The seasonality, steroid use, and lower ratio of neutrophil to lymphocyte associated with bacteremia of Listeria monocytogenes in Japan from 2010 to 2019: a case-control study

Risk factors associated with early mortality after recovery from severe listeriosis: a multicentre 17-year longitudinal study

BACKGROUND

Listeriosis presents high rates of mortality but prognostic factors for early prevention are not well established. The aim of this study was to analyse factors associated with in-hospital and early mortality of adults after recovery from severe infection caused by Listeria monocytogenes.

METHODS

All cases of listeriosis notified in the province of Granada from January 2005 to December 2021, including 9 centres, were included. Only laboratory confirmed non-neonatal cases were considered. Follow-up was conducted by accessing medical records and epidemiological data. Bivariate and multivariate analyses were conducted to detect potential risk factors associated to in-hospital mortality, 1-year, and 5-year early death after recovery. Multivariate Cox regression models were performed. A total of 206 patients were identified.

RESULTS

The mean age was 62.6 years (sd, 18.8). A high frequency of comorbidities (88.3%) was observed, and 42 patients (20.4%) died during hospitalisation. Of the patients who recovered from acute infection, 26 (15.9%) died during the following year and 47 (28.7%) died during the following 5 years. The main factors associated with early mortality after recovery were age (HR: 1.03; 95% CI 1.02-1.07), diabetes mellitus (HR 1.86, 95% CI 1.01-3.44), chronic kidney disease (HR 3.96, 95% CI 1.87-8.38), liver disease (HR 3.62, 95% CI 1.64-8.51), and cancer (HR 3.76, 95% CI 1.90-7.46).

CONCLUSION

Listeriosis is associated with high early post-recovery mortality. Our study describes the main prognostic factors, which may help to improve preventive follow-up strategies of adults with severe listeriosis.

Nonhemolytic Listeria monocytogenes-Prevalence Rate, Reasons Underlying Atypical Phenotype, and Methods for Accurate Hemolysis Assessment

Listeria monocytogenes is a foodborne pathogen that typically presents β-hemolytic activity. However, there are literature reports indicating that L. monocytogenes strains are sometimes nonhemolytic or their zones of hemolysis are perceivable only after removal of the colonies from the agar plate. Nonhemolytic L. monocytogenes are most commonly encountered in food products, but some have also been detected in clinical samples. Usually, atypical bacteria of this species belong to serotype 1/2a. Mutations of the prfA gene sequence are the most common reason for changed phenotype, and mutations of the hly gene are the second most common cause. There are also reports that the methodology used for detecting hemolysis may influence the results. Sheep or horse blood, although most commonly used in modern studies, may not allow for the production of clear hemolytic zones on blood agar, whereas other types of blood (guinea pig, rabbit, piglet, and human) are more suitable according to some studies. Furthermore, the standard blood agar plate technique is less sensitive than its modifications such as bilayer or top-layer (overlay) techniques. The microplate technique (employing erythrocyte suspensions) is probably the most informative when assessing listerial hemolysis and is the least susceptible to subjective interpretation.