical decrease in body temperature after termination of pregnancy; subsequently, fever usually does not recur.

Acute and chronic listeriosis of a pregnant woman can be the cause of severe obstetric pathology: early termination of pregnancy at different times, habitual miscarriage, fetal malformations, intrauterine death, etc.

A listeriosis infection can persist for a long time in a woman's body, in particular in the kidneys, and become more active during pregnancy, against the background of declining immunity. In screening studies, it was found that listeria is isolated from women who have had urogenital diseases in 16-17% of cases. Almost all women with listeriosis had a “rich” obstetric and gynecological history: cervical erosion, adnexitis, pyelonephritis, induced and spontaneous abortions, etc.

Listeriosis of the newborn. Unlike pregnant women, in whom listeriosis usually proceeds benignly and clinical recovery occurs even without treatment, listeriosis of newborns is a severe generalized disease with a high mortality rate (more than 20%), proceeding as sepsis. The proportion of listeriosis in perinatal mortality is 25%. The timing and clinical manifestations of listeriosis in newborns depend on the time and route of infection (antenatal or intranatal, transplacental or aspiration infection).

In the case of transplacental infection of the fetus, if its intrauterine death has not occurred, a child with congenital listeriosis is usually born prematurely, with reduced body weight. After a few hours, sometimes after 1-2 days, his condition deteriorates sharply, body temperature rises, papular, sometimes hemorrhagic exanthema appears, anxiety, shortness of breath, cyanosis, convulsions occur, and in most cases death occurs, the cause of which may be pneumonia, purulent pleurisy, hepatitis, meningoencephalitis, damage to other organs, intrauterine sepsis.

With intranatal infection, the child looks healthy immediately after birth, clinical signs of listeriosis in the form of sepsis appear after the 7th day of the child's life.

Aspiration of an infected fetus amniotic fluid can lead to severe lung damage; mortality in this case reaches 50%.

In some newborns, listeriosis develops 10-12 days after birth and in these cases usually occurs in the form of meningitis with a mortality rate of up to 25%. This form is most characteristic of nosocomial outbreaks of listeriosis in maternity hospitals.

Specific laboratory diagnostics. It is extremely difficult to establish the diagnosis of listeriosis according to clinical and epidemiological data due to the polymorphism of clinical manifestations and the impossibility in some cases to identify the source of infection. The more, in fact crucial acquires laboratory diagnostics. A preliminary conclusion can be given on the basis of the results of a bacterioscopic examination of Gram-stained smears of CSF sediment and amniotic fluid.

The final diagnosis is possible only with the help of a bacteriological method or polymerase chain reaction(PCR).

Listeria can be isolated from patients from various clinical specimens: blood, CSF, swabs from the tonsils, punctates of the lymph nodes, swabs from the vagina and cervical canal, feces, purulent discharge from the eyes, etc. If listeriosis sepsis is suspected, blood cultures are performed, with meningitis and meningoencephalitis - CSF, with neonatal disease - meconium. In a woman who has given birth to a dead child or with signs of listeriosis, the amniotic fluid, placenta, and discharge of the birth canal are examined.

In addition, it is possible to isolate listeria in smears from the oropharynx and from the feces of healthy people, which is regarded as asymptomatic carriage.

Methods for the serodiagnosis of listeriosis have not been developed in detail. In the determination of specific antibodies by currently available methods, both false-negative and false-positive test results occur.

Treatment. It is necessary to prescribe antibiotic therapy as early as possible. In the localized (glandular, gastroenteric) form, one of the following drugs is used: ampicillin, amoxicillin, co-trimoxazole, erythromycin, tetracycline, doxycycline, chloramphenicol in medium therapeutic doses inside .

With generalization of infection (nervous, septic forms), listeriosis of newborns, a combination of ampicillin (adults 8-12 g / day; children 200 mg / kg / day) or amoxicillin with gentamicin (5 mg / kg / day) or amikacin is recommended during the entire febrile period and another 3-5 days, and in severe cases up to 2-3 weeks from the moment the temperature returns to normal. If such therapy is ineffective, it is necessary to change the antibiotic, taking into account the sensitivity of the Listeria strain isolated from the patient. IN last years vancomycin and meropenem have been reported to be effective.

