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.

The symptoms of listeriosis are varied. There is no single clinical classification.

The following forms of listeriosis are distinguished:

• glandular;
• gastroenteritis;
• nervous (meningitis, meningoencephalitis);
• septic;
• carriage of bacteria.

Listeriosis of pregnant women and newborns is distinguished separately. Acute (1-3 months), subacute (3-6 months) and chronic (more than 6 months) listeriosis are distinguished.

The glandular form has two variants:

• angino-glandular;
• ocular-glandular.

The first of them is characterized by an increase in body temperature, intoxication, tonsillitis (ulcer-necrotic or membranous), enlargement and soreness of the submandibular, less often cervical and axillary lymph nodes. Enlargement of the liver and spleen is also possible. The febrile period is 5-7 days. Monocytosis ("monocytic tonsillitis") is noted in the hemogram. Symptoms of listeriosis resemble infectious mononucleosis. Some classifications separately distinguish the angina-septic form of listeriosis, which combines tonsillitis, hepatosplenomegaly, prolonged hectic fever, severe intoxication, generalized lymphadenopathy, rash.

For the oculoglandular variant, unilateral purulent conjunctivitis with pronounced swelling of the eyelids and narrowing of the palpebral fissure is typical. Nodular rashes appear on the transitional fold of the conjunctiva. Visual acuity decreases; the parotid and submandibular lymph nodes on the corresponding side enlarge and become painful.

The gastroenteric form is characterized by an acute onset, a rapid increase in body temperature to high numbers, severe intoxication (chills, headache, arthralgia and myalgia). After a few hours, nausea, repeated mild vomiting, cramping abdominal pains, and more frequent stools occur. The feces are liquid, sometimes with an admixture of mucus and/or blood. The following symptoms of listeriosis are characteristic: abdominal distension, pain upon palpation, especially pronounced in the right iliac region. The duration of fever is 5-7 days or more. Significant dehydration usually does not occur, and intoxication symptoms dominate. The high mortality rate (20% and higher) characteristic of this form is due to the development of ISS or the transition to more severe, nervous, septic forms.

The nervous form is one of the most common, occurs most often in children under three years of age and in adults over 45-50 years of age, and occurs in the form of meningitis or meningoencephalitis. The frequency of listeriosis 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, many countries around the world have seen an increase in the incidence of listeriosis meningitis, with not only elderly patients with various concomitant pathologies falling ill, but also young, previously healthy individuals. In addition, listeria is one of the main causative agents of meningitis in newborns, patients with lymphomas, and recipients of various organs.

In terms of clinical signs, listeriosis meningitis does not differ significantly from bacterial meningitis of other etiologies. The most common symptoms of listeriosis are high body temperature, impaired consciousness, and headaches that become increasingly intense. However, in some cases, body temperature is subfebrile or does not rise at all. Some patients experience frequent loose stools for 1-3 days.

Compared with other bacterial meningitis, listerial meningitis is less likely to have meningeal symptoms (including stiff neck, bulging fontanelle), the cerebrospinal fluid is less likely to have a neutrophilic composition, high protein content and low glucose concentration. Often, listerial meningitis is accompanied by convulsions, tremors of the extremities, tongue, symptoms of damage to the cranial nerves (abducens, facial, etc.). One of the notable features of listerial meningitis is severe complications: hydrocephalus, rhombencephalitis, encephalopolyneuritis, dementia, etc. In addition to the brain, spinal cord damage is possible in the form of intramedullary abscesses, cysts, arachnoiditis, myelitis, etc.

The course of the nervous form is usually undulating, often severe, the mortality rate reaches 30% and higher, in approximately 7% of cases there are relapses. Recovery occurs slowly, after months. Listeriosis 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, and hepatosplenomegaly. Large-spotted rash may appear, mainly around large joints; on the face, the rash may have a "butterfly" appearance. Hepatitis with jaundice often occurs, polyserositis and pneumonia are possible. The hemogram shows anemia and thrombocytopenia. The development of the septic form is sometimes gradual or subacute, the first signs of the disease in these cases are either catarrhal (sore throat, sore eyes) or dyspeptic symptoms (nausea, vomiting, bowel disorders). The septic form of listeriosis is more often found in newborns, individuals with severe immunodeficiency, in patients with liver cirrhosis, and chronic alcoholism. Mortality reaches 60%. The cause of death may be ISS, massive bleeding due to the development of DIC syndrome, acute respiratory failure (ARF) and ARF.

