What are the Symptoms of Listeriosis?

A person with listeriosis usually has fever and muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms. Almost everyone who is diagnosed with listeriosis has "invasive" infection, in which the bacteria spread beyond the gastrointestinal tract. The symptoms vary with the infected person:

Pregnant women: Pregnant women typically experience only a mild, flu-like illness. However, infections during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn. Persons other than pregnant women: Symptoms, in addition to fever and muscle aches, can include headache, stiff neck, confusion, loss of balance, and convulsions. Listeriosis can present in different ways depending on the type of infection. Manifestations of listeriosis are host-dependent. In older adults and persons with immunocompromising conditions, septicemia and meningitis are the most common clinical presentations. Pregnant women may experience a mild, flu-like illness followed by fetal loss or bacteremia and meningitis in their newborns. Immunocompetent persons may experience acute febrile gastroenteritis or no symptoms. Outbreaks Multistate Outbreak of Listeriosis Linked to Whole Cantaloupes from Jensen Farms, Colorado Outbreak Highlights, December 8, 2011 (FINAL Update) A total of 146 persons infected with any of the four outbreak-associated strains of Listeria monocytogenes were reported to CDC from 28 states. Thirty deaths were reported. In addition, one woman pregnant at the time of illness had a miscarriage.

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Surveillance

All states have regulations requiring health care providers to report cases of listeriosis, and public health officials interview all persons with listeriosis promptly using a standard questionnaire about high risk foods. The Listeria Initiative is an enhanced surveillance system that aids in investigations of listeriosis outbreaks and clusters. States participating in the Listeria Initiative conduct prompt interviews of patients using the Listeria Case Report Adobe PDF file [PDF - 15 pages], a standardized questionnaire developed to collect detailed information about food exposures.

When PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance, identifies a cluster of Listeria monocytogenes patient isolates with the same molecular pattern, epidemiologists can conduct a preliminary case-control analysis by comparing responses to food exposures reported on the Listeria Case Report Adobe PDF file [PDF - 15 pages] from patients in the cluster to those from patients outside the cluster.

Statistics

Incidence

In the United States, an estimated 1,600 persons become seriously ill with listeriosis each year. Of these, 260 die.

Trends

Compared to 1996-1998, the incidence of listeriosis had declined by about 38% by 2003. However, illnesses and deaths continue to occur. On average from 1998-2008, 2.4 outbreaks per year were reported to CDC. Before 2011, the largest outbreak occurred in 2002, when 54 illnesses, 8 deaths, and 3 fetal deaths in 9 states were found to be associated with consumption of contaminated turkey deli meat.

Who Gets Listeriosis?

The following groups are at increased risk:

• Pregnant women: Pregnant women are about 20 times more likely than other healthy adults to get listeriosis. About one in six (17%) cases of listeriosis occurs during pregnancy.

• Newborn babies: Newborn babies suffer the most serious effects of infection in pregnancy.

• Persons with weakened immune systems from transplants or certain diseases, therapies, or medications.

• Persons with cancer, diabetes, alcoholism, liver or kidney disease.

• Persons with AIDS: They are almost 300 times more likely to get listeriosis than people with normal immune systems.

• Older adults

• Healthy children and adults occasionally get infected with Listeria, but they rarely become seriously ill.

Causes

How does someone get listeriosis?

You get listeriosis by eating food contaminated with Listeria monocytogenes. Babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. However, healthy persons may consume contaminated foods without becoming ill. Persons at risk can prevent listeriosis by avoiding certain high-risk foods and by handling and storing food properly.

Organism (Etiologic Agent) Listeria monocytogenes, a gram-positive rod-shaped bacterium.

Reservoir

Listeria monocytogenes is commonly found in soil and water. Animals can carry the bacterium without appearing ill and can contaminate foods of animal origin, such as meats and dairy products.

Transmission

Most human infections follow consumption of contaminated food. Rare cases of nosocomial transmission have been reported.

When Listeria bacteria get into a food processing factory, they can live there for years, sometimes contaminating food products. The bacterium has been found in a variety of raw foods, such as uncooked meats and vegetables, as well as in foods that become contaminated after cooking or processing, such as soft cheeses, processed meats such as hot dogs and deli meat (both products in factory-sealed packages and products sold at deli counters), and smoked seafood. Unpasteurized (raw) milk and cheeses and other foods made from unpasteurized milk are particularly likely to contain the bacterium.