If necessary, infusion detoxification, as well as desensitizing and symptomatic therapy, treatment of concomitant diseases is carried out.

Ampicillin is used to treat pregnant women. A woman who has given birth to a child with listeriosis is given a course of antibiotic therapy with ampicillin or doxycycline in two cycles of 7-10 days with an interval of 1.5 months.

Prevention of listeriosis. Includes control over food, provided for by the relevant regulatory documents; health education among the population, especially risk groups.

Foods to be excluded from the diet of pregnant women food industry for fast food that have not undergone long-term heat treatment (for example, hamburgers), as well as feta cheese, soft cheeses and raw milk.

To prevent listeriosis in newborns, it is necessary to examine women with a burdened obstetric and gynecological history, as well as those who have constant contact with the soil and / or animals. Women with identified listeriosis, clinically manifest or asymptomatic, are subject to specific therapy.

Thus, in Russia, as in many other countries of the world, there is currently an increase in the incidence of listeriosis, while not only elderly patients are affected, with various comorbidities but also young, previously healthy faces. Listeriosis is characterized by polymorphic clinical symptoms, so patients can contact doctors of various specialties (general practitioners, gastroenterologists, neurologists, obstetrician-gynecologists, etc.). In sporadic cases, the diagnosis of listeriosis is impossible without bacteriological confirmation or DNA detection. PCR method. With timely started and adequate antibiotic therapy, the disease is curable.

Literature

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G. N. Karetkina, candidate medical sciences, assistant professor MGMSU, Moscow

What is Listeria? Listeria are small, rod-shaped bacteria that live in meat and dairy products. Why are Listeria dangerous? The risk group for intoxication with listeriosis is employees of livestock and poultry farms, meat and dairy plants, slaughterhouses and primary processing shops, that is, people who have constant contact with animals, poultry and raw materials. Animals become infected with bacteria through contact with soil, plants and raw water. Living in meat, Listeria penetrate the human body and accumulate in its organs: the liver and spleen, causing diarrhea and fever.

The viability of Listeria in meat reaches 3-4 months (even in frozen), as they can exist in the absence of oxygen. To kill Listeria, meat must be cooked at a high temperature for more than an hour. Listeriosis was discovered by English scientists from the University of Cambridge in 1911. And Listeria got its name in honor of Joseph Lister, a surgeon, scientist and creator of surgical antisepsis, as he studied this disease for many years.

Listeria infection has several forms, which depend on the affected organ. Most often, listeriosis manifests itself in the form of a sore throat. Symptoms are high fever, sore throat and swollen lymph nodes. When the nervous system is affected by listeria, meningitis develops, accompanied by a severe headache, high fever, tension and soreness of the neck muscles. Listeriosis of the nervous system can lead to muscle paralysis, memory loss, neuritis, and lethal outcome.

What are the dangers of listeria in contact with the eyes?

The oculo-glandular form of the disease develops. This is a fairly rare manifestation of the disease with a favorable prognosis. But it has quite unpleasant symptoms: pus, edema, swollen lymph nodes, blurred vision.

The typhoid form of listeriosis is dangerous. Symptoms: fever, enlarged liver and spleen, pain and rash. More than half of those who get sick die.

To prevent listeriosis, it is necessary to thoroughly wash food, cook meat / seafood at a high temperature, and store them separately from other products. Employees of the risk group must use overalls, follow all the rules of personal hygiene, wash and disinfect equipment and containers in a timely manner. The organization will help to avoid listeriosis diseases.

For your information…

In 1997, there was a massive outbreak of listeriosis in Italy. The infection occurred in two schools and affected 1,500 people.

Listeriosis is one of the less common bacterial infections, the causative agent of which is sufficiently stable in the external environment. Clinical symptoms depend on the specific type of disease, usually nerve cells and mononuclear cells are affected. Transmission occurs in a variety of ways, with immunocompromised individuals, children and the elderly most susceptible. Treatment is carried out with antimicrobial drugs of systemic and local action.

The term refers to a disease of an infectious nature caused by the ingestion of the gram-positive bacterium Listeria monocytogenes into the human body. You can become infected through food, by aerosol, the pathogen is transmitted through the placenta, as well as through breast milk during pregnancy and lactation. The clinical course is characterized by polymorphism, the general code for listeriosis according to ICD 10 is A32. stand out the following forms pathologies, each of which has a certain symptomatology:

septic-granulomatous;
meningoencephalitic;
anginal-septic;
oculo-glandular;
mixed.

