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 registered around the world, the mortality rate among which is 20-30%, which significantly exceeds that from other foodborne diseases, including salmonellosis and botulism. Listeria represents great danger for pregnant women, newborns, the elderly and patients with severely reduced immunity. They infect mononuclear phagocytes, which is why they are called Listeria monocytogenes.

Listeria lives 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 consuming infected products - raw milk, products made from raw milk, meat and meat products, herbs, vegetables and fruits contaminated with soil containing the excretions of sick animals.

Listeria enters the human body through the mucous membranes of the mouth and nose, conjunctiva, mucous membrane of the digestive tract, respiratory organs and damaged skin. The disease occurs in localized or generalized forms. When Listeria monozotogenes multiplies massively 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, and high mortality are the main signs of listeriosis in humans.

Rice. 1. Photo of Listeria (electronogram, ultrathin section).

A little history

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

D. Murray and co-authors (Cambridge University) isolated the pathogen from patients in 1926 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 species name monocytogenes.

A similar pathogen was isolated in Africa from rodents by J. Pirie in 1927, from a person with tonsillitis by A. Nifeldt in 1929, and from postpartum women 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 it causes began to be called listeriosis.

More recently, listeriosis was perceived as an animal disease. The disease has been reported in sheep, cattle, pigs and horses, causing death among them. In humans, listeriosis has been rarely reported. From 1960 to 1982, more than 10 thousand cases were registered in the world. Then, thousands of sick people began to be registered annually, the mortality rate among which was 20-30%, which significantly exceeds that from other foodborne diseases, including salmonellosis and botulism.

Rice. 2. Photo of the English surgeon Lister Joseph (1827 - 1912), in whose honor the bacterium was named Listeria monocytogenes in 1940. and the disease that it causes began to be 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, mobile rod or coccobacterium. Its dimensions are 0.3 - 0.5 x 0.8 - 2.0 microns. Bacteria are located singly, in pairs, or less often in short chains.
Listeria has flagella that provide bacterial motility. Some microbial cells quickly lose their flagella, which deprives them of motility.

Rice. 3. Listeria are located singly, in pairs, or less often in short chains. When stained with Gram stain, bacteria appear pink.

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

Rice. 5. Listeria in the human body moves using flagella only for a few days, then movement is carried out using an actin tail.

Video. Movement of Listeria within host cells.

Rice. 6. Listeria monocytogenes, located inside the cell.

Cultivation of Listeria monocytogenes

Listeria monocytogenes is unpretentious. They grow at room temperature on normal 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 tint, like dew drops on glass. In transmitted light, the colonies acquire a pearlescent hue. Colonies of virulent bacterial strains have an S-shape. Colonies of weakened and avirulent bacteria - R-form. There is an 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, which detects the phospholipase enzyme, which is present only in Listeria monocytogenes colonies. In the presence of this enzyme, bacterial colonies acquire a blue color and there is no opaque halo.

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. When Listeria grows in meat-peptone broth, a cloudiness with slight opalescence is formed. A cloudy, viscous consistency is formed when an old crop grows. It sticks to the bottom of the test tube. With rapid rotation, the sediment rises upward in a “pigtail”.

Listeria resistance

Listeria monocytogenes exhibits high resistance in the external environment:

Inactivation of bacteria as a result of exposure to sunlight occurs within 2 to 15 days.
In a 2.5% solution of formaldehyde 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 a 6-20% concentration of table salt for a long time.
Bacteria are able to multiply at temperatures from 1 to 45°C. They persist for a long time in water, soil, on plants, food products, silage, straw, grain and in animal carcasses, as well as in a home refrigerator.
In premises where livestock are 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 for up to 20 days in summer, up to 33 days in spring, up to 52 days in autumn, and up to 115 days in winter. In corpses buried in the ground, L. monocytogenes persists 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 number 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 naturally occurring zoonotic infection. Distributed everywhere. Most often, outbreaks of listeriosis are recorded in temperate climate zones, where the soil is rich in organic fertilizers. Contributes to the spread of listeriosis on a large scale 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 those with weakened immune systems 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 recorded throughout the year, but more often in spring and summer.

