Febrile Gastroenteritis Research Articles

Comparative seropositivity of Listeria monocytogenes in the serum of pregnant women with and without a history of abortion by serological and culture methods.

Listeria monocytogenes is a major cause of miscarriage and postpartum infections in infant. Determining antibody levels against listeriolysin O can be valuable for diagnosing both invasive listeriosis and febrile gastroenteritis. However, serological methods that detect antibodies against incomplete forms of listeriolysin O can be more specific. The objective of this study was to identify (Listeria monocytogenes) in the serum of pregnant women using serological and culture methods. Clinical samples (120 cases) were collected from pregnant women with a gestational age of less than 20 weeks. Diagnosis of Listeria monocytogenes was conducted using culture methods to identify anti-Listeria antibodies. Statistical analysis of the results was conducted using IBM SPSS Statistics version 23.0 (New York, USA), Pearson's Chi Square and fisher tests. The number of positive samples by culture and ELISA was 24.16% (29) and 28.3% (34), respectively. Out of the 29 positive sample by the culture method, 10 individuals had no abortion history, 16 and 3 individuals had 1 and 2 abortions and no sample had 3 abortions. Maybe, the more abortions a person has had, the less likely they are to be infected. In the Enzyme Linked Immuno-Sorbent Assay (ELISA) method, 13 individuals tested positive for both IgG and IgM antibodies and 38 individuals tested negative. Additionally, among the positive individuals with 1, 2, and 3 miscarriages, 0, 17, and 3 people were positive for the IgG antibody and 0, 18, and 3 individuals were positive for the IgM antibody. The analysis results indicated that there was no significant relationship between culture and abortion history (p = 0.316), IgG ELISA and history of miscarriage (p = 0.672) and IgM ELISA and history of miscarriage (p = 0.552). There was no significant relationship between infection with Listeria monocytogenes and abortion (p ⩾ 0.05) in our samples. These results should be interpreted with caution due to the limitation of our small sample size.

Enterovirus A71-associated acute flaccid paralysis in a pediatric patient: a case report

BackgroundEnterovirus A71 is one of the causative agents of hand, foot, and mouth disease, which is usually a self-limiting disease. Complications of enterovirus infection are also very rare. However, when such complications occur, they can lead to serious neurological diseases or even death.Case presentationIn this report, we describe a case of enterovirus A71-associated acute flaccid paralysis in a 13-month-old Caucasian girl that was managed in our hospital. The patient presented with sudden onset of left arm paresis that could not be attributed to any other cause. Establishing a diagnosis was furthermore complicated by negative virological investigations of cerebrospinal fluid and non-pathological radiological findings. A polymerase chain reaction test of the child’s stool sample however tested positive for enterovirus and sequencing results revealed the presence of enterovirus A71. A previous history of febrile gastroenteritis just before the paresis started also supported the suspected diagnosis of enterovirus-associated acute flaccid paralysis. Following this, the child was treated with intravenous immunoglobulin over 5 days and a remarkable improvement was observed in the child’s paresis.ConclusionThis case report describes a possible complication of enterovirus A71 infection in a child. It also highlights the prolonged detection of enterovirus in the child’s stool sample as compared with cerebrospinal fluid weeks after the primary infection occurred. Finally, it shows the need for increased clinical and diagnostic awareness especially in the management of sudden and unknown causes of paresis or paralysis in children.

SHIGELLEMIA IN A CHILD WITH GASTROENTERITIS: A CASE REPORT AND REVIEW OF MICROBIOLOGY AND MANAGEMENT

Shigellemia is a rare entity of sepsis encountered in individuals having gastroenteritis caused by shigella spp. It is reported to be common in infants, immunocompromised, those having chronic illnesses and post-transplant patients on immunosuppressants. We present a case of a two and half year-old child who developed sepsis like illness during recovery from gastroenteritis. Shigella spp was isolated from blood culture and he responded well to oral antibiotics. This case illustrates the importance of blood and stool cultures that need to be sent in every febrile gastroenteritis case irrespective of immune status. Early detection and prompt treatment will likely improve outcome. Keywords: Shigellemia, Gastroenteritis, Child

