Listeriosis - Causes, symptoms and treatment. MF.

Listeriosis is an infectious disease characterized by the defeat of protective cells of the immune system with the development of numerous symptoms, among which the angino-septic form prevail, as well as the pathology of the nervous system.

The disease is widespread in various countries. In general, listeriosis occurs in wild and farm animals. A person rarely becomes infected, but the disease is extremely difficult to infect. It was found that the fatal outcome in case of newborn listeriosis is registered in 80%.In pregnant women, in the presence of the disease, the pathological course of pregnancy is often diagnosed: miscarriage, premature birth, stillbirth. Particularly difficult is the disease in people with reduced immunity. These are elderly people, patients with chronic diseases, HIV-infected patients. At present, cases of illness in people suffering from drug and alcohol dependence are registered more and more often. As a rule, listeriosis in these patients ends lethal.

Causes of Listeriosis

The causative agent is a microorganism in the form of a rod called Listeria monocytogene.

Listeria monocytogene - causative agent of listeriosis in humans

The main host of this microorganism is domestic or wild animals. Moreover, it is established that listeria can parasitize in the body of various animals, ranging from wolves, foxes, sheep, bulls, ending with parrots and canaries. In the external environment, the microorganism is excreted with feces, urine of animals, and also in large quantities determined in milk, meat.

A characteristic feature of Listeria is its stability in the external environment. It is established that at a temperature of 62 ° C it perishes in 35-40 minutes, when boiled in water, after a few minutes. Listeria well tolerates and low temperature, excellently multiplies in foods that are in the refrigerator. At the same time, the microorganism can be completely destroyed by a standard set of disinfectants.

A person becomes infected by using insufficiently thermally processed foods obtained from animals. Listeria in large quantities can be contained in pasteurized milk, eggs, soft cheeses, ice cream, and also in not enough fried meat. Also, the causative agent can get into the human body when drinking unboiled water, fresh vegetables and fruits, when watering them, contaminated water was used.

Infection is possible by aerogenic means when working with down, animal skins, as well as contact method for penetration of infection through wounds and abrasions on the skin.

Transmission of the pathogen from the mother to the newborn is now of great importance. It has been established that after giving birth, the mother and newborn give microorganisms to the external environment for 12 days, which can cause infection of medical personnel and other puerperas. In rare cases, the sexual way of transmission from a sick person is possible.

Symptoms of listeriosis

After penetration into the body, listeria settles in the lymph nodes, where they begin to multiply intensively. Then the blood flow is carried to various organs( central nervous system, liver, spleen), granulomas( dense tubercles, containing microorganisms in large numbers) are formed, and in some cases abscesses.

The period from the moment of infection to the development of characteristic symptoms ranges from 3 to 45 days. The following forms of the disease are distinguished.

• Angiogenous-septic form of listeriosis is the most common form of the disease. It appears in the form of angina. With the progression of the disease, characteristic signs of damage to the nervous system are formed.
Catarrh and follicular angina is characterized by reddening of throat, pain during swallowing, enlarged tonsils and a number of located lymph nodes. The body temperature increases to 38-38.5 ° C, holds 5-6 days. Simultaneously with the temperature there are symptoms of poisoning the body: headache, weakness, drowsiness, muscle pain, nausea.
For ulcerative-pleural tonsillitis , along with reddening of the throat and enlargement of the tonsils, the appearance of gray films or ulcers on the tonsils is characteristic.

Ulcerative-film angina with listeriosis. Attention is drawn to the reddening of the throat, a gray coating on the enlarged tonsils.

The disease is severe. Lymph nodes are significantly enlarged and painful. Intoxication is much more pronounced, body temperature can reach 39-40 ° C.Often, an increase in the liver, spleen. On average, the duration of the disease with adequate treatment is about 10-12 days.
In the absence of treatment, the progression of angina leads to the development of sepsis( penetration of microorganisms and their toxins into the blood).Symptoms of intoxication are expressed significantly. Body temperature reaches 40-42 ° C, characteristic rapid ups and downs of temperature, which especially exhausts the patient. There is reddening of the face, runny nose, cough, tonsils enlarged, covered with whitish coating. The lymph nodes of different regions are also enlarged and painful. On the skin appear reddish elements of irregular shape, single or multiple.

Skin rash, characteristic of sepsis

• For the nervous form of listeriosis is characterized by the development of meningitis, meningoencephalitis, brain abscess.
Meningitis is manifested by severe headache, vomiting. The neck muscles are in a tonus, painful when feeling. Perhaps a violation of consciousness: delirium, hallucinations, the appearance of seizures.
With meningoencephalitis, the ptosis of the eyelids( pathological lowering of the upper eyelid), anisocoria( an increase in the size of one of the pupils), and violation of skin sensitivity are added to the above symptoms. Often there are paresis and paralysis.

