Listeriosis in children

Listeriosis (listerellosis) is an acute infectious disease caused by Listeria monocytogenes, accompanied by fever, symptoms of intoxication, frequent damage to the lymphoid formations of the pharyngeal ring, central nervous system, liver and spleen.

The disease often occurs as a long-term, often chronic sepsis.

ICD-10 code

• A32.0 Cutaneous listeriosis.
• A32.1 Listerial meningitis and meningoencephalitis.
• A32.7 Listeria septicemia.
• A32.8 Other forms of listeriosis (cerebral arthritis, endocarditis, oculoglandular listeriosis).
• A32.9 Listeriosis, unspecified.

Epidemiology of listeriosis in children

The main reservoir of infection in nature are rodents (field mice, rats, jerboas, hares, rabbits, etc.). Pathogens are often found in raccoons, deer, wild boars, foxes, as well as in domestic animals: pigs, goats, cows, sheep, cats, chickens, ducks, etc. Taking into account the source of infection, listeriosis can be classified as a typical zoonotic infection. Human infection most often occurs through the gastrointestinal tract when consuming insufficiently thermally processed infected meat and dairy products. Often, a person becomes infected through infected water. Transmission of infection by airborne dust, as well as by contact when caring for sick animals, is possible. In pediatric practice, cases of intrauterine infection of the fetus from a mother sick with listeriosis or a carrier of listeria are more often observed. The incidence of the disease is recorded all year round, but its maximum occurs in spring and summer. There are sporadic cases, but epidemic outbreaks are also possible among children, mainly in rural areas. All groups of the population are susceptible to listeriosis, but especially children in the first years of life, who often develop severe septic forms of the disease.

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Causes of Listeriosis in Children

The causative agent of the disease Listeria monocytogenes belongs to the family of corynebacteria, has the appearance of small polymorphic rods 0.5-2 μm long and 0.4-0.5 μm thick; gram-positive, do not form spores. 7 serovars and several subtypes have been identified. When the microbial cell disintegrates, endotoxin is released.

Pathogenesis of listeriosis

The entry points of infection are the pharyngeal ring, gastrointestinal tract, conjunctiva of the eyes, respiratory organs, damaged skin. From the sites of introduction, listeria enter the regional lymph nodes by the lymphatic route, and then are carried by the hematogenous route to the parenchymatous organs, as well as to the central nervous system. The development of the pathological process depends significantly on the site of penetration of the pathogen.

• When the pathogen penetrates through the pharyngeal ring, an anginal form occurs, in which the primary accumulation of the pathogen occurs in the lymphoid formations of the pharynx, followed by generalization of the infection and the possible formation of septic lesions.
• When the pathogen penetrates through the gastrointestinal tract, Listeria accumulates in Peyer's patches and solitary follicles. Such patients usually develop a typhoid form of the disease.
• If Listeria penetrates through the conjunctiva of the eye, the ocular-glandular form will most likely develop.
• With transplacental infection, the process usually becomes generalized with damage to many organs, primarily the liver and central nervous system.

Symptoms of Listeriosis in Children

The anginal form manifests itself as catarrhal, ulcerative-necrotic or membranous tonsillitis. Regional lymph nodes are enlarged and painful. Sometimes an increase in other groups of lymph nodes is noted: cervical, axillary. The liver and spleen are enlarged. At the height of the disease, a polymorphic rash may appear. Leukocytosis, monocytosis are noted in the blood: ESR is increased. In severe cases, sepsis, meningitis or meningoencephalitis may develop. Listerial endocarditis, osteomyelitis, etc. have been described. The anginal form of the disease is especially difficult to differentiate from infectious mononucleosis.

The oculoglandular form occurs when the pathogen penetrates through the conjunctiva of the eye. The eyelids of the affected eye are swollen, compacted, the palpebral fissure is narrowed. There is purulent discharge in the corners of the eye. Bright follicles - granuloma nodules - are visible on the hyperemic edematous conjunctiva, especially in the area of the infiltrated transitional fold. The process does not spread to the cornea. The parotid, often submandibular, cervical, and sometimes occipital lymph nodes are enlarged and painful.