Moyamoya disease presenting with tubular dysfunction in a child: pitfalls in diagnosing an atypical hyponatremic-hypertensive syndrome

BackgroundMoyamoya disease, a cause of pediatric stroke, has been shown to affect furthermore extra-cranial districts, mostly the kidney arterial site, resulting in steno-occlusive changes. Unilateral renal artery stenosis accounts for 8%-10% out of cases of renovascular hypertension in childhood, however it rarely underlies a hyponatremic-hypertensive syndrome (HHS).Case presentationWe describe an 18-month-old boy with a recent history of polyuria and polydipsia, who presented an acute febrile gastroenteritis with neurological impairment, severe dehydration, hyponatremia, hypokalemia, kidney tubular dysfunction, and elevated aldosterone and renin even with a normal blood pressure. Fluid and electrolytes correction was performed, with complete recovery. An abdominal ultrasound displayed a smaller right kidney. A brain magnetic resonance and an electroencephalogram did not show any relevant abnormalities. Five months later, the child experienced a left-side hemiparesis after a traumatic concussion, and a severe hypertension. A brain tomography documented a cerebral ischemia. Brain and kidney angiographic studies displayed puff of smoke findings of internal right carotid artery branches and a steno-occlusive pattern of right renal artery, respectively. Hence, moyamoya disease with HHS secondary to unilateral renal artery stenosis was diagnosed. After an unsuccessful antiplatelet and antihypertensive pharmacological treatment, the boy underwent a renal angioplasty and a cerebral STA-MCA bypass (direct superficial temporal artery-to-middle cerebral artery bypass), resulting in a significant improvement of both neurological and kidney disease.ConclusionsAlthough the association between unilateral renal artery stenosis and HHS has been previously shown, this is the first report of atypical HHS, with hypertension preceded by tubular dysfunction, recognized in the framework of moyamoya disease.

Systematic Review of Safety of RTS,S with AS01 and AS02 Adjuvant Systems Using Data from Randomized Controlled Trials in Infants, Children, and Adults.

Emergence of antimalarial drugs and insecticides resistance alarms scientists to develop a safe and effective malaria vaccine. A pre-erythrocytic malaria vaccine called RTS,S has made great strides. The review was aimed to assess the safety of the candidate malaria vaccine RTS,S with AS01 and AS02 adjuvants using data from Phase I-III randomized controlled clinical trials (RCTs). This systematic review was conducted based on PRISMA 2020. Regardless of time of publication year, all articles related with safety of RTS,S, RCTs published in the English language were included in the study. The last search of databases, and registry was conducted on 30 May, 2022. Pubmed, Google Scholar, Cochrane Library, Wiley Online Library, and Clinical trials.gov were thoroughly searched for accessible RCTs on the safety of RTS,S malaria vaccine. The studies were screened in three steps: duplicate removal, title and abstract screening, and full-text review. The included studies' bias risk was assessed using the Cochrane risk of bias tool for RCTs. This systematic review is registered at Prospero (registration number: CRD42021285888). The qualitative descriptive findings from the included published studies were reported stratified by clinical trial phases. A total of thirty-five eligible safety studies were identified. Injection site pain and swelling, febrile convulsion, fever, headache, meningitis, fatigue, gastroenteritis, myalgia, pneumonia, reactogenicity, and anemia were the most commonly reported adverse events. Despite few clinical trials reported serious adverse events, none of them were related to vaccination. Most of the adverse events observed from RTS,S/AS01 and RTS,S/AS02 malaria vaccines were reported in the control group and shared by other vaccines. Hence, the authors concluded that both RTS,S/AS01 and RTS,S/AS02 malaria vaccines are safe.

