Symptoms of Listeriosis

The disease has an incubation period that lasts from 1-2 days to 2-4 weeks, occasionally up to 1.5-2 months, after which symptoms of listeriosis appear.

Symptoms of listeriosis are manifold. There is no single clinical classification.

The following forms of listeriosis are distinguished:

• glandular;
• gastroenteric;
• nervous (meningitis, meningoencephalitis);
• septic;
• bacteriocarrier.

Separately, listeriosis is allocated to pregnant and newborns. There are acute (1-3 months), subacute (3-6 months) and chronic (more than 6 months) listeriosis.

The glandular form has two variants:

• anginal-glandular;
• glandular glandular.

The first of them is characterized by an increase in body temperature, intoxication, angina (ulcerative-necrotic or membranous), an increase and morbidity in the submandibular, less often cervical and axillary lymph nodes. It is also possible to enlarge the liver and spleen. The febrile period is 5-7 days. In the hemogram note monocytosis ("monocytic angina"). Symptoms of listeriosis resemble infectious mononucleosis. In some classifications, an angina-septic form of listeriosis is separately isolated, in which tonsillitis, hepatosplenomegaly, long-term fever of a hectic type, expressed intoxication, generalized lymphadenopathy, rash are combined.

For glazozhelezistogo variant one-sided purulent conjunctivitis with the expressed edema of eyelids, narrowing of an eye crack is typical. On the transitional fold of the conjunctiva - nodular rashes. Reduces visual acuity; the parotid and submandibular lymph nodes from the corresponding side grow and become painful.

The gastroenteric form is characterized by an acute onset, a rapid rise in body temperature to high figures, expressed by intoxication (chills, headache, arthralgia and myalgia). A few hours later, nausea, repeated unvoiced vomiting, cramping pains in the abdomen, a chair becomes frequent. Fecal masses are liquid, sometimes with an admixture of mucus and / or blood. Characteristic of the following symptoms of listeriosis: bloating, soreness with palpation, especially pronounced in the right ileal region. The duration of the fever is 5-7 days or more. Significant dehydration usually does not happen, the symptoms of intoxication dominate. The high lethality (20% and higher) that is inherent in this form is due to the development of ITH or the transition to more severe, nervous, septic forms.

Nervous form - one of the most common, occurs most often in children under three years old and in adults older than 45-50 years, occurs in the form of meningitis or meningoencephalitis. The frequency of listeriogenic meningitis is about 1% of all bacterial meningitis, but among some categories, in particular patients with oncological diseases, this is the most common form of meningitis.

In recent years, in many countries around the world, there has been an increase in the incidence of listeriogenic meningitis, with not only elderly patients with various concomitant pathologies becoming ill, but also young, previously healthy individuals. In addition, listeria is one of the main pathogens of meningitis in newborns, patients with lymphomas, in recipients of various organs.

According to clinical signs, listeriogenic meningitis does not differ significantly from bacterial meningitis of another etiology. The most frequent symptoms of listeriosis are high body temperature, impaired consciousness, and an intensifying headache. However, in some cases, body temperature is subfebrile or does not increase at all. In some patients, rapid fluid stools are noted for 1-3 days.

In comparison with other bacterial meningitis, with listeriosis, meningeal symptoms are noted less often (including stiff neck stiffness, fontanel bulging), spinal fluid less often has neutrophil composition, high protein content and low glucose concentration. Often, with listeriosis meningitis, convulsions, tremors of the extremities, tongue, symptoms of the defeat of the cranial nerves (leading, facial, etc.) are noted. One of the notable features of listeriosis meningitis is severe complications: hydrocephalus, rhombencephalitis, encephalopolyneuritis, dementia, etc. In addition to the head, it is possible to damage the spinal cord in the form of intramedullary abscesses, cysts, arachnoiditis, myelitis, etc.

The course of the nervous form is usually wavy, often severe, lethality reaches 30% or more, approximately 7% of cases are relapses. Recovery comes slowly, after months. Listeriogenic meningitis (meningoencephalitis), tonsillitis, conjunctivitis, gastroenteritis can be both independent forms of listeriosis, and one of the manifestations of the septic form or precede it.

The septic form is characterized by repeated attacks of chills, fever with large fluctuations in body temperature, intoxication, hepatosplenomegaly. Perhaps the appearance of coarse rash, mainly around large joints; on the face the rash may look like a "butterfly". Often there is hepatitis with jaundice, polyserositis, pneumonia are possible. In the hemogram - anemia, thrombocytopenia. The development of the septic form is sometimes gradual or subacute, the first signs of the disease in these cases are either catarrhal (perspiration or sore throat, pain in the eyes) or dyspeptic symptoms (nausea, vomiting, stool disorders). Septic form of listeriosis is more common in newborns, people with severe immunodeficiency, in patients with cirrhosis of the liver, chronic alcoholism. Mortality reaches 60%. The cause of death may be ITSH, massive bleeding due to the development of DIC-syndrome, acute respiratory failure (ODN) and OPN.