More recently, listeriosis was perceived as an animal disease. The disease has been reported in sheep, cattle, pigs and horses, causing death among them. In humans, listeriosis has been rarely reported. Since 1960, thousands of sick people began to be registered annually, the mortality rate among whom was 20 - 30%, which significantly exceeds that from other foodborne diseases, including salmonellosis and botulism. In severe forms of listeriosis, mortality reaches 90 - 100%. In the United States, listeriosis affects 1,600 people each 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 disease of listeriosis is predicted, which is associated with the high adaptive ability of Listeria monocytogenes, the ability to reproduce in unfavorable 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. The increase in the number of people with immunodeficiencies leads to an increase in the disease.

Rice. 12. Listeria carriage is found in a significant proportion 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 sensitive 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 mouse-like): mice, rats, water rats, gerbils, jerboas, hares, etc.
Bacteria were isolated from raccoons, foxes, goitered gazelles, and wild boars. Among the birds are wood grouse and partridges.

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

In fish hatcheries, listeriosis is recorded in trout. The bacteria are isolated from crayfish and frogs, shellfish and shrimp.
Listeria carriage is found in a significant proportion of insects, including 8 species of ixodid ticks, 5 species of fleas, 1 species of lice, 1 species of hamasat and argasid mites, flies and gadflies, which play a certain role in the circulation of pathogens among wild animals. They become infected by biting sick animals and spread listeriosis to healthy animals.
Cases of listeriosis have been reported among monkeys, dogs and cats.
A person has listeriosis. The 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 the infection by contaminating soil, water and animal feed.

Listeriosis transmission factors

The main source of listeriosis for humans are animals, as well as objects and natural substrates of the external environment where listeria develops. Pets become infected with listeriosis by consuming food and water contaminated by the secretions of sick rodents or their carcasses. Bacteria from sick animals enter the external environment with secretions from the nasal cavity, genitals, feces, urine and aborted fetuses, contaminating meat and dairy products. Listeria contaminates water waste water, soil, plants, silage and straw.

Unboiled milk and products made from it - soft cheeses, butter, ice cream - may become contaminated. The source of infection can be fruits and vegetables, including frozen ones, meat and semi-finished meat products, sausages and sausages in vacuum packaging.

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

Rice. 14. Listeria in the photo.

Mechanisms of transmission of Listeria

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

Nutritional mechanism of infection

The nutritional route of transmission of infection is of primary importance for humans. Infection occurs through consumption 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 salads and cabbage), including frozen ones, grown on land fertilized with manure and feces;
seafood (shrimp, shellfish).

Listeria is well tolerated 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, when cutting meat and processing hides. Cases of sexual transmission of infection have been described.

Aerogenic route of infection

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

Transmissible route of infection

Transmissible infection occurs through bites by ticks and other insects.

Human-to-human transmission

Infection between humans and humans is recorded only in the case of listeriosis in pregnant women who infect the fetus transplacentally (through the placenta) or intranatally (during childbirth). Postpartum women and infected newborns pose a danger to others within 12 days after birth. In maternity hospitals, there was a spread of nosocomial infections associated with Listeria both here and abroad.

Listeria carriers

Asymptomatic listeria carriage is common in 2 to 20% of people. In 5 - 6% of cases, healthy people Listeria is isolated from stool.

Rice. 15. Listeria can come from soft cheeses, meat and meat products.

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 has developed due to AIDS, kidney disease, chemotherapy, liver cirrhosis, diabetes, removal of the spleen, and during treatment with immunosuppressants.

Those at risk include field farmers, poultry and livestock workers, veterinarians, and workers in primary processing departments at poultry and meat processing plants.

A person can become infected from a variety of rodents, both wild and synanthropic. Infection can also occur in various environmental objects. The most favorable place for listeria to multiply is silage, namely its layers on the surface. In animals, the period of contagion is very long, and a person infected with the infection becomes a source of perinatal and neonatal pathology. Thus, the pathogen is isolated from postpartum women and newborns for 10-12 days after birth.