Diagnostic capabilities of modern methods of determination pathogenic listeria in meat products

Annual reports on the morbidity of the adult population report outbreaks of listeriosis caused by Listeria monocytogenes with clinically pronounced febrile gastroenteritis. The main transmission route to humans is believed to be through consumption of contaminated food, especially ready-to-eat meat products. Rapid and specific detection of L. monocytogenes in food is critical for ensuring the safety of consumers. The aim of this work was to study the occurrence of L. monocytogenes in vacuum-packed meat products using modern diagnostic methods. In total, 60 vacuum-packed meat products were studied using real-time PCR (iQ-Check™ realtime PCR kit), immunoassay (VIDAS LMO2 test) and culturing. Thirty-two of 60 (53%) vacuum-packed meat products were L. monocytogenes positive by real-time PCR. The occurrence was especially high in heat-treated sausages (80%). Only two products (two bacons) were VIDAS and culture positive. Additionally, L. monocytogenes was isolated from one heat-treated sausage, which was VIDAS negative. All VIDAS and culture-positive samples were also PCR positive. In two (12%) out of 17 vacuum-packed ready-to-eat products, the number of L. monocytogenes was over 100 cfu/g demonstrating that the shelf life assigned to some vacuum-packed products is not appropriate. Real-time PCR based on iQ-Check™ realtime PCR kit was shown to be very sensitive to detect L. monocytogenes in foods and thus a useful tool for screening.

Mutations in atpG2 may confer resistance to gentamicin in Listeria monocytogenes.

Introduction Listeriosis, a foodborne infection caused by Listeria monocytogenes, could lead to febrile listerial gastroenteritis and a more invasive form which is often associated with a high mortality and hospitalisation rate. Gentamicin, used as an adjunct therapy with ampicillin, remains the treatment of choice for this life-threatening and invasive infection.Gap statement Nevertheless, there is little data on gentamicin resistance determinants in L. monocytogenes.Aim In this study, we selected and characterised B2b, a gentamicin-resistant mutant derived from L. monocytogenes ATCC 19115 to determine the target(s) of resistance in L. monocytogenes after exposure to gentamicin.Methodology Whole-genome sequencing was carried out to identify the mutation site(s) and possible mechanism(s) of resistance. The mutant was characterised using antimicrobial susceptibility testing and PCR. For biological verifications, complementation and allelic exchange mutagenesis were carried out.Results We found that the gentamicin resistance in B2b was caused by a 10 bp deletion in atpG2 which encodes a gamma subunit of the ATP synthase in L. monocytogenes. Using atpG2 PCR, various other mutations were identified in other gentamicin resistant mutants derived from ATCC 19115. In addition, the mutation from B2b, when introduced into L. ivanovii, also caused gentamicin resistance in this Listeria species.Conclusion Hence, atpG2 mutations appear to be important determinants of gentamicin resistance not only in L. monocytogenes but possibly also in other Listeria species.

Listeria monocytogenes-How This Pathogen Uses Its Virulence Mechanisms to Infect the Hosts.

Listeriosis is a serious food-borne illness, especially in susceptible populations, including children, pregnant women, and elderlies. The disease can occur in two forms: non-invasive febrile gastroenteritis and severe invasive listeriosis with septicemia, meningoencephalitis, perinatal infections, and abortion. Expression of each symptom depends on various bacterial virulence factors, immunological status of the infected person, and the number of ingested bacteria. Internalins, mainly InlA and InlB, invasins (invasin A, LAP), and other surface adhesion proteins (InlP1, InlP4) are responsible for epithelial cell binding, whereas internalin C (InlC) and actin assembly-inducing protein (ActA) are involved in cell-to-cell bacterial spread. L. monocytogenes is able to disseminate through the blood and invade diverse host organs. In persons with impaired immunity, the elderly, and pregnant women, the pathogen can also cross the blood-brain and placental barriers, which results in the invasion of the central nervous system and fetus infection, respectively. The aim of this comprehensive review is to summarize the current knowledge on the epidemiology of listeriosis and L. monocytogenes virulence mechanisms that are involved in host infection, with a special focus on their molecular and cellular aspects. We believe that all this information is crucial for a better understanding of the pathogenesis of L. monocytogenes infection.