In all the above-described forms of listeriosis, leukocytosis (up to hyperleukocytosis), a shift of band cells to the left, and in some cases monocytosis are observed in the blood.

Rare forms of listeriosis have also been described: endocarditis, dermatitis, arthritis, osteomyelitis, abscesses of various organs, mumps, urethritis, prostatitis, etc.

Listeriosis hepatitis is possible in the septic form, in some cases it is accompanied by jaundice. It is extremely rare that hepatitis with pronounced hyperfermentemia, signs of hepatocellular insufficiency, symptoms of acute hepatic encephalopathy dominates in the clinical picture of listeriosis.

Manifest forms of listeriosis develop in no more than 20% of those infected; the rest develop either transient (more common) or chronic (less common) asymptomatic carriage of bacteria, which is detected only through special laboratory tests.

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Listeriosis in pregnant women

The decrease in cellular immunity that naturally occurs during pregnancy causes increased susceptibility to listeriosis. In the United States, listeriosis in pregnant women accounts for more than a quarter of all cases of this infection and more than half of cases in people aged 10-40 years. Pregnant women are believed to be 10-20 times more susceptible to listeriosis than other women.

Listeriosis can develop at any stage of pregnancy, although most cases occur in the second half. Listeriosis in pregnant women is either completely asymptomatic or mild, with vague polymorphic symptoms of listeriosis, so the correct diagnosis is often established retrospectively, after the death of the fetus or newborn. Pregnant women may experience short-term fever, muscle pain, catarrhal symptoms of the upper respiratory tract, conjunctivitis. Some patients have symptoms of gastroenteritis, while others have inflammation of the urinary tract. Nervous system damage in pregnant women is extremely rare.

Maternal listeriosis can lead to transplacental infection of the fetus, and the development of intrauterine infection can be quite intense, due to which the sick mother and fetus "exchange" the infection: first the mother infects the fetus, then it re-infects the mother, causing a secondary wave of the disease in the form of fever of unknown etiology. This 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 termination of pregnancy; fever usually does not recur subsequently.

Acute and chronic listeriosis of pregnant women can be the cause of severe obstetric pathology: early termination of pregnancy at different times, habitual miscarriage, fetal malformations, intrauterine death, etc. The pathogen can persist in the woman's body for quite a long time, in particular in the kidneys, and become active during pregnancy, against the background of reduced immunity. Screening studies have shown that 16-17% of women who have suffered from urogenital diseases isolate listeria. Almost all women who have developed listeriosis had a "rich" obstetric and gynecological history: cervical erosion, adnexitis, artificial and spontaneous abortions, etc.

Listeriosis in newborns

Listeriosis of newborns is a severe generalized disease with high mortality (up to 50%), occurring as sepsis. The share of listeriosis in perinatal mortality reaches 25%. The timing of occurrence and clinical manifestations of listeriosis of newborns depend on the time and route of infection (antenatal or intranatal, transplacental or aerosol infection).

In case of transplacental infection of the fetus, if there was no intrauterine death, a child with congenital listeriosis is usually born prematurely, with reduced body weight. After a few hours, sometimes after 1-2 days, his condition deteriorates sharply: body temperature rises, characteristic papular, sometimes hemorrhagic exanthema appears, anxiety, dyspnea, cyanosis, convulsions occur and in most cases death occurs, the cause of which can be intractable RDS, pneumonia, purulent pleurisy, hepatitis, meningoencephalitis. damage to other organs, intrauterine sepsis. In case of intranatal infection, which occurs during the passage of the fetus through the infected birth canal of the mother, the child looks healthy after birth, symptoms of listeriosis in the form of sepsis occur after 7 days of the child's life. Aspiration of infected amniotic fluid by the fetus 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 as meningitis with a mortality rate of up to 25%. This form is most typical for outbreaks of listeriosis in maternity hospitals.