The main diagnostic methods for suspected infection are a blood test and a tank of sowing for listeriosis, which allows to identify the pathogen.

Causes and ways of infection

Listeriosis is caused by the gram-positive, motile bacterium Listeria monocytogenes, which does not form spores. Penetrating into the cell of a macroorganism, it can form a capsule, which leads to infection in latent form. Reservoirs and, accordingly, sources of contamination can be both animals and abiotic natural objects. From soil, water, plants, pathogens enter the organisms of wild animals, livestock, poultry and fish. A person can act as a source with a vertical (from mother to gestating fetus) method of transmission.

At what temperature does listeriosis die and how stable is it in the external environment:

For the death of bacteria, 5 to 10 minutes of boiling at T 100⁰С is required.
When frozen, viability is preserved, and active reproduction in animal corpses, water, soil, and plants begins at 4-6⁰С.
Sunlight also has a negative effect on Listeria, killing them within 2-15 days.
The inactivation process in formalin takes about 20 minutes.
In products preserved by salting, pathogens survive for a long time if the brine concentration does not exceed 20%.
Almost all strains of Listeria monocytogenes are susceptible to broad spectrum antibiotics.

The transmission of the pathogen is carried out in different ways, mainly alimentary. Infection of animals occurs through the use of water and plants, as well as through the bites of blood-sucking insect vectors (ticks, for example). The last way contributes to the maintenance of focality and is decisive in epidemiological terms.

A person becomes infected in the following most common ways:

Through products of plant and animal origin (vegetables, meat), infected water. As for listeriosis from blue cheese, it is possible, but not because of the mold cultures used in the technology. Infection occurs because raw, unpasteurized milk is used for production.
In the process of processing fluff, skins, when contact with injured skin occurs;
Vertically - the infection enters the fetus through the placenta from the mother;
Sexually.

The last two options are quite rare. Human body in general, it is quite resistant to listeriosis, however, with a weakened immune system, the likelihood of infection increases many times over. The risk group includes, first of all, the elderly, young children and people with immunodeficiency conditions.

Symptoms of listeriosis in humans

The entrance gate for this infection is in most cases the mucous membranes, less often - injured skin. Spreading with the flow of lymph and blood and simultaneously causing a feverish reaction, pathogenic microorganisms settle in different tissues and lymph nodes. When they multiply, an inflammatory process of a local nature develops, necrotic nodules (listeriomas) can also occur, and in especially severe cases, sepsis.

In listeriosis, the incubation period can last from several days to six weeks. The process can proceed acutely, subacutely, and also be abortive or chronic. There are also cases of asymptomatic carriage of Listeria monocytogenes, which is due to the ability of the bacterium to form a capsule. Each type of disease is characterized by specific clinical symptoms.

Anginal-septic listeriosis

It occurs most often, in external manifestations it is similar to follicular or catarrhal tonsillitis. There is hyperemia of the mucosa, sore throat, the temperature rises slightly. With adequate treatment, this form is cured within a week. If ulcerative membranous angina develops, fever, runny nose and cough, an increase in regional lymph nodes are noted. On examination, the tonsils are swollen, reddened and covered with films. Painful manifestations disappear with a favorable course in 2 weeks, however, in case of complications, endocarditis or sepsis develop.

Septic-granulomatous

It develops in those newborns whose mothers were diagnosed with listeriosis during pregnancy. Infection occurs during fetal development or during childbirth. The main symptoms of infection are:

severe fever;
vomit;
diarrhea;
intoxication;
difficulty breathing;
violations of cardiac activity;
characteristic papular rash with listeriosis (against the background of cyanosis of the skin).

Forecasts in this case are quite unfavorable. When the infection spreads to the membranes of the brain, death occurs, and mortality is about 20% of the total number of cases of septic-granulomatous listeriosis. During recovery, functional disorders of the central nervous system persist, and the inflammatory process often becomes chronic.

Meningoencephalitic

This type of pathology develops with damage to the meninges, as well as the cerebral substance. In this case, meningoencephalitis, brain abscesses or meningitis are diagnosed, the symptoms inherent in them appear:

hyperthermia;
headache;
vomiting and nausea;
stiff neck and neck muscles;
paralysis;
paresis;
pupillary anisocoria;
eyelid ptosis.