Totally implantable venous access port infection with Listeria monocytogenes: 2 case reports at a tertiary center and literature review

Listeria monocytogenes infection in humans is mostly asymptomatic in immunocompetent patients. It rarely can cause self-limiting febrile gastroenteritis, bacteremia, meningoencephalitis, and maternal-neonatal infections. The latter three manifestations are the most common, especially among immunocompromised patients. We present two cases of Listeria monocytogenes bacteremia in cancer patients, a 79-year-old man and a 70-year-old woman in whom the source of bacteremia was identified to be the implantable venous access port (TIVAP). In both cases, the TIVAP has been removed after “positive control cultures the following readmission to the hospital despite targeted therapy with ampicillin and gentamicin”. Removal of TIVAP was warranted to control the infection.

Infecciones por Listeria, Corynebacterium y Bacillus

Listeria, Corynebacterium, and Bacillus are ubiquitous gram-positive bacilli. L. monocytogenes is a zoonotic pathogen that is transmitted by food. Listeriosis is a disease with a wide spectrum of severity that ranges from self-limiting febrile gastroenteritis to severe invasive disease with frequent involvement of the central nervous system. It predominantly affects people with some degree of cellular immunosuppression. It has a predilection for pregnant women, in whom it does not tend to produce severe disease, but is associated with severe obstetric complications and high rates of neonatal morbidity and mortality. C. diphtheriae is the causal agent of cutaneous or respiratory tract diphtheria, with potential cardiac or neurological complications mediated by the diphtheria toxin. The rest of the Corynebacterium species have traditionally been considered saprobionts, although various species have been described as the causal agents of opportunistic infections in recent decades. B. anthracis produces cutaneous, respiratory, or gastrointestinal anthrax, according to the spores’ route of entry. The spores are capable of germinating and multiplying, generating the toxin that is responsible for the disease. It is considered a potential bioterrorism agent for its high degree of lethality.

Ecology of Listeria monocytogenes and Listeria species in India: the occurrence, resistance to biocides, genomic landscape and biocontrol.

Listeria monocytogenes, the causative agent of listeriosis, has been implicated in increasing foodborne outbreaks worldwide. The disease is manifested in various forms ranging from severe sepsis in immune-compromised individuals, febrile gastroenteritis, still birth, abortions and meningoencephalitis. In India, data from studies on the detection and molecular epidemiological analysis of L. monocytogenes are only recently emerging. The presence of Listeria in different ecological niches has been recorded from India, including foods, soil, vegetables, mangrove swamps, seafood, freshwater fishes, clinical cases, and also insects. The organism has also been isolated from women with spontaneous abortions, miscarriage or recurrent obstetric history, aborted foetuses, animal clinical cases and wildlife samples. A novel species of Listeria has also been characterized. Listeria monocytogenes strains isolated from clinical, environmental, and foods showed biofilm-forming abilities. Listeria monocytogenes serotype 4b isolates of ST328, a predominant and unique ST observed in India, was repeatedly isolated from different sources, times, and geographical locations. Here, we reviewed the occurrence of Listeria in different sources in India, its resistance to biocides, and provide epidemiological analysis on its genomic landscape.

An outbreak of salmonellosis among Filipinos in a private camp, Saudi Arabia

In October 1994, 19 Filipino professional staff of a large company in Damman city were hospitalized with acute febrile gastroenteritis. All ate three daily meals at the company cafeteria. A case-control investigation was begun to determine the cause of the outbreak. We searched the compound for any resident with a diarrhoeal illness. Both cases and controls were asked where and when foods were eaten during the three days before onset. Stool cultures were done for all patients and all 25 kitchen employees. Food cooking, handling and storage procedures were reviewed