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. Thus, infection in animals occurs through listeria-contaminated water and food, they are also infected by rodents, or infection occurs through their corpses. People become infected with listeria mainly through contaminated water and food of animal origin. The risk of infection increases if water and food are not heat treated, and also if food is stored at inappropriately high temperatures before consumption. Listeria can enter the human body through consumption of fresh vegetables. There is also a possibility airborne infection when working with animal raw materials: wool, leather, down, etc. By contact, the infection enters the body through abrasions And injuries on the skin after particles of secretions from infected animals come into contact with 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 infectious agent is transmitted from mother to child.

The disease most often manifests itself in older people, newborns, as well as in patients with immunodeficiency . The disease is widespread and has all the characteristics of a saprozoonotic infection. The incidence can be either sporadic or group. Among livestock workers, as well as at meat processing enterprises, 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 lymphogenous and hematogenously, then the infected person develops a condition, and listeria is fixed in lymph nodes , lungs , tonsils , liver , spleen and other organs. After this, the process of bacterial reproduction begins. When subsequent inflammation occurs, the nodes become enlarged, but suppuration does not appear. In its most severe stage, the disease has symptoms listeria 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 had listeriosis develop stable immunity to the 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 , oculoglandular , mixed . Cases of asymptomatic carriage of listeriosis over 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 considered to be 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 there is an ulcerative-membranous listeriosis sore throat, then the patient’s body temperature rises sharply, reaching 39 °C, and symptoms may appear. sore throat , cough And . The tonsils are loose and enlarged, filmy plaques or ulcers covered with films are observed on them, regional lymph nodes enlarge and become painful. A blood test indicates that the patient has an increase in leukocytosis , the number of mononuclear cells increases significantly. If the course is favorable, 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 observed monocytosis , later discovered leukocytosis And granulocytosis . With this form, various types and types are possible. The ocular-glandular form of the disease is quite rare. As a rule, it is the result of infection by a pathogen from animals. This form is characterized by blurred vision , high body temperature , conjunctiva , swelling of the eyelids , narrowing of the palpebral fissure , parotid and cervical lymph nodes. This form of the disease occurs long period– 1-3 months.

The septic-granulomatous form of listeriosis is characteristic of fetuses and newborns. In pregnant women, the disease can occur without any symptoms at all or in an atypical or erased form. If the fetus is infected in the early stages of pregnancy, it may die or have developmental abnormalities.

In newborns, listeriosis is severe. Yes, it arises fever , circulatory disorders And breathing , problems at work 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 similarities with 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 experience jaundice , liver enlargement , meningeal symptoms . After recovery, approximately one fifth of the children who have recovered from the disease have disorders in the functioning of the peripheral nervous system and central nervous system. In chronic listeriosis, the clinical manifestations are quite hidden, and if the disease worsens, fever with catarrhal symptoms and dyspeptic disorders are observed.

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 tonsillitis 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 peripheral blood in stock large number. 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, and punctate lymph nodes.

Complications of listeriosis

In the presence of an anginal-septic form of the disease, it may develop, as alternative drugs. Prescribed antibiotics should be taken throughout the febrile period. If the oculoglandular form of listeriosis is diagnosed, it is used 1% , 20% sodium sulfacyl solution () .

Doctors

Medicines

Prevention of listeriosis

In order to prevent the spread of this infection, a set of veterinary, sanitary and hygienic measures is carried out. As a preventive measure, deratization and measures to protect water sources and catering enterprises from rodents are used. In places that are recognized as unfavorable for listeriosis, animals are inspected and those that could 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, feta cheese and all products of the so-called fast food due to 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 person and laboratory diagnostics. M.: Medicine for everyone, 2002.
Bakulov I.A., Vasiliev D.A. Listeriosis as a food infection: Study. allowance. Ulyanovsk, 1991.

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

According to ICD 10, it is registered under code A32. In the minds 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 and his co-authors described an outbreak of the disease among rabbits and guinea pigs at the Cambridge University nursery, caused by a previously unknown bacterium that causes a monocytic reaction in the blood of animals. Three years later, 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 primarily by veterinary specialists, because the disease affects many animals, including agricultural ones (sheep, cattle, pigs, horses, etc.), causing their death.