Listeria is killed by pasteurization and cooking; however, in some ready-to-eat foods, such as hot dogs and deli meats, contamination may occur after factory cooking but before packaging. Unlike most bacteria, Listeria can grow and multiply in some foods in the refrigerator.

How can I reduce my risk for listeriosis?

The general guidelines recommended for the prevention of listeriosis are similar to those used to help prevent other foodborne illnesses, such as salmonellosis. In addition, there are specific recommendations for persons at higher risk for listeriosis.

General recommendations to prevent an infection with Listeria:

FDA recommendations for washing and handling food.

• Rinse raw produce, such as fruits and vegetables, thoroughly under running tap water before eating, cutting, or cooking. Even if the produce will be peeled, it should still be washed first. Cuisine Clean - Fruit and Vegetable Washer - oZone

• Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
• Dry the produce with a clean cloth or paper towel.
• Separate uncooked meats and poultry from vegetables, cooked foods, and ready-to-eat foods.

Keep your kitchen and environment cleaner and safer.

• Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.

• Be aware that Listeria monocytogenes can grow in foods in the refrigerator. Use an appliance thermometer, such as a refrigerator thermometer, to check the temperature inside your refrigerator. The refrigerator should be 40°F or lower and the freezer 0°F or lower.

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• Clean up all spills in your refrigerator right away–especially juices from hot dog and lunch meat packages, raw meat, and raw poultry.

• Clean the inside walls and shelves of your refrigerator with hot water and liquid soap, then rinse.

Cook meat and poultry thoroughly.

Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature.

Safe Minimum Cooking Temperatures

Use the chart below and a food thermometer to ensure that meat, poultry, seafood, and other cooked foods reach a safe minimum internal temperature.

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Remember, you can’t tell whether meat is safely cooked by looking at it. Any cooked, uncured red meats – including pork – can be pink, even when the meat has reached a safe internal temperature.

After you remove meat from a grill, oven, or other heat source, allow it to rest for the specified amount of time. During the rest time, its temperature remains constant or continues to rise, which destroys harmful germs.

Category	Food	Temperature (°F)	Rest Time
Ground Meat & Meat Mixtures	Beef, Pork, Veal, Lamb	160	None
	Turkey, Chicken	165	None
Fresh Beef, Veal, Lamb	Steaks, roasts, chops	145	3 minutes
Poultry	Chicken & Turkey, whole	165	None
	Poultry breasts, roasts	165	None
	Poultry thighs, legs, wings	165	None
	Duck & Goose	165	None
	Stuffing (cooked alone or in bird)	165	None
Pork and Ham	Fresh pork	145	3 minutes
	Fresh ham (raw)	145	3 minutes
	Precooked ham (to reheat)	140	None
Eggs & Egg Dishes	Eggs	Cook until yolk and white are firm	None
	Egg dishes	160	None
Leftovers & Casseroles	Leftovers	165	None
	Casseroles	165	None
Seafood	Fin Fish	145 or cook until flesh is opaque and separates easily with a fork.	None
	Shrimp, lobster, and crabs	Cook until flesh is pearly and opaque.	None
	Clams, oysters, and mussels	Cook until shells open during cooking.	None
	Scallops	Cook until flesh is milky white or opaque and firm.	None

Store foods safely.

Use precooked or ready-to-eat food as soon as you can. Do not store the product in the refrigerator beyond the use-by date; follow USDA refrigerator storage time guidelines:

• Hot Dogs – store opened package no longer than 1 week and unopened package no longer than 2 weeks in the refrigerator.

• Luncheon and Deli Meat – store factory-sealed, unopened package no longer than 2 weeks. Store opened packages and meat sliced at a local deli no longer than 3 to 5 days in the refrigerator.

• Divide leftovers into shallow containers to promote rapid, even cooling. Cover with airtight lids or enclose in plastic wrap or aluminum foil. Use leftovers within 3 to 4 days.

Choose safer foods.

Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.

