Listeriosis in Adults: A Changing Pattern. Report of Eight Cases and Review of the Literature, 1968-1978

Nieman, Roger E.; Lorber, Bennett

doi:10.1093/clinids/2.2.207

Cited by 314 publications

(52 citation statements)

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“…This finding is consistent with that of previous case reports, in which patients with bacteremia usually are noted as being older than those with CNS listeriosis [4][5][6][7][8][9]; this is especially true for those with listerial rhombencephalitis [10]. Several explanations for the age difference in our study were hypothesized, but neither a particular virulence factor of the epidemic strains nor a difference in inoculum size could be proven retrospectively to be associated with this finding.…”

Section: Discussionsupporting

confidence: 92%

“…The higher meningoencephalitis-associated case-fatality rate in this outbreak (36%) was counterbalanced by a lower bacteremia-associated case-fatality rate (25% vs. 44%-68% in previous descriptions) [7,28]. The case-fatality rate associated with meningitis (30%) was similar to that noted in another outbreak (33%) [13] and in review articles [5,6,23,24,29,30]. Older age and a presentation of meningoencephalitis were significantly and independently associated with an increased risk of death in a multivariate logistic regression model.…”

Section: Discussionsupporting

confidence: 69%

“…Fourth, early microbiological diagnosis is difficult; few (23%) of the gram stain results in our study were positive, despite a high index of suspicion during the epidemic period. Other investigators have previously described this phenomenon [5,6,10,23,25]. In addition, the percentage of positive blood cultures we observed (52% of meningitis cases and 46% of meningoencephalitis cases) was lower than described in the literature (60%-75%) [5,20,23,24].…”

Section: Discussioncontrasting

confidence: 64%

“…Other investigators have previously described this phenomenon [5,6,10,23,25]. In addition, the percentage of positive blood cultures we observed (52% of meningitis cases and 46% of meningoencephalitis cases) was lower than described in the literature (60%-75%) [5,20,23,24]. In contrast, CSF cultures were positive in the great majority of patients with CNS listeriosis (96% of those with meningitis and 86% of those with meningoencephalitis), and positive results were all obtained within 48 hours.…”

Section: Discussioncontrasting

confidence: 63%

“…However, the proportion of patients with meningoencephalitis with an underlying condition only marginally increases, from 32% to 45%. In addition, proportions of bacteremia and meningitis cases involving an underlying disease in this outbreak (67% and 39%, respectively) are in the range described in the literature (68%-77% for bacteremia and 25%-50% for meningitis) [5,7]. Thus, the higher proportion of patients with meningoencephalitis in this outbreak seems a more likely explanation for the overall low proportion of underlying conditions.…”

Section: Discussionsupporting

confidence: 53%

See 4 more Smart Citations

An Epidemic of Food-Borne Listeriosis in Western Switzerland: Description of 57 Cases Involving Adults

Büla¹,

Billé²,

Glauser³

1995

Clinical Infectious Diseases

215

104

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This article describes 57 cases of listeriosis that occurred in adults in western Switzerland during an outbreak associated with the consumption of a soft cheese. Twenty-one percent of the cases were of bacteremia, 40% were of meningitis, and 39% were of meningoencephalitis. Overall, 42% of the patients had an underlying disease and 54% were >65 years of age. Patients with bacteremia were significantly older than those with meningitis or meningoencephalitis (median ages, 75, 69, and 55 years, respectively). The epidemic strain, defined by phage typing, was isolated in three-quarters of the listerial cases observed during the epidemic period and did not appear to differ significantly from the nonepidemic strains in terms of virulence. The overall mortality associated with the 57 cases was 32%. Among the patients' characteristics, age and type of clinical presentation were independent predictors of death in a multivariate logistic regression model (pseudo-fa' [coefficient of determination], .26; both P values <.05), and a presentation of meningoencephalitis was associated with an increased death risk (odds ratio, 6.5; 95% confidence interval, 1.1-39.5; P < .05). Neurological sequelae developed in 30% of the survivors of CNS listeriosis.From 1974 to 1982, 28 cases of human listeriosis (an equal number of maternofetal infections and cases involving nonpregnant adults) occurred in western Switzerland. During the winter of 1983-1984, the number of cases of listeriosis increased, and the disease occurred in a surprisingly large number of relatively young and previously healthy patients. A common origin was suspected [1] but could not be identified by a preliminary case-control study. A similar increase in cases of listeriosis occurred again the following winters. In 1987, a third case-control study established the association (odds ratio [OR], 8.0; 95% confidence interval [CI], 2.8-22.6; P < .05) with the consumption of a locally produced Swiss soft cheese (Vacherin Mont d'Or), which is eaten in winter months only. Two epidemic-associated strains of Listeria monocytogenes (serotype 4b) with particular phage types were isolated from the majority of patients, from the incriminated cheese, and from the factories' environments [2].From 1983 to 1987 the annual incidence of human listeriosis increased from 5 to 50 cases per one million people. During this 5-year period, a total of 122 cases occurred. Sixty-five cases occurred in newborn infants and pregnant women, and 57 cases in nonpregnant adults. We describe the clinical presentation, laboratory findings, and outcome in those 57 cases. Patients and MethodsPatients. All patients included in the study were >18 years of age, and L. monocytogenes was isolated from either their blood or their CSF at the Bacteriology Laboratory of the Centre Hospitalier Universitaire Vaudois (CHUV, Lausanne, Switzerland) between January 1983 and December 1987. Most patients (77%) were initially hospitalized in this facility, which is a 1,200-bed university-affiliated tertiary care center for t...

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