With all the forms of listeriosis described above, leukocytosis (up to hyperleukocytosis), a stab-shift leftward, in some cases monocytosis, is noted in the blood.

Also described are rare forms of listeriosis: endocarditis, dermatitis, arthritis, osteomyelitis, abscesses of various organs, parotitis, urethritis, prostatitis, etc.

Listeriemic hepatitis is possible in septic form, in some cases it is accompanied by jaundice. Exceptionally rare is hepatitis with severe hyperfermentemia, signs of hepatic-cell insufficiency, symptoms of acute hepatic encephalopathy dominates in the clinic of listeriosis.

Manifest forms of listeriosis develop in no more than 20% of infected, in others, either transient (more often) or chronic (less often) asymptomatic bacteriocarrier emerges, which can only be detected by special laboratory tests.

[1], [2], [3]

Listeriosis of pregnant women

Reduction of the level of cellular immunity, naturally occurring during pregnancy, causes an increased susceptibility to listeriosis infection. In the US, the listeriosis of pregnant women accounts for more than a quarter of the total number of diseases with this infection and more than half of cases in people aged 10-40 years. It is believed that pregnant women are 10-20 times more susceptible to listeriosis than other women.

Listeriosis can develop on any term of pregnancy, although most of the cases are in its second half. Listeriosis in pregnant women occurs either in general asymptomatic or not, having erased polymorphic symptoms of listeriosis, so a correct diagnosis is often established retrospectively, after the death of the fetus or newborn. Pregnant women may have short-term fever, muscle pains, catarrhal symptoms from the upper respiratory tract, conjunctivitis. Some patients are diagnosed with gastroenteritis, others have inflammation of the urinary tract. The defeat of the nervous system in pregnant women is extremely rare.

Listeriosis of the mother can lead to transplacental infection of the fetus, and the development of intrauterine infection is quite intense, so that the affected mother and fetus "exchange" the infection: first the mother infects the fetus, then he again infects the mother, causing her a secondary wave of the disease in the form of fever unclear etiology. That is why listeriosis is sometimes called a "ping-pong" infection.

A characteristic clinical feature of listeriosis in pregnant women is a critical decrease in body temperature after abortion; in the future, usually the fever does not resume.

Acute and chronic listeriosis of a pregnant woman can be the cause of severe obstetric pathology: premature termination of pregnancy at different times. Habitual miscarriage of pregnancy, malformations of the fetus, its fetal death, etc. The causative agent may persist for a long time in the body of a woman, in particular in the kidneys, and become more active during pregnancy, against a background of reduced immunity. Screening studies have shown that 16-17% of women who have suffered urogenital diseases, allocate listeria. Practically all women who fell ill with listeriosis had a "rich" obstetric-gynecologic history: cervical erosion, adnexitis, artificial and spontaneous abortions, and others.

Listeriosis of newborns

Listeriosis of the newborns is a severe generalized disease with a high mortality (up to 50%), proceeding according to the type of sepsis. The specific gravity of listeriosis in perinatal mortality reaches 25%. The timing of the onset and clinical manifestations of newborn listeriosis depend on the time and pathway of infection (antenatal or intranatal, transplacental or aerosol contamination).

In the case of transplacental fetal infection, if an intrauterine death occurs, a child with congenital listeriosis is usually born prematurely, with a reduced body weight. A few hours later, sometimes 1-2 days later, his condition deteriorates sharply: the body temperature rises, a characteristic papular, sometimes hemorrhagic exanthema appears, anxiety, dyspnea, cyanosis, convulsions occur and in most cases death occurs, which can be caused by an uncontrollable RDS, pneumonia , purulent pleurisy, hepatitis, meningoencephalitis. Defeat of other organs, intrauterine sepsis. With intrapartum infection that occurs during passage of the fetus through the mother's infected maternal pathways, the child appears healthy after birth, symptoms of listeriosis in the form of sepsis occur after 7 days of the child's life. Aspiration with the fruit of an infected amniotic fluid can lead to severe lung damage; the mortality rate reaches 50%. In some newborns, listeriosis develops 10-12 days after birth and in these cases usually occurs in the form of meningitis with a mortality rate of up to 25%. This form is most typical for outbreaks of listeriosis in maternity hospitals.