Ptosis of the eyelids with meningoencephalitis. Omission of the right upper eyelid.

Anisocoria in meningoencephalitis. Asymmetry of the pupils.

Brain abscess is most often formed in patients with significantly weakened immunity. This disease is characterized by headache, fever, vomiting, development of neurological disorders, characteristic for each lesion zone, epileptic seizures.

• Septic-granulomatous form of listeriosis .This form of the disease is characteristic of newborn children. In children, infected from a sick mother immediately after birth, acute damage to the respiratory and cardiovascular system. Very quickly develop symptoms of sepsis and lesions of the central nervous system. The cause of death of these children is most often purulent meningitis. In infants, the disease begins as an ARVI: runny nose, cough. Very quickly develops bronchopneumonia, purulent pleurisy. There is a rash on the skin, the respiratory and cardiovascular system is affected. Often convulsions, paralysis develop. The disease is extremely difficult, in the case of recovery in children for a long time there are disorders of the central nervous system.

• The eye-glandular form of listeriosis is currently rare. In this case, infection is usually carried out by direct contact with animals. The defeat of the eyes is manifested by purulent conjunctivitis( inflammation of the mucous membrane), purulent discharge from the eye, edema of the eyelid, narrowing of the eye gap.

Conjunctivitis

Visual acuity decreases. Attention is drawn to the increase and soreness of a number of located lymph nodes, an increase in temperature.

Diagnosis of Listeriosis

The disease can be assumed by the above symptoms. Diagnosis of the disease is based on the determination of the pathogen in the blood of a sick person, its toxins, as well as a number of proteins( antibodies and antigens), the formation of which is specific for listeriosis. For research, mucus from the nose or throat, blood, amniotic fluid, placenta, conjunctiva pus, lymphatic tissue and cerebrospinal fluid are used. To determine the pathogen, luminescent microscopy is used. Specific proteins are detected by immune reactions: the indirect hemagglutination reaction and the complement fixation reaction.

Treatment of listeriosis

If suspected of listeriosis, patients are necessarily hospitalized in the infectious disease department. Treatment is carried out in specialized boxes. Patients are recommended a plentiful drink and a diet with a high content of vitamins. Treatment is complex, depending on the prevailing form of the disease. All patients are shown antibiotic therapy( tetracycline, erythromycin, levomycitin).Antibacterial drugs are prescribed for the entire period of elevated body temperature and for another 5-7 days after the temperature normalization.

For the treatment of intoxication, drip infusion of various solutions( isotonic sodium chloride solution, Ringer's solution) is shown against the background of drugs that stimulate the excretion of urine.

To treat the glandular glandular form of listeriosis, a solution of albucid and glucocorticoids is topically applied.

The length of stay in the hospital varies depending on the form of the disease and ranges from 14 to 28 days. It is believed that after the temperature normalization and the disappearance of the main clinical manifestations of the disease, the patient becomes non-communicable, and can be discharged from the hospital. After discharge from the hospital, the patient is under the supervision of an infectious disease specialist for two years.

Possible complications of listeriosis

The most common complications of listeriosis are:

• endocarditis in septic-granulomatous form of the disease;
• congenital malformations in children of sick women, stillbirth, premature birth.
• death of newborns with progression of respiratory and cardiovascular insufficiency, as well as in the development of purulent meningitis;
• pneumonia and purulent pleurisy in infants;
• hepatitis;
• effects of the central nervous system( mental retardation, paralysis, epilepsy, convulsions) after a cure.

Prognosis of the course of the disease with

listeriosis In the absence of a pronounced immunodeficiency and with timely treatment, the prognosis for recovery is favorable. Disease of newborns and children under one year, elderly people and immunocompromised persons, even with adequate treatment, is accompanied by a high mortality rate.

Prevention of listeriosis

Specific prevention of listeriosis has not been developed.
General measures of prevention are observance of hygienic measures at the maintenance of domestic animals, destruction of house rodents. When working with animals, personal protective equipment( masks, gloves, respirators) should be used. To prevent infection, it is recommended to thoroughly wash fresh fruits and vegetables, do not consume water from natural and artificial water bodies, conduct sufficient thermal treatment of livestock products. For example, in distressed areas it is necessary to boil milk, refuse to eat products from pasteurized milk. Meat dishes should be thoroughly roasted. It is unacceptable to eat meat with blood. Fresh meat should be stored separately from other food products. Each housewife in the kitchen should have a separate board for cutting meat. If this is not the case, after the cutting of meat, the board must necessarily be treated with disinfectants( cleaning powder).
Compliance with simple safety measures will minimize the risk of infection with listeriosis.

Doctor therapist Sirotkina EV