Treatment Of Listeriosis Research Articles

Outbreak of encephalitic listeriosis in Holstein bulls

Five Holstein bulls in a herd of 478 bulls were diagnosed with clinical encephalitic listeriosis. Four bulls survived after intensive therapy with oxytetracycline, dexamethasone, and oral fluid with electrolytes. The bull which did not survive had histological findings of lymphoplasmacytic encephalitis and inflammation of the trigeminal ganglion, which were consistent with the diagnosis of clinical listeriosis. A suspect silage sample was submitted for laboratory evaluation. The silage had a pH of 6.9 and was positive for Listeria monocytogenes. In vitro antibiotic testing of the organism isolated revealed resistance to penicillin, the drug commonly recommended for the treatment of listeriosis. It is concluded that caution should be exercised, however, when evaluating in vitro susceptibility results associated with a listeriosis outbreak because multiple ribotypes may be involved.

Overview of listeriosis

Three cases of Listeria monocytogenes infection are presented to illustrate the spectrum of disease caused by this gram-positive organism. The most common forms of infection are ‘early’ and ‘late onset’ perinatal listeriosis and listeriosis in the immunocompromised host. The treatment of listeriosis, the epidemiology of the infection, and the virulence factors of Listeria monocytogenes are briefly reviewed.

Assessment of the bactericidal activity of sparfloxacin, ofloxacin, levofloxacin, and other fluoroquinolones compared with selected agents of proven efficacy against Listeria monocytogenes

The search for alternative therapeutic agents for listeriosis includes the quinolone group. Accordingly, the bactericidal activity of ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin, sparfloxacin, and temofloxacin, in comparison with that of ampicillin and sulfamethoxazole-trimethoprim, was evaluated against Listeria monocytogenes at 24 and 48 h of incubation using time-kill kinetic methodology. The inhibitory concentrations for each agent fell into a narrow range comparable with ampicillin. For example, the minimum inhibitory concentration (MIC) ranges, MIC90 (24 h), and MIC90 (48 h) of the most active quinolone, sparfloxacin, were 0.25-2, 2, and 2 micrograms/ml, respectively, with 4 micrograms/ml achieving > or = 99.9% killing of the inoculum at 24 h with no regrowth by 48 h. At 2-4 times the MIC, bactericidal activity for all quinolones tested was noted at 24 h, unlike the action of ampicillin, which only becomes bactericidal at 48 h. These concentrations are within the achievable range of serum concentrations for a number of these agents. Because selected new fluoroquinolones at two to four times the MIC show bactericidal activity at 24 h, these agents may prove useful as therapeutic alternatives for the treatment of listeriosis.

Epidemiological Spectrum and Current Treatment of Listeriosis

To reassess the epidemiology and treatment of listeriosis in the United States, we reviewed greater than 120 cases of listeriosis from four medical centers in three geographically separated cities: Los Angeles County-University of Southern California Medical Center (LAC-USCMC); Rush-Presbyterian-St. Luke's Hospital, Chicago; the University of Illinois Hospital, Chicago; and Vanderbilt University Hospital, Nashville, Tennessee. The epidemiological pattern at LAC-USCMC was relatively narrow; more than two-thirds of the cases occurred during the perinatal period. Cases at Vanderbilt University Hospital represented the opposite end of the spectrum; the majority of these occurred in nonpregnant, older adults who had received organ transplants. An intermediate pattern of cases was observed at the two medical centers in Chicago. Potential risk factors included pregnancy, neonatal status, organ transplantation, renal failure, malignancy, systemic lupus erythematosus, steroid therapy, and AIDS (two cases). Antimicrobial agents noted to be effective were, as expected, penicillin and ampicillin; the cephalosporins were ineffective. The mortality associated with listeriosis occurred mainly among premature infants and stillbirths delivered from infected pregnant women and was markedly less among neonates and adults.

Successful antepartum treatment of listeriosis

A pregnant patient had a flulike illness at 27 weeks. Listeria monocytogenes infection was diagnosed by blood cultures. Electronic monitoring suggested the fetus was stressed. Use of tocolytics inhibited uterine contractions while the mother was treated with intravenous ampicillin. Four days later when labor began because of chorioamnionitis, the infant was delivered in good condition.

Infecção por listeria monocytogenes pós-transplante renal: relato de seis casos

São relatados 6 casos de listeriose em pacientes transplantados renais, que ocorreram entre 13 dias e 57 meses após iniciarem imunossupressão clássica, sendo 3 casos classificados como meningite, 2 casos como meningoencefalite e 1 caso como bacteremia. Houve um óbito e os 5 pacientes restantes apresentaram boa evolução. Com dados adicionais da literatura, são discutidos a epidemiologia, o diagnóstico e tratamento, da listeriose pós-transplante renal.

