The majorhuman pathogen in the genus isL. monocytogenes. AlthoughL. monocytogenes has low infectivity, it is hardy and can grow in a refrigerator temperature of 4 °C (39.2 °F) up to the human body temperature of 37 °C (98.6 °F).[5] It is the usual cause of the relatively rare bacterial diseaselisteriosis, aninfection caused by eatingfood contaminated with the bacteria. The overt form of the disease has acase-fatality rate of around 20–30%. Listeriosis can cause serious illness inpregnant women,newborns, adults withweakened immune systems and theelderly, and may causegastroenteritis in others who have been severely infected. The incubation period can vary from three to 70 days.[6] The two main clinical manifestations aresepsis andmeningitis, often complicated byencephalitis, a pathology unusual for bacterial infections.
In the late 1920s, two groups of researchers independently identifiedL. monocytogenes from animal outbreaks, naming itBacterium monocytogenes.[8][9] They proposed the genusListerella in honour of surgeon and early antiseptic advocateJoseph Lister, but that name was already in use for aslime mould and aprotozoan. Eventually, the genusListeria was proposed and accepted. The genusListeria was classified in the family Corynebacteriaceae through the seventh edition (1957) ofBergey's Manual of Systematic Bacteriology.16S rRNA cataloging studies demonstrated thatL. monocytogenes is a distinct taxon within theLactobacillus-Bacillus branch of the bacterial phylogeny[10] constructed by Woese. In 2004 the genus was placed in the newly created familyListeriaceae, of which the only other genus in the family isBrochothrix.[11][12] The first documented human case of listeriosis was in 1929, described by the Danish physician Aage Nyfeldt.[13]
All species within the genusListeria aregram-positive,catalase-positiverods and do not produceendospores. Under the microscope,Listeria species appear as small rods, sometimes arranged in short chains. In direct smears, they may becoccoid, and can be mistaken forstreptococci. Longer cells may resemblecorynebacteria.Flagella are produced at room temperature, but not at 37 °C. Hemolytic activity on blood agar has been used as a marker to distinguishL. monocytogenes from otherListeria species, but it is not a definitive criterion. Further biochemical characterization may be necessary to distinguish between the different species ofListeria.[citation needed]
Listeria monocytogenes is commonly found in soil, stream water, sewage, plants, and food.[5] Listeria in soil can contaminate vegetables, and animals can be carriers. It has been found in uncooked meats, uncooked vegetables, fruits includingcantaloupe[14] and apples,[15] pasteurized orunpasteurized milk and milk products, and processed foods. Pasteurization and sufficient cooking killListeria; however, contamination may occur after cooking and before packaging. For example, meat-processing plants producing ready-to-eat foods, such as hot dogs and deli meats, must follow extensive sanitation policies and procedures to preventListeria contamination.[16]
Listeria is responsible for listeriosis, a rare but potentially lethalfoodborne illness. The case fatality rate for those with a severe form of infection may approach 25%.[41] (Salmonellosis, in comparison, has a mortality rate estimated at less than 1%.[42]) AlthoughL. monocytogenes has low infectivity, it is hardy and can grow in temperatures from a refrigerator temperature of 4 °C (39.2 °F) up to the human body temperature of 37 °C (98.6 °F).[5] Listeriosis may manifest as meningitis, and can affect newborns due to its ability to penetrate the endothelial layer of theplacenta.[41]
Listeria uses the cellular machinery to move around inside the host cell. It induces directed polymerization ofactin by theActAtransmembrane protein, thus pushing the bacterial cell around.[43]
Listeria monocytogenes, for example, encodes virulence genes that arethermoregulated. The expression of virulence factor is optimal at 39 °C, and is controlled by a transcriptional activator, PrfA, whose expression is thermoregulated by thePrfA thermoregulator UTR element. At low temperatures, the PrfA transcript is not translated due tostructural elements near the ribosome binding site. As the bacteria infect the host, the temperature of the host denatures the structure and allows translation initiation for the virulence genes.[citation needed]
The majority ofListeria bacteria are attacked by theimmune system before they are able to causeinfection. Those that escape the immune system's initial response, however, spread through intracellular mechanisms, which protects them from circulating immune factors (AMI).[41]
To invade,Listeria induces macrophagephagocytic uptake by displaying D-galactose in theirteichoic acids that are then bound by themacrophage'spolysaccharides. Other important adhesins are theinternalins.[42]Listeria uses internalin A and B to bind to cellular receptors. Internalin A binds to E-cadherin, while internalin B binds to the cell's Met receptors. If both of these receptors have a high enough affinity toListeria's internalin A and B, then it will be able to invade the cell via an indirect zipper mechanism.[citation needed] Once phagocytosed, the bacterium is encapsulated by the host cell's acidicphagolysosome organelle.[5]Listeria, however, escapes the phagolysosome by lysing the vacuole's entire membrane with secretedhemolysin,[44] now characterized as the exotoxinlisteriolysin O.[5] The bacteria then replicate inside the host cell's cytoplasm.[41]
Listeria must then navigate to the cell's periphery to spread the infection to other cells. Outside the body,Listeria hasflagellar-driven motility, sometimes described as a "tumbling motility". However, at 37 °C, flagella cease to develop and the bacterium instead usurps the host cell'scytoskeleton to move.[41] Inventively,Listeria polymerizes an actin tail or "comet",[44] from actin monomers in the host's cytoplasm[45] with the promotion of virulence factor ActA.[41] The comet forms in a polar manner[46] and aids the bacterial migration to the host cell's outer membrane. Gelsolin, an actin filament severing protein, localizes at the tail ofListeria and accelerates the bacterium's motility.[46] Once at the cell surface, the actin-propelledListeria pushes against the cell's membrane to form protrusions calledfilopods[5] or "rockets". The protrusions are guided by the cell's leading edge[47] to contact adjacent cells, which then engulf theListeria rocket and the process is repeated, perpetuating the infection.[41] Once phagocytosed, the bacterium is never again extracellular: it is anintracellular parasite[44] likeS. flexneri,Rickettsia spp., andC. trachomatis.[41]