The nervous form is very difficult, and even with adequate assistance, it leads to death in a third of the case. Often there are relapses after recovery, as well as persistent neuritis and paralysis.

Oculo-glandular

A fairly rare variety, usually caused by contact with infected animals. Symptoms include fever and intoxication, enlarged parotid and cervical lymph nodes, eyelid swelling, and conjunctivitis. Treatment can take from 1 to 3 months, the prognosis is usually favorable.

Listeriosis during pregnancy

Women during the period of bearing a child fall into the risk group for morbidity, because hormonal changes often lead to a weakening of the body's defenses. The situation is aggravated by the fact that very often it is difficult to recognize the disease: specific symptoms listeriosis during pregnancy in most cases are absent. Pathology can be manifested by fever of unknown origin, flu-like conditions, tonsillitis. Sometimes gastroenteritis and pyelitis develop, especially against the background of a significant decrease in immunity.

Listeriosis during pregnancy early term(in the first three months) usually leads to intrauterine infection through the placenta and spontaneous abortion or severe developmental anomalies. In more late period infection is fraught premature birth, septic-granulomatous listeriosis in a newborn.

Listeriosis in children

When infected in prenatal period or in childbirth, the septic-granulomatous form of the disease develops, described above. It leads to the death of newborns in a third of cases. In the early childhood Listeria infection after the incubation period is manifested by signs that are rapidly aggravated. The temperature rises significantly, or bronchopneumonia develops. The results of treatment may be different: in a fifth of patients, innervation disorders and dysfunction of the central nervous system persist, sometimes chronicity is observed. inflammatory process. After three years, listeriosis in a child proceeds in the same way as in an adult, without specific features.

Laboratory diagnosis of listeriosis

Specific clinical symptoms that allow you to put accurate diagnosis does not have this disease. It manifests itself as meningitis, tonsillitis or flu, so without laboratory research indispensable for diagnosis. Blood samples, cerebrospinal fluid are taken from the patient, smears are made from the nasopharynx and from the conjunctiva, punctures of the lymph nodes. Additionally, for analysis for listeriosis during pregnancy, placental punctate or amniotic fluid. The procedures for taking biomaterials in this case are called chorionic biopsy and amniocentesis, respectively.

Analysis for listeriosis

Biological fluids are examined using various techniques. First of all, it is carried out clinical analysis the patient's blood, since in most cases it indicates the presence of an anginal-septic type of pathology. A characteristic sign of the disease is a significant increase in the number of monocytes. With their norm no more than 11% of the total number of leukocytes, general analysis blood listeriosis confirms indicators of 60 percent or more.

For specific diagnosis is being done bacterial culture to reliably determine the presence of Listeria. However this method takes time to grow a colony of pathogens, so the blood is additionally examined for serological reactions methods of RNGA and RSK. An enzyme-linked immunosorbent assay is also carried out, which detects antibodies to certain pathogenic microorganisms.

Treatment of listeriosis

This disease is treated systemic antibiotics, which are selected according to the nature of the disease and age characteristics. The list includes:

sodium salt of benzipenicillin, which is administered intravenously in meningoencephalitic forms;

These antibiotics are the drugs of choice, and clarithromycin and ciprofloxacin can be used as backups. At congenital pathology Newborns are shown parenterally gentamicin in combination with ampicillin.

In the case of the ocular-glandular form, listeriosis is treated with topical drugs: hydrocortisone emulsions and drops with sulfacetamide. With severe intoxication, appropriate infusion therapy is prescribed with Ringer's solutions, glucose, Reopoliglyukin, etc. According to indications, antihistamine and antipyretic drugs are also used, as general tonic- multivitamin complexes.

Prevention

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Listeriosis is not among the common infectious diseases, but its consequences and high mortality rate are the basis for the implementation of tough preventive measures from the side of the state. Prevention of listeriosis in humans is carried out in accordance with SP 3.1.7.2817-10-1, which regulates the actions and activities of healthcare institutions. Livestock farms, water sources, enterprises are regularly inspected Food Industry. As an individual prevention measure, it is not recommended to eat foods of dubious origin, especially for women during pregnancy and other people at risk.