Before 1960, human listeriosis was rare; in 1960-1982 More than 10 thousand cases have already been reported in the world, and subsequently thousands of cases are registered annually. At the end of the last and beginning of this 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 ranging from several dozen to 300; they are associated with the consumption of animal products (soft cheeses, semi-finished meat products, sausages in vacuum packaging, sausages, butter, etc.), vegetable ( vegetable salads, cabbage) origin, as well as seafood (shellfish, shrimp). The authors of relevant publications always pay attention to the high mortality rate among patients. Currently, listeriosis is considered one of the most important foodborne infections. In this regard, the epidemic situation around the world continues to worsen; and 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 causative agent of the infection is various animals, but now it is classified as a sapronoses, and the main source and reservoir of the pathogen are recognized as environmental objects, natural substrates in which listeria is able to multiply - primarily soil. Listeria is also isolated from plants, silage, dust, water bodies and wastewater.

The main route of human infection with listeriosis is through food, through the consumption of various food products (see above) without preliminary heat treatment. Increased danger represent soft cheeses, as well as products instant cooking(“fast food”)—hot dogs, hamburgers, etc. Also possible contact path infection (from infected animals and rodents), aerogenic (indoors when processing skins, wool, as well as in hospitals), transmissible (from insect bites, in particular ticks). Special significance has the possibility of transmitting Listeria from a pregnant woman to her fetus, either during pregnancy (transplacentally) or through contact of the newborn with birth canal postpartum women (intrapartum). Listeria can cause nosocomial infections, in particular in maternity hospitals, and outbreaks that occur 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 carrier of the bacteria. The exception is pregnant women, who can transmit the infection to the fetus.

In Russia, official registration of listeriosis began in 1992; since then, from 40 to 100 patients are identified annually in the country. Obviously, these figures do not reflect the true incidence and will increase as doctors of different specialties become more familiar with the variants of clinical manifestations and subject to the 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 reproduce in abiotic environment, including in food products during their production (cheese ripening, preparation of meat, fish and chicken semi-finished products for " quick food") and storage; an increase in the proportion of people with various immunodeficiencies, most susceptible to this infection; predominance food tract infection.

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 varied depending on the route of penetration of the microbe into the human body, the reaction immune system and a number of other cofactors (age, gender, concomitant diseases, etc.).

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

Listeriosis of pregnant women and newborns is distinguished separately.

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

The glandular form occurs in two variants: anginal-glandular and oculoglandular. The first of them is characterized by an increase in body temperature, intoxication, tonsillitis (ulcerative-necrotic or membranous), enlargement and soreness of the submandibular, less often cervical and axillary lymph nodes. Enlargement of the liver and spleen is also possible. The febrile period is 5-7 days. The hemogram shows monocytosis (“monocytic tonsillitis”). The disease resembles infectious mononucleosis.

For the oculoglandular variant, one-sided is typical purulent conjunctivitis; There is pronounced swelling of the eyelids, narrowing of the palpebral fissure. Nodular rashes are detected on the transitional fold of the conjunctiva. Visual acuity decreases; the parotid and submandibular areas enlarge and become painful lymph nodes from the corresponding 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). After a few hours, gastrointestinal symptoms appear in the form of nausea, repeated mild vomiting, cramping abdominal pain, rapid loose stool, sometimes mixed with mucus. Characterized by bloating and pain on palpation, especially pronounced in the right iliac region. The duration of fever is 5-7 days or more. 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 caused either by the development of infectious toxic shock (ITS) or by the transition to more severe forms—nervous, septic forms.

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

According to clinical signs, listeriosis meningitis does not differ from bacterial meningitis of other etiologies. The most frequent symptoms are high body temperature, impaired consciousness and increasing intensity of headache. However, in some cases the temperature is low-grade or does not rise at all. Compared with other bacterial meningitis, listeria meningitis is less likely to have meningeal signs (including a stiff neck), cerebrospinal fluid(CSF) less often has a neutrophilic composition and high content squirrel . Thus, among the 32 adult patients with listeria meningitis we observed, lymphocytes predominated in the CSF in 5 of them. This fact deserves special attention clinicians, since lymphocytic pleocytosis of the CSF usually gives grounds to assume a viral etiology of meningitis and not to prescribe antibacterial therapy, which is certainly indicated for meningitis of listeriosis etiology. One of the notable features of the described meningitis is severe complications: hydrocephalus, rhombencephalitis, encephalopolyneuritis, dementia, etc. In addition to the brain, 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% or higher, and relapses occur in approximately 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 repeated chills, fever with sharp fluctuations in body temperature, intoxication (headache, weakness, loss of appetite, muscle aches, etc.), enlarged liver and spleen. A large spotted rash may appear on the skin, mainly around large joints; on the face the rash may be in the form of a “butterfly”. Hepatitis with jaundice often occurs, there may be polyserositis, pneumonia. The hemogram reveals anemia and 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, persons with severe immunodeficiencies, patients with liver cirrhosis, chronic alcoholism; mortality reaches 60%. The cause of death may be ITS, massive bleeding due to the development of disseminated intravascular coagulation (DIC), acute respiratory and acute renal failure.