S2598 Yersiniosis: The Other Great Imitator

INTRODUCTION: Yersinia entercolitica is a Gram-negative bacterium that causes foodborne illnesses, typically characterized by acute febrile gastroenteritis and associated with a variety of gastrointestinal and extraintestinal manifestations. Isolated febrile illness without gastrointestinal symptoms is rare. We report a case of Y. entercolitica infection with severe anicteric hepatitis. CASE DESCRIPTION/METHODS: A 33-year-old Chinese male with no significant medical history presented on multiple occasions to the emergency department with recurrent high grade fever with chills without gastrointestinal symptoms. No recent travel, sick contacts, alcohol abuse or high risk behaviors noted. Initial labs were remarkable only for mild neutropenia with normal hepatic panel. Computed tomography of the abdomen revealed terminal ileitis and mesenteric adenitis. Repeat hepatic panel showed gradually raising transaminases over the next 2 weeks that peaked at AST of 991 U/L and ALT of 1664 U/L. He had normal bilirubin and alkaline phosphatase. He was given a 14-day course of empiric doxycycline for suspected typhus fever with resolution of fever. In the setting improvement of his symptoms yet rising liver chemistries, he was referred to hepatology. Extensive non-infectious and infectious work-up was unremarkable (acute hepatitis viral panel, malaria, TORC panel, CMV, HSV, EBV, TB, rickettsial panels, HIV, Widal, blood and stool cultures/PCR). As part of work-up for terminal ileitis, we found positive serology for Yersinia enterolitica IgM, IgG, and IgA. Ultimately, he improved with supportive care. His hepatic panel normalized in 6 weeks and repeat CT scan after 3 months showed resolution of earlier mentioned radiographic findings. DISCUSSION: Yersiniosis is a great imitator. Here, it masqueraded as a ricketisial illness—given high rate of tick-borne illnesses in Southwest Texas. The fever pattern mimicked malaria. Given his demographics, the imaging findings imitated Crohn’s disease and tuberculosis. While rare, yersinosis is known to have hepatic involvement. This case highlights the importance of thorough work-up of terminal ileitis and “Crohn's mimics” which ultimately revealed a unifying diagnosis. With minimal cofounding factors and resolution with antibiotics, it is easier to attribute his severe anicteric hepatitis to Yersiniosis. Therefore, this case highlights an important addition to the work-up for severe isolated hepatocellular liver injury (AST, ALT >15x ULN).Figure 1.: CT abdomen/pelvis with focal moderate thickening of the wall of the terminal ileum consistent with terminal ileitis.Figure 2.: Three month follow-up CT abdomen/pelvis imaging with resolution of terminal ileitis.Figure 3.: Hepatocellular liver chemistry trend during the course of yersiniosis illness.

Listeria spondylodiscitis: an uncommon etiology of a common condition; a case report

BackgroundListeriosis is a severe food-borne infection caused by the Gram-positive rod, Listeria monocytogenes. Despite the low incidence (3–8 cases per million), Listeriosis has a case fatality rate of 20–30% as it occurs predominantly in immunocompromised individuals at extremes of age, diabetics and pregnant women. Listeriosis classically presents as a febrile gastroenteritis, isolated bacteremia, meningitis, or maternal-fetal infections. Focal bone and joint infection are rare and primarily involve orthopedic implant devices. Here, we present the first case of Listeria-associated spondylodiscitis.Case presentationA 79-year-old male presents with acute-on-chronic back pain in the absence of risk factors or exposures, aside from age. On radiological imaging, spondylodiscitis of L3-L4 was diagnosed. Subsequently, a CT-guided biopsy was performed to aid in confirming microbiological aetiology. Listeria monocytogenes was grown in culture and patient received appropriate antibacterial therapy.ConclusionThe case highlights the utility of image-guided tissue sampling in aiding diagnosis and management in patients with vertebral osteomyelitis. It also encourages consideration of uncommon organisms such as Listeria as an etiology of vertebral osteomyelitis, even in the absence of prosthetic implants.

Infección invasiva por Listeria monocytogenes en un paciente con síndrome de Evans.

Listeria monocytogenes es una bacteria intracelular facultativa que tiene predilección por causar infecciones del sistema nervioso central en humanos. Cuya población de riesgo predominante es lactantes, adultos mayores y en estados de inmunosupresión. Los principales síndromes clínicos causados por Listeria monocytogenes incluyen gastroenteritis febril, infección perinatal e infecciones sistémicas marcadas por infecciones del sistema nervioso central con o sin bacteriemia. Presentamos el caso de un paciente masculino de 66 años portador de síndrome de Evans en tratamiento inmunosupresor quien acude al servicio de emergencias del Hospital San Carlos el 27 de agosto de 2019, por un cuadro agudo de fiebre, cefalea y ataque al estado general en quien se documenta síndrome de respuesta inflamatoria sistémica y meningitis bacteriana ante lo cual inicio empíricamente cefotaxime. El panel molecular y los hemocultivos fueron positivos por Listeria monocytogenes. El paciente recibió 3 semanas de antibioticoterapia con ampicilina con excelente evolución clínica y sin secuelas neurológicas.

