Effect of prevention measures on incidence of human listeriosis, France, 1987-1997

Molecular Characterization of Listeria monocytogenes in the Food Chain of the Republic of Kosovo from 2016 to 2022

The present study describes the genetic characterization of L. monocytogenes strains found in the Republic of Kosovo's food chain. From 2016 to 2022, 995 samples were collected. Overall, 648 samples were from ready-to-eat (RTE) food products, 281 from food products consumed cooked (FPCC), 60 from raw materials, and 6 from environmental samples. Overall, 11.76% (117 out of 995) of the samples were contaminated by L. monocytogenes, comprising 6.33% (41 out of 648) from RTE products, 14.95% (42 out of 281) from FPCC, 55.00% (33 out of 60) from raw materials, and 16.66% (1 out of 6) from environmental samples. All isolates were subjected to molecular serotyping and clonal complex (CC) identification by using real-time PCR, as well as multilocus sequence typing. All isolates were grouped into four molecular serotypes, IIa (34.19%), IIb (3.48%), IIc (32.48%), and IVb (29.91%), as well as Lineage I (33.33%) and Lineage II (66.66%). In total, 14 CCs were identified from 41 RTE isolates; however, CC29 (7), CC2 (6), and CC6 (6) were the most dominant. By contrast, CC9 was by far the most represented CC in both FPCC (21) and RM (14). Moreover, 30 isolates expressed CC1, CC2, CC4, or CC6, which are particularly associated with severe human infections.

Clinical Findings of Listeria monocytogenes Infections with a Special Focus on Bone Localizations

Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the microorganism can occur after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described in the past. L. monocytogenes can cause a number of different clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. L. monocytogenes systemic infections can develop following tissue penetration across the gastrointestinal tract or to hematogenous spread to sterile sites, possibly evolving towards bacteremia. L. monocytogenes only rarely causes bone or joint infections, usually in the context of prosthetic material that can provide a site for bacterial seeding. We describe here the clinical findings of invasive listeriosis, mainly focusing on the diagnosis, clinical management, and treatment of bone and vertebral infections occurring in the context of invasive listeriosis.

Human Listeriosis

Listeria monocytogenes is a Gram-positive facultative intracellular pathogen that can cause severe invasive infections upon ingestion with contaminated food. Clinically, listerial disease, or listeriosis, most often presents as bacteremia, meningitis or meningoencephalitis, and pregnancy-associated infections manifesting as miscarriage or neonatal sepsis. Invasive listeriosis is life-threatening and a main cause of foodborne illness leading to hospital admissions in Western countries. Sources of contamination can be identified through international surveillance systems for foodborne bacteria and strains' genetic data sharing. Large-scale whole genome studies have increased our knowledge on the diversity and evolution of L. monocytogenes, while recent pathophysiological investigations have improved our mechanistic understanding of listeriosis. In this article, we present an overview of human listeriosis with particular focus on relevant features of the causative bacterium, epidemiology, risk groups, pathogenesis, clinical manifestations, and treatment and prevention.

Quantitative risk assessment model to investigate the public health impact of varying Listeria monocytogenes allowable levels in different food commodities: A retrospective analysis

Invasive listeriosis is a potentially fatal foodborne disease that according to this study may affect up to 32.9 % of the US population considered as increased risk and including people with underlying conditions and co-morbidities. Listeria monocytogenes has been scrutinized in research and surveillance programs worldwide in Ready-to-Eat (RTE) food commodities (RTE salads, deli meats, soft/semi-soft cheese, seafood) and frozen vegetables in the last 30 years with an estimated overall prevalence of 1.4-9.9 % worldwide (WD) and 0.5-3.8 % in the United States (US). Current L. monocytogenes control efforts have led to a prevalence reduction in the last 5 years of 4.9-62.9 % (WD) and 12.4-92.7 % (US). A quantitative risk assessment model was developed, estimating the probability of infection in the US susceptible population to be 10-10,000× higher than general population and the total number of estimated cases in the US was 1044 and 2089 cases by using the FAO/WHO and Pouillot dose-response models. Most cases were attributed to deli meats (>90 % of cases) followed by RTE salads (3.9-4.5 %), soft and semi-soft cheese and RTE seafood (0.5-1.0 %) and frozen vegetables (0.2-0.3 %). Cases attributed to the increased risk population corresponded to 96.6-98.0 % of the total cases with the highly susceptible population responsible for 46.9-80.1 % of the cases. Removing product lots with a concentration higher than 1 CFU/g reduced the prevalence of contamination by 15.7-88.3 % and number of cases by 55.9-100 %. Introducing lot-by-lot testing and defining allowable quantitative regulatory limits for low-risk RTE commodities may reduce the public health impact of L. monocytogenes and improve the availability of enumeration data.