With all the above-described forms of listeriosis, leukocytosis (up to hyperleukocytosis), band shift, and sometimes monocytosis are observed in the blood. However, contrary to the name of the microbe, pronounced monocytosis is not often recorded in the hemogram: 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, mumps, urethritis, prostatitis, etc. have been described.

Listeria hepatitis can occur in a septic form, and in some cases it is accompanied by jaundice. It is extremely rare that hepatitis with severe hyperfermentemia, signs of hepatic cellular failure, and symptoms of acute hepatic encephalopathy (AHE) dominates the clinical picture of listeriosis. We observed a case of listeria sepsis with a fatal outcome in a 19-year-old patient without any signs of immunodeficiency. IN clinical picture Fulminant hepatitis syndrome predominated. Similar descriptions are given in the literature.

Listeriosis in pregnant women. Level reduction cellular immunity during pregnancy causes increased susceptibility to listeria infection. In the United States, listeriosis in 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 second half. Acute listeriosis in pregnant women is either completely asymptomatic or mild, with erased polymorphic symptoms, therefore correct diagnosis It is often established retrospectively after the death of a fetus or newborn. A pregnant woman may have fever, muscle pain, catarrhal symptoms from the upper respiratory tract, conjunctivitis; in these cases, influenza or ARVI is suspected. Some patients show symptoms of gastroenteritis, others have inflammation urinary tract. Damage to the nervous system 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, due to which the sick mother and fetus seem to exchange infection: first the mother infects her fetus, then the fetus infects the mother a second time, causing her to have a secondary wave of the disease in the form of fever unknown etiology. Due to this feature, listeriosis is sometimes called a “ping pong” infection.

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

Acute and chronic listeriosis in a pregnant woman can cause severe obstetric pathology: early termination of pregnancy at different stages, recurrent miscarriage, fetal malformations, intrauterine death, etc.

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

Listeriosis of newborns. Unlike pregnant women, in whom listeriosis usually has a benign course and clinical recovery occurs even without treatment, listeriosis in newborns is a severe generalized disease with high mortality (more than 20%), occurring as sepsis. The share of listeriosis in perinatal mortality is 25%. The timing of the onset and clinical manifestations of listeriosis in newborns depend on the time and route of infection (antenatal or intrapartum, transplacental or aspiration infection).

In the case of transplacental infection of the fetus, if 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 sharply worsens, 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 intrapartum 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 by fetus of infected amniotic fluid may cause severe lung damage; the mortality rate 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 typical for nosocomial outbreaks of listeriosis in maternity hospitals.

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

A final diagnosis is only possible using a bacteriological method or polymerase chain reaction(PCR).

Listeria can be isolated from patients from various clinical samples: blood, CSF, tonsil smears, lymph node punctures, vaginal smears and cervical canal, feces, purulent discharge from the eyes, etc. If listeria sepsis is suspected, a blood culture is performed, for meningitis and meningoencephalitis, CSF is performed, and for newborn disease, meconium is cultured. In a woman who gave birth to a stillborn child or with signs of listeriosis, the amniotic fluid, placenta, and discharge from 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 serodiagnosis of listeriosis have not been developed in detail. When determining specific antibodies using currently available methods, both false-negative and false-positive research results occur.

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

For generalized infection (nervous, septic forms), listeriosis in 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 throughout the febrile period. period and another 3-5 days, and in severe cases up to 2-3 weeks from the moment the temperature normalizes. 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 recent years There have been reports of the effectiveness of vancomycin and meropenem.

