infeksi listeria presentasi infeksi.pptx

Listeria infection

1. Listeriosis

2. Etiology Listeria monocytogenes  is a facultatively anaerobic, rod-shaped, gram-positive bacterium. It can be readily isolated in standard bacterial culture of normally sterile body sites. It is widespread in the environment and can be isolated from soil, water, and decaying vegetation. Serotyping differentiates isolates of  Listeria  below the species level.  Listeria  serotypes are designated based on the immunoreactivity of two cell surface structures, the O and H antigens. Twelve serotypes of  L. monocytogenes  (1/2a, 1/2b, 1/2c, 3a, 3b, 3c, 4a, 4b, 4c, 4d, 4e, and 7) are recognized, three of which (1/2a, 1/2b, and 4b) cause most (95%) human illness; serotype 4b is most commonly associated with outbreaks.

3. Who is at risk Older adults, people with weakened immune systems, and pregnant people and their newborns are at highest risk of listeriosis. Otherwise healthy young people only rarely develop invasive listeriosis.

4. How it spreads Listeriosis is usually acquired through foodborne transmission, except for fetal and neonatal infection, which is usually acquired  in utero . Cutaneous infections have been reported very rarely among veterinarians and farmers following direct animal contact. Many of these cases have involved particularly livestock products of conception.

5. Incidence The annual incidence of laboratory-confirmed listeriosis in the United States is about 0.24 cases per 100,000 population, based on active surveillance in 10  FoodNet  sites. The  U.S. Healthy People 2020  target for listeriosis is 0.2 cases per 100,000. Approximately 800 laboratory-confirmed cases are reported annually to CDC's  National Notifiable Disease Surveillance System . However, many cases are not detected or reported, and CDC's  2011 Estimates of Foodborne Illness , which includes estimates of cases not diagnosed or reported, indicates that approximately 1,600 cases occur annually in the United States

6. Mortality rates CDC estimates that listeriosis is the third leading cause of death from foodborne illness with about 260 deaths per year. Nearly everyone with listeriosis is hospitalized. The case-fatality rate is about 20%. Nearly 25% of pregnancy-associated cases result in fetal loss or death of the newborn.

7. Clinical features The clinical features of listeriosis depend on the patient. In older adults and people with immunocompromising conditions, the most common clinical presentations are invasive infections, such as sepsis, meningitis, and meningoencephalitis. People can also experience focal infections, including septic arthritis, osteomyelitis, prosthetic graft infections, and infections of sites inside the chest and abdomen or of the skin and eye. Less commonly, otherwise healthy young people may also develop invasive listeriosis. Listeriosis during pregnancy is typically a relatively mild "flu-like" illness. Some pregnant people with  Listeria  infection have no symptoms. Although severe disease in the pregnant person is rare, infection during pregnancy can result in miscarriage, stillbirth, preterm labor, and sepsis or meningitis in the neonate. Some neonates with listeriosis develop granulomatosis infantiseptica , a severe disorder involving the internal organs and skin. Neonatal listeriosis is classified as early (within 6 days of birth) or late onset (7­–28 days after birth). Early-onset neonatal listeriosis is usually acquired through transplacental transmission. The sources of late-onset listeriosis are less clear; they may involve exposure during delivery or nosocomial exposure. People with normal immune systems rarely develop invasive infection. However, they may experience a self-limited acute febrile gastroenteritis following high-dose  Listeria  exposure. Because  Listeria  cannot be detected by routine stool culture, febrile gastroenteritis from  Listeria  infection is rarely diagnosed outside of outbreak settings.

8. Patient management This page presents a framework for assessment and medical treatment of high-risk people (pregnant women, older adults, and people with weakened immune systems) who may have been exposed to  L. monocytogenes  by eating contaminated foods. The risk of invasive listeriosis after exposure to  L. monocytogenes  is very low. Exposure is common, but disease is rare. A  study related to a 2011 outbreak  linked to cantaloupe estimated the attack rate at roughly 1 case per 10,000 pregnant persons who ate the implicated cantaloupe.

9. In the United States, efforts have been aimed at the prevention of listeriosis, including reducing listeria contamination of ready-to-eat foods, such as processed meats; proper food preparation and storage; and general food safety, hygiene, and sanitation, with information on safe practices found at  www.cdc.gov/listeria/prevention.html   12 . In addition, women have been advised to avoid high-risk foods during pregnancy  Box 1 . Although recommendations exist for treating pregnant women with listeriosis  10   13   14 , few guidelines exist for management of cases of possible exposure in pregnancy. High-profile listeriosis outbreaks, such as the multistate outbreak in the fall of 2011 and the resultant publicized recall of cantaloupes grown on a single farm, highlight the need for such guidance  15 .

10. Foods With a High Risk of Contamination With Listeria Pregnant women should avoid eating the following foods: Hot dogs, lunch meats, cold cuts (when served chilled or at room temperature; heat to internal temperature of 74°C [165°F] or steaming hot) Refrigerated pâté and meat spreads Refrigerated smoked seafood Raw (unpasteurized) milk Unpasteurized soft cheeses such as feta, queso blanco , queso fresco, Brie, queso panela, Camembert, and blue-veined cheeses Unwashed raw produce such as fruits and vegetables (when eating raw fruits and vegetables, skin should be washed thoroughly in running tap water, even if it will be peeled or cut)