Perinatal listeriosis

From April to August, 1981, 15 cases of perinatal listeriosis were seen in Halifax, Nova Scotia, Canada. Nine of the 15 mothers presented with 'flu-like' symptoms, 3 had symptoms of an upper respiratory infection and 2 a history of fever alone. During labor 11 mothers had fevers greater than 38 degrees C and 9 had stained amniotic fluid. Twelve delivered prematurely. Among the 15 infants the most common clinical features were perinatal depression, respiratory distress, fever, hematologic abnormalities and rash. There were 7 deaths (case fatality rate of 46.7%). A transplacental route of infection for the fetus was suggested by the signs of systemic illness in most mothers, the lack of positive maternal vaginal cultures and evidence of chorioamnionitis, premature labor, severe fetal disease and intrauterine death prior to membrane rupture. The delivery of healthy infants to two mothers who had received antepartum treatment for listeriosis suggests that earlier recognition and treatment of maternal disease will improve perinatal outcome.

Antibiotic susceptibility of clinical isolates of Listeria monocytogenes.

A broth microdilution method was used to measure the minimal inhibitory concentrations (MICs) of the antibiotics most often recommended for treatment of listeriosis. The MICs of ampicillin, penicillin, erythromycin, and tetracycline for 175 strains of Listeria monocytogenes were below the approximate MIC breakpoint for susceptible strains as recommended by the National Committee on Clinical Laboratory Standards. Inhibition diameters for 125 strains were measured by the standardized disk method (National Committee on Clinical Laboratory Standards) and compared with the appropriate MIC values. By both methods, strains were susceptible to the above four antibiotics, except for three strains, which were intermediate in susceptibility to penicillin by the disk method. Since the minimal bactericidal concentrations for ampicillin and penicillin significantly exceeded the MICs for these antibiotics, 45 strains were evaluated with ampicillin (5 mug/ml) and gentamicin (1 mug/ml) to compare the synergistic bactericidal effect of the two used in combination and singly. An increased kill of 100-fold was observed with the antibiotics combined in 19 strains after 4 to 6 h and in 40 strains after 24 h. A comparison of results with microdilution in Trypticase soy broth and agar dilution in Mueller-Hinton agar revealed that MICs for gentamicin, kanamycin, and streptomycin were strongly influenced by the media used. The MICs were consistently lower in Mueller-Hinton agar.

Clinical aspects on 64 cases of juvenile and adult listeriosis in Sweden.

In 1958-74 altogether 64 cases of bacteriologically verified infections of Listeria monocytogenes were diagnosed in Sweden in children, aged more than 27 days, and in adults. Immunosuppression predisposed to the disease. Thus, many patients had co-existing disorders, such as leukemia and alcoholism. Sixteen patients had been treated with corticosteroids, which were combined with cytostatic drugs in nine. Meningoencephalitis was diagnosed in 52 patients and was fatal in 16. The clinical symptoms did not differ from those in purulent meningitis caused by other bacteria. In the cerebrospinal fluid the cellular response was dominated by polymorphonuclear cells in 29 patients and by mononuclear cells in 20. Ten patients had septicemia, which was fatal in four. Clinical symptoms were dominated by chills, high fever and general prostration. One patient had pleurisy and one an abscess of the neck; both recovered. Serotypes 1 and 4b prevailed and were equally common. Many patients developed raised antibody titers in both the O-agglutination test and the complement fixation test. The titers were often not positive until after a month. Moderate granulocytosis was the rule and monocytosis was rarely seen. Ampicillin alone or combined with an aminoglycoside seemed to be the drug of choice in the treatment of listeriosis. An alternative drug was tetracycline. Most deaths occurred within six days of onset of the illness. Early diagnosis and treatment were imperative. Most patients recovered and serious sequelae were rare.

Ampicillin treatment of listeriosis

Two infants and one adult with infections due to Listeria monocytogenes received ampicillin as the principal therapeutic agent and recovered without sequelae. Quantitative tube and plate dilution antibiotic susceptibility studies on 4 strains of Listeria were carried out. These studies revealed minimum inhibiting concentration values of 0.2 to 0.8 μg per milliliter for penicillin, 0.4 to 0.8 μg per milliliter for ampicillin, 1.6 to 3.1 μg per milliliter for cephalothin, 0.4 to 0.8 μg per milliliter for tetracycline, 6.3 μg per milliliter for chloramphenicol, and 12.5 to 25 μg per milliliter for kanamycin. Ampicillin is a useful therapeutic agent for listeriosis. However, careful antibiotic sensitivity studies are indicated for each patient.