Genetic characterization of Listeria monocytogenes strains isolated during 2007-2014 in Chile

Listeria monocytogenes is a foodborne pathogen that causes listeriosis, a disease that can present as febrile gastroenteritis or as an invasive form that has high mortality rates. So far, the genetic diversity of strains of L. monocytogenes isolated from patients, foods and environmental sources in Chile has been poorly studied. To characterize genetically L. monocytogenes strains received by the Institute of Public Health of Chile (ISP) between 2007 and 2014. We selected 94 strains of L. monocytogenes corresponding to 94 different pulsotypes identified by pulsed field gel electrophoresis (PFGE), DNA was extracted and serotyping was performed by polymerase chain reaction (PCR) and multilocus sequence typing (MLST). The most common serotype was 4b (55.3%), followed by serotypes 1/2a (25.5%), 1/2b (17%) and 1/2c (2.2%). 32 sequence-type (ST) were identified, of which 4 were new, and the predominant ones were ST1 (28.7%) and ST2 (13.8%). All the strains of L. monocytogenes were grouped in Lineages I and II. A great genetic variability was observed in the strains of L. monocytogenes analyzed, being predominant the ST1 and ST2, both belonging to Lineage I. Our results contribute to know the population structure of this pathogen in Chile and its presence in clinical samples, food and the environment.

Severe Sepsis Caused by Listeria monocytogenes in A Patient Given Monoclonal Antibodies Against CD38 and Proteosome Inhibitor

Severe Sepsis Caused by Listeria monocytogenes in A Patient Given Monoclonal Antibodies Against CD38 and Proteosome Inhibitor

Ten years of molecular epidemiology surveillance of Listeria monocytogenes in Chile 2008–2017.

Listeria monocytogenes causes severe diseases in humans, including febrile gastroenteritis and systemic infections that has a high mortality despite antibiotic treatment. This pathogen may cause massive outbreaks associated to the consumption of contaminated food products, which highlight its importance in public health. In the last decade, L. monocytogenes has emerged as a foodborne pathogen of major importance in Chile. A previous work showed that in Chile during 2008 and 2009, L. monocytogenes serotypes 1/2a, 1/2b and 4b were the most frequently identified in food and clinical strains. Here we report the molecular characterization of L. monocytogenes strains isolated from 2008 to 2017 in the country. Our results indicate that serotypes 1/2a, 1/2b and 4b continue to be the most commonly found in food products. In addition, we identify persistent and widespread PFGE subtypes. This study reports ten years of epidemiological surveillance ofL. monocytogenes in Chile.

Microbe Profile: Listeria monocytogenes: a paradigm among intracellular bacterial pathogens

Listeria monocytogenes is a food-borne bacterial pathogen that is responsible for listeriosis, a disease characterized by occasional febrile gastroenteritis in immunocompetent individuals, abortions in pregnant women, meningitis in the newborn and fatal bacteraemia in immunocompromised individuals or the elderly. The ability of L. monocytogenes to produce disease is intimately associated with its potential to traverse several human barriers (including the intestinal, placental and blood/brain barriers), to promote its internalization within diverse populations of epithelial cells and to proliferate in the intra-ic environment while escaping host immune responses. L. monocytogenes is often regarded as a paradigm for intracellular parasitism.

Successful treatment of infective endocarditis caused by Listeria monocytogenes in a patient after previous open-heart surgery (clinical case)

Listeriosis has a variety of clinical manifestations from febrile gastroenteritis to bacteremia, sepsis, meningoencephalitis and infective endocarditis with valvular heart disease. In this report, we present a rare case of successful treatment of infective endocarditis of the mitral valve due to Listeria monocytogenes after previous open-heart surgery.