If necessary, infusion detoxification, as well as desensitizing and symptomatic therapy, and treatment of concomitant diseases are 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 antibacterial 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 products provided for by relevant regulatory documents; sanitary educational work among the population, especially risk groups.

Foods should be excluded from the diet of pregnant women food industry for fast food that has 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 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, and not only elderly patients with various concomitant diseases, but also young, previously healthy faces. Listeriosis is characterized by polymorphic clinical symptoms, so patients can consult doctors of different specialties (general practitioners, gastroenterologists, neurologists, obstetricians-gynecologists, etc.). In sporadic cases, diagnosis of listeriosis is impossible without bacteriological confirmation or DNA detection PCR method. With timely and adequate antibiotic therapy, the disease is curable.

Literature

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Epidemiology and prevention of listeriosis. Method. instructions. M.: Federal TsGSEN Ministry of Health of Russia, 2002. 12 p.

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

What is listeria? Listeria is a small rod-shaped bacteria that lives in meat and dairy products. Why is listeria dangerous? The risk group for listeriosis intoxication are 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 upon contact with soil, plants and raw water. Listeria living in meat penetrates the human body and accumulates in its organs: the liver and spleen, causing diarrhea and fever.

The viability of listeria in meat reaches 3-4 months (even frozen), since they can exist in the absence of oxygen. To kill listeria, meat must be cooked at high temperature for more than an hour. The disease 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 surgical antisepsis, since 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 include high fever, sore throat and swollen lymph nodes. When the nervous system is affected by Listeria, meningitis develops, accompanied by 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 fatal outcome.

How dangerous is listeria if it comes into contact with the eyes?

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

The typhoid form of listeriosis is dangerous. Symptoms: elevated temperature, enlarged liver and spleen, pain and rash. According to statistics, more than half of the sick die.

To prevent listeriosis, it is necessary to thoroughly wash food, cook meat/seafood at high temperatures, and store it separately from other foods. Risk group workers must wear special clothing, follow all personal hygiene rules, and promptly wash and disinfect equipment and containers. The organization will help avoid diseases of listeriosis.

FYI...

In 1997, Italy experienced a large outbreak of listeriosis. 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 quite stable in the external environment. Clinical symptoms depend on the specific type of disease; nerve cells and mononuclear cells are usually affected. Transmission occurs in a variety of ways, with immunocompromised individuals, children and the elderly most susceptible to the disease. Treatment is carried out with systemic and local antimicrobial drugs.

The term refers to an infectious disease caused by the entry of the gram-positive bacterium Listeria monocytogenes into the human body. You can become infected through food, aerosols, 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 following forms pathologies, each of which has certain symptoms:

septic-granulomatous;
meningoencephalitic;
anginal-septic;
oculoglandular;
mixed.

The main diagnostic methods for suspecting this infection are a blood test and culture for listeriosis, which allows identifying the pathogen.

Causes and routes of infection

Listeriosis is caused by the gram-positive, motile bacillus Listeria monocytogenes, which does not form spores. By introducing itself 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, and plants, pathogens enter the bodies of wild animals, livestock, birds and fish. A person can act as a source in a vertical (from mother to gestating fetus) mode of transmission.

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

To kill the bacteria, it takes 5 to 10 minutes of boiling at 100⁰C.
When frozen, viability is preserved, and active reproduction in animal corpses, water, soil, and plants begins at 4-6⁰C.
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 pickling, 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 pathogen is transmitted in different ways, mainly through nutrition. Animals become infected by consuming water and plants, as well as by the bites of blood-sucking insect carriers (ticks, for example). Last method 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 due to the mold cultures used in the technology. Contamination occurs because raw, unpasteurized milk is used for production.
During the processing of fluff and skins, when contact with injured skin occurs;
Vertically – the infection reaches 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, but when the immune system is weakened, the likelihood of infection increases many times over. The risk group primarily includes the elderly, young children and people with immunodeficiency conditions.