The typhoid form is characterized by prolonged fever, enlarged liver and spleen, and skin rashes. Parenchymatous hepatitis with jaundice, dark urine, and discolored feces often occurs. Polyserositis with pericarditis and pleurisy are possible. The lungs, gastrointestinal tract, and central nervous system may be involved in the process. Anemia, thrombocytopenia, and decreased coagulability are possible in the blood, which may result in bleeding. Such forms usually occur in weakened children, as well as in newborns and children in their first year of life. Changes in the pharynx are not typical for the typhoid form. The disease is severe and can be fatal.

The nervous form manifests itself as meningitis, encephalitis or meningoencephalitis. During a spinal puncture in the early stages of the disease, the fluid is transparent, flows out under increased pressure, it contains an increased protein content, a slight pleocytosis due to both lymphocytes and neutrophils. At the height of the disease, the cerebrospinal fluid becomes cloudy, with a high protein content and neutrophilic cytosis. Residual effects are possible in the form of mental disorders, memory loss, persistent paresis, paralysis of individual muscle groups up to long-term polyradiculoneuritis.

Congenital listeriosis

On the skin of the newborn, nodular rashes or papular, roseolous, and less often hemorrhagic rashes similar to rashes in meningococcemia are found. Similar rashes are found in the pharynx, especially on the tonsils. Sometimes there are ulcers on the mucous membranes of the oral cavity. The general condition of children is severe, respiratory and circulatory disorders are noted. Phenomena of enterocolitis are possible. As a rule, the liver and spleen are enlarged. Jaundice often appears.

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Classification of listeriosis

The incubation period for listeriosis is from 3 to 45 days. There are angina, typhoid, oculoglandular, nervous clinical forms and congenital listeriosis. Atypical forms are also possible: latent, subclinical, flu-like, etc.

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Diagnosis of listeriosis in children

For the diagnosis of congenital listeriosis, anamnesis data (miscarriages, stillbirths, premature births) and the fact of the birth of a child with signs of intrauterine infection (hypotrophy, adynamia, hypotension, dyspnea, attacks of cyanosis, enlargement of the liver and spleen, rashes on the skin and mucous membranes, convulsions, etc.) are important.

Listeriosis in older children can be suspected by lesions of the pharynx (necrotic-ulcerative or membranous tonsillitis) with a long course and mononuclear shift in the blood, as well as with the occurrence of the oculoglandular form. PCR and ELISA are of decisive importance. In addition, RPGA, RSK, RA are used. Specific antibodies in the blood begin to appear on the 2nd week of the disease. The increase in the antibody titer in the dynamics of the disease is of diagnostic importance.

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Differential diagnostics

It is necessary to differentiate:

• congenital listeriosis - with congenital cytomegalovirus, toxoplasmosis, syphilis, staphylococcal sepsis, hemolytic disease of the newborn, intracranial trauma;
• anginal form - with glandular form of tularemia, diphtheria, agranulocytic angina, infectious mononucleosis:
• typhoid form - with typhoid fever, sepsis, pseudotuberculosis;
• nervous form - with meningitis and encephalitis of other etiologies.

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Treatment of listeriosis in children

As etiotropic therapy, antibiotics are prescribed: chloramphenicol, erythromycin, ampicillin, cephalosporins in an age-appropriate dose throughout the febrile period and for another 3-5 days at normal body temperature.

In severe forms with damage to the nervous system, liver and other visceral organs, glucocorticoids are prescribed at a rate of 1-2 mg/kg per day of prednisolone for 7-10 days.

For the purpose of dehydration, intravenous infusions of 1.5% reamberin, rheopolyglucin, polyglucin, 10% glucose solution, etc. are administered. Desensitizing and symptomatic agents, probiotics (acipole, bifidumbacterin, etc.) are prescribed as indicated.

Prevention of listeriosis in children

Specific prevention has not been developed. Of decisive importance are strict adherence to personal hygiene rules when caring for animals, food control, drinking milk only after boiling, especially in places unfavorable for listeriosis. It is necessary to destroy stray dogs, cats, and control domestic rodents. To prevent congenital listeriosis, all pregnant women with an unfavorable obstetric history are subject to examination for listeriosis. If listeria is detected, they are treated with an antibiotic in combination with sulfonamides for 7 days.