Some of the foods most commonly implicated inListeria contaminations include ready-to-eat salads and seafood, deli meats, soft and semi-soft cheese, and frozen vegetables.[48]
Cold-cut meats were implicated in anoutbreak in Canada in 2008 and a widespread one the US in 2024.[49] Improperly handled cantaloupe was implicated in both theoutbreak of listeriosis from Jensen Farms in Colorado in 2011,[50] and a similar listeriosis outbreak across eastern Australia in early 2018.[51][52] 35 people died across these two outbreaks.[50][53] The Australian company GMI Food Wholesalers was finedA$236,000 for providingL. monocytogenes-contaminatedchicken wraps to the airlineVirgin Blue in 2011.[54] Caramel apples have also been cited as a source of listerial infections which hospitalized 26 people, of whom five died.[55][56]
In 2019, theUnited Kingdom experienced nine cases of the disease, of which six[57] were fatal, in an outbreak caused by contaminated meat (produced by North Country Cooked Meats) in hospital sandwiches.[58] In 2019, two people in Australia died after probably eating smoked salmon and a third fell ill but survived the disease.[59] In September 2019, three deaths and a miscarriage were reported in the Netherlands after the consumption of listeria-infected deli meats produced by Offerman.[60]
Preventing listeriosis as afoodborne illness requires effective sanitation of food contact surfaces.[61]Ethanol is an effective topical sanitizer againstListeria.Quaternary ammonium can be used in conjunction with alcohol as a food-contact safe sanitizer with increased duration of the sanitizing action.
Keeping foods in the home refrigerated below 4 °C (39 °F) discourages bacterial growth. Unpasteurized dairy products may pose a risk.[62] Heating of meats (including beef, pork, poultry, and seafood) to a sufficient internal temperature, typically 74 °C (165 °F), will kill the food-borne pathogen.[63]
Non-invasive listeriosis: bacteria are retained within the digestive tract. Symptoms are mild, lasting only a few days and requiring only supportive care. Muscle pain and fever can be treated with over-the-counter pain relievers; diarrhea and gastroenteritis can be treated with over-the-counter medications.[64]
Invasive listeriosis: bacteria have spread to the bloodstream and central nervous system. Treatment includes intravenous delivery of high-doseantibiotics and hospital in-patient care of (probably) not less than two weeks stay, depending on the extent of the infection.[64]Ampicillin,penicillin, oramoxicillin are typically administered for invasive listeriosis;gentamicin may be added in cases of patients with compromised immune systems.[65] In cases of allergy to penicillin,trimethoprim-sulfamethoxazole,vancomycin, andfluoroquinolones may be used.[65] For effective treatment the antibiotic must penetrate the host cell and bind topenicillin-binding protein 3 (PBP3).Cephalosporins are not effective for treating listeriosis.[65]
In cases of pregnancy, prompt treatment is critical to prevent bacteria from infecting thefetus; antibiotics may be given to pregnant women even in non-invasive listeriosis.[66] Mirena Nikolova,et al., states that applying antibiotics is crucial during the third trimester because cell-mediated immunity is reduced during this time. Pfaff and Tillet say that listeriosis can cause long-term consequences—including meningitis, preterm labor, newborn sepsis, stillbirths—when contracted during pregnancy. Oral therapies in less severe cases may include amoxicillin orerythromycin.[65] Higher doses may be given to pregnant women to ensure penetration of theumbilical cord andplacenta.[67] Infected pregnant women may receiveultrasound scans to monitor the health of the fetus.
Asymptomatic patients who have been exposed toListeria typically are not treated, but are informed of the signs and symptoms of the disease and advised to return for treatment if any develop.[64]
SomeListeria species are opportunistic pathogens:L. monocytogenes is most prevalent in the elderly, pregnant mothers, and patients infected with HIV. With improved healthcare leading to a growing elderly population and extended life expectancies for HIV infected patients, physicians are more likely to encounter this otherwise-rare infection (only seven per 1,000,000 healthy people are infected with virulentListeria each year).[5] Better understanding the cell biology ofListeria infections, including relevant virulence factors, may lead to better treatments for listeriosis and other intracytoplasmic parasite infections.
In oncology, researchers are investigating the use ofListeria as a cancer vaccine, taking advantage of its "ability to induce potent innate and adaptive immunity" by activatinggamma delta T cells.[45][68]
Researchers have also been investigating the continuous presence ofListeria in food processing plants. The bacteria’s presence has been partially attributed to the formation ofbiofilms.[69] This increases the likelihood of food contamination and is further complicated by the fact that biofilms are highly resistant to many disinfectants.[70] The detection of these biofilms was made much easier through the use of quantitative techniques such as plate counting and crystalline violet staining. Although the structures and components of these biofilms have been extensively studied, how they are formed at the molecular level remains a subject of contention. This uncertainty surrounding their formation complicates any methods to completely eradicate the biofilms. However, it has been observed that certain antimicrobial agents such as bacteriophages and enzymes have made promising progress in the effort to eradicate theListeria biofilm. The enzymes specifically have been noted to have the capability to disrupt specific chemical components of the biofilms, degrading them in the process. More research and development is needed to make these biofilm elimination processes more affordable and efficient to be used on a larger scale. In another study, scientists isolated a strain ofLactobacillus plantarum that was able to completely eradicateListeria from a sample of sauerkraut.[71]
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