Symptoms of listeriosis in humans

The entry points for this infection are in most cases the mucous membranes, and less often - injured skin. Spreading with the flow of lymph and blood and simultaneously causing a febrile reaction, pathogenic microorganisms settle in various tissues and lymph nodes. When they multiply, a local inflammatory process develops; necrotic nodules (listeriomas) may also appear, and in especially severe cases, sepsis.

For listeriosis, the incubation period can last from several days to six weeks. The process can occur 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.

Anginous-septic listeriosis

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

Septic-granulomatous

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;
cardiac dysfunction;
a characteristic papular rash with listeriosis (against the background of cyanosis of the skin).

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

Meningoencephalitic

This type of pathology develops when the meninges, as well as the cerebral substance, are damaged. In this case, meningoencephalitis, brain abscesses or meningitis are diagnosed, and their inherent symptoms appear:

hyperthermia;
headaches;
vomiting and nausea;
stiffness of the neck and neck muscles;
paralysis;
paresis;
anisocoria of the pupils;
eyelid ptosis.

The nervous form is very difficult, and even with adequate assistance, leads to death in a third of cases. Relapses after recovery, as well as persistent neuritis and paralysis, are often observed.

Oculoglandular

A fairly rare species, usually caused by contact with infected animals. The list of symptoms includes fever and intoxication, enlarged parotid and cervical lymph nodes, swelling of the eyelids and conjunctivitis. Treatment can take from 1 to 3 months, the prognosis is usually favorable.

Listeriosis during pregnancy

Women during childbearing are at risk for morbidity because hormonal changes often lead to a weakening of the body's defenses. The situation is aggravated by the fact that it is very often difficult to recognize the disease: specific symptoms There is no listeriosis during pregnancy in most cases. Pathology can manifest itself as fever of unknown origin, flu-like conditions, and sore throat. Sometimes gastroenteritis and pyelitis develop, especially against the background of a significant decrease in immunity.

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

Listeriosis in children

When infected in prenatal period or during childbirth the septic-granulomatous form of the disease described above develops. It leads to the death of newborns in a third of cases. In the early childhood Listeria infection after the incubation period manifests itself with symptoms that quickly worsen. The temperature rises significantly and bronchopneumonia develops. Treatment results may vary: in a fifth of patients, innervation and dysfunction of the central nervous system persist, and 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 diagnosis accurate diagnosis, this disease does not. It manifests itself as meningitis, sore throat or flu, so without laboratory research indispensable during diagnosis. Blood and cerebrospinal fluid samples are taken from the patient, smears are made from the nasopharynx and conjunctiva, and lymph nodes are punctured. Additionally, to test for listeriosis during pregnancy, you will need placental puncture or amniotic fluid. The procedures for collecting biomaterials in this case are called chorionic villus biopsy and amniocentesis, respectively.

Test 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. If their norm is no more than 11% of the total number of leukocytes, general analysis blood listeriosis is confirmed by indicators of 60 percent or more.

For specific diagnostics done bacterial culture, allowing you to reliably determine the presence of listeria. However this method takes time to grow a colony of pathogens, so the blood is additionally tested for serological reactions by RNGA and RSK methods. An enzyme immunoassay is also performed to detect 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:

benzipenicillin sodium salt, which is administered intravenously for meningoencephalitic forms;

These antibiotics are the drugs of choice, and clarithromycin and ciprofloxacin can be used as backup ones. At congenital pathology Gentamicin in combination with ampicillin is indicated for newborns parenterally.

In the case of the oculoglandular form, treatment of listeriosis is carried out using topical medications: hydrocortisone emulsion and drops with sulfacetamide. In case of severe intoxication, appropriate infusion therapy is prescribed with Ringer's solutions, glucose, Reopoliglucin, etc. According to indications, antihistamines and antipyretic drugs are also used, as tonic– multivitamin complexes.

Prevention

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Listeriosis is not a common infectious disease, but its consequences and high mortality rate are the basis for implementing strict measures. preventive measures from the state. Prevention of listeriosis in people is carried out in accordance with SP 3.1.7.2817-10–1, which regulates the actions and activities of healthcare institutions. Inspections of livestock farms, water sources, and enterprises are carried out regularly food industry. As an individual preventive measure, it is not recommended to eat foods of questionable origin, especially for women during pregnancy and other people at risk.