Guidelines for Listeriosis Infection Management in Canada

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Title: Guidelines for Listeriosis Infection Management in Canada
URL: http://www.pslgroup.com/dg/22BE92.htm
Doctor's Guide
September 11, 2008

NEW YORK -- September 11, 2008 -- With the current outbreaks of listeriosis in Canada connected to deli meats and cheese, the Canadian Medical Association Journal is releasing guidelines for healthcare professionals about symptoms, who is at risk, symptom management, and how to reduce the risk of listeriosis.

The information is based on a MEDLINE search on listeriosis and discussion

with experts.

Initial symptoms of infection include nonspecific flu-like symptoms, nausea, vomiting, cramps, diarrhoea, and fever. There are few clinical features that are unique to listeriosis. Therefore, clinicians must consider a variety of potential causes for infection, including viral and other bacterial infections that may cause sepsis or meningitis. Symptoms can develop at any time from 2 to 70 days after eating contaminated food.

In people with healthy immune systems, listeriosis usually resolves without treatment after a flu-like illness. However, pregnant women are 20 times more likely than healthy adults to contract listeriosis and risk passing it on to their babies, which can result in miscarriage or infant death. The elderly and people with cancer, diabetes, kidney disease, AIDS/HIV, and other illnesses that weaken immune systems are high-risk groups for contracting listeriosis.

Early diagnosis and treatment of listeriosis in high-risk patients is critical, since the outcome of untreated infection can be devastating. This is especially true for pregnant women because of the increased risk of spontaneous abortion and preterm delivery.

According to the guidelines, people at high risk of contracting listeriosis include:

Pregnant women

• The risk of listeriosis is about 20 times higher among pregnant women than among nonpregnant healthy adults

• Pregnant women with listeriosis are at increased risk of spontaneous abortion, preterm delivery, or stillbirth

Newborns

• Newborns are at greater risk of the serious effects of infection

• Early-onset listeriosis (<7 days) is typically diagnosed within the first 24 hours of life and is usually transmitted from the mother transplacentally

• Late-onset neonatal listeriosis (>=7 days) is less common; the mode of acquisition is poorly understood, but in most cases there is no history of maternal infection

• Mortality among infected newborns is high (50%)

Elderly people (age ≥60 yr)

• About 50% of cases occur in this age group

Immunocompromised people

• People with cancer, diabetes, or kidney disease

• People with HIV/AIDS: listeriosis is up to 300 times more likely to occur in this group than in healthy adults

• Patients receiving immunosuppressive drug therapy

• Transplant patients receiving antirejection drug therapy

The complete guideline can be viewed here:

http://www.cmaj.ca/cgi/rapidpdf/cmaj.081377v1

SOURCE: Canadian Medical Association Journal

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