Milk and products made from milk (including certain cheeses, ice cream, and yogurt) are foods that, when consumed raw, can pose severe health risks. Milk and products made from milk need minimal processing, called pasteurization, which can be done by heating the milk briefly (for example heating it to 161 °F for about 20 seconds), to kill disease-causing germs (e.g., Salmonella, Escherichia coli O157, Campylobacter) that can be found in raw milk.

Before the invention and acceptance of pasteurization, raw milk was a common source of the bacteria that cause tuberculosis, diphtheria, severe streptococcal infections, typhoid fever, and other foodborne illnesses. These illnesses killed many people each year, especially young children. In the 1900s many mothers recognized this risk and would boil milk (bringing it to a temperature of 212°F) before giving it to their infants and young children.

Many studies have shown that pasteurization does not significantly change the nutritional value of milk – pasteurized milk is rich in proteins, carbohydrates, and other nutrients. Heat slightly affects a few of the vitamins found in milk-- thiamine, vitamin B12, and vitamin C-- but milk is only a minor source of these vitamins.

Recommendations for persons at higher risk, such as pregnant women, persons with weakened immune systems, and older adults in addition to the recommendations listed above, include:

Meats

• Do not eat hot dogs, luncheon meats, cold cuts, other deli meats (e.g., bologna), or fermented or dry sausages unless they are heated to an internal temperature of 165°F or until steaming hot just before serving.

• Avoid getting fluid from hot dog and lunch meat packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.

• Pay attention to labels. Do not eat refrigerated pâté or meat spreads from a deli or meat counter or from the refrigerated section of a store. Foods that do not need refrigeration, like canned or shelf-stable pâté and meat spreads, are safe to eat. Refrigerate after opening.

Cheeses

Do not eat soft cheese such as feta, queso blanco, queso fresco, brie, Camembert, blue-veined, or panela (queso panela) unless it is labeled as made with pasteurized milk. Make sure the label says, "MADE WITH PASTEURIZED MILK."

Seafood

• Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole, or unless it is a canned or shelf-stable product.

• Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, and mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky."

  These fish are typically found in the refrigerator section or sold at seafood and deli counters of grocery stores and delicatessens.

• Canned and shelf stable tuna, salmon, and other fish products are safe to eat.

Safety tips for eating melons

Follow this general FDA advice for melon safety:

• Consumers and food preparers should wash their hands with warm water and soap for at least 20 seconds before and after handling any whole melon, such as cantaloupe, watermelon, or honeydew.

• Scrub the surface of melons, such as cantaloupes, with a clean produce brush under running water and dry them with a clean cloth or paper towel before cutting. Be sure that your scrub brush is sanitized after each use, to avoid transferring bacteria between melons.

• Promptly consume cut melon or refrigerate promptly. Keep your cut melon refrigerated at, or less than 40 degrees F (32-34 degrees F is best), for no more than 7 days.

• Discard cut melons left at room temperature for more than 4 hours.

Diagnosis & Testing

How do I know if I have Listeriosis?

If you develop fever and chills while pregnant or if you are very sick with fever and muscle aches or stiff neck, consult your doctor immediately. A blood or spinal fluid test (to look for the bacteria) will show if you have listeriosis.

Clinical Diagnosis

Diagnosis is confirmed only after isolation of Listeria monocytogenes from a normally sterile site, such as blood, or from amniotic fluid or the placenta in the setting of pregnancy. Listeria monocytogenes can be isolated readily on routine media, but care must be taken to distinguish this organism from other Gram-positive rods, particularly diphtheroids. Selective enrichment media improve rates of isolation from contaminated specimens. Serological tests are unreliable, and not recommended at the present time.

Treatment & Outcomes

How is Listeriosis Treated?

Listeriosis is treated with antibiotics. A person in a high-risk category who experiences flu-like symptoms within 2 months of eating contaminated food should seek medical care and tell the physician or health care provider about eating the contaminated food.

If a person has eaten food contaminated with Listeria and does not have any symptoms, most experts believe that no tests or treatment are needed, even for persons at high risk for listeriosis.

Outcomes

Even with prompt treatment, some listeriosis cases result in death. This is particularly likely in older adults and in persons with other serious medical problems.