Listeria-Associated Lymphadenitis: A Series of 11 Consecutive Cases and Review of the Literature

We studied 11 cases of culture-proven Listeria-associated lymphadenitis reported to the French National Reference Center for Listeria from 1994 to 2019 and 8 additional published cases. Listeria-associated lymphadenitis is rare, but it is associated with a mortality as high as for invasive listeriosis, and it is frequently diagnosed with concomitant neoplasia.

A fluorescence immunoassay for a rapid detection of Listeria monocytogenes on working surfaces

Listeria monocytogenes is a foodborne pathogen responsible for human listeriosis. The increasing incidence of listeriosis induced governments and food manufacturing enterprises to act to diminish the problem. Several methods for the detection of Listeria monocytogenes in food industries were developed. However, they are time-consuming and require the use of specialized equipment. To reduce the detection time of Listeria monocytogenes in food, in this work we developed a fluorescence sandwich immunoassay based on the use of an innovative chitosan-cellulose nanocrystal (CNC) membrane that improves the antigen capture during bacterial growth. The combined use of CNC film for the capture of p60 protein-specific antigen together with the use of fluorescence detection reduced the time of analysis from 24 to 12 h with a limit of detection (LOD) of the assay of 10² CFU/mL (2 Log). In addition, the use of monoclonal anti-PepD covalently immobilized to a CNC membrane assured a high specificity of the assay. Interestingly, the obtained results show no cross-reactivity with the five most diffused pathogen bacteria strains tested.

Maternal-neonatal listeriosis

Listeriosis is a rare and severe foodborne infection caused by Listeria monocytogenes. It manifests as septicemia, neurolisteriosis, and maternal-fetal infection. In pregnancy, it may cause maternal fever, premature delivery, fetal loss, neonatal systemic and central nervous system infections. Maternal listeriosis is mostly reported during the 2nd and 3rd trimester of pregnancy, as sporadic cases or in the context of outbreaks. Strains belonging to clonal complexes 1, 4 and 6, referred to as hypervirulent, are the most associated to maternal-neonatal infections. Here we review the clinical, pathophysiological, and microbiological features of maternal-neonatal listeriosis.

Epidemiology and Clinical Manifestations of Listeria monocytogenes Infection

Listeria monocytogenes is a Gram-positive pathogenic bacterium which can be found in soil or water. Infection with the organism can develop after ingestion of contaminated food products. Small and large outbreaks of listeriosis have been described. Listeria monocytogenes can cause a number of clinical syndromes, most frequently sepsis, meningitis, and rhombencephalitis, particularly in immunocompromised hosts. The latter syndrome mimics the veterinary infection in ruminants called "circling disease". Neonatal infection can occur as a result of maternal chorioamnionitis ("early onset" sepsis) or through passage through a birth canal colonized with Listeria from the gastrointestinal tract. ("late onset" meningitis). Treatment of listeriosis is usually with a combination of ampicillin and an aminoglycoside but other regimens have been used. The mortality rate is high, reflecting the combination of an immunocompromised host and an often delayed diagnosis.

Implicated Food Products for Listeriosis and Changes in Serovars of Listeria monocytogenes Affecting Humans in Recent Decades

Listeriosis is a foodborne disease with a high fatality rate, and infection is mostly transmitted through ready-to-eat (RTE) foods contaminated with Listeria monocytogenes, such as gravad/smoked fish, soft cheeses, and sliced processed delicatessen (deli) meat. Food products/dishes stored in vacuum or in modified atmospheres and with extended refrigerator shelf lives provide an opportunity for L. monocytogenes to multiply to large numbers toward the end of the shelf life. Elderly, pregnant women, neonates, and immunocompromised individuals are particularly susceptible to L. monocytogenes. Listeriosis in humans manifests primarily as septicemia, meningitis, encephalitis, gastrointestinal infection, and abortion. In the mid 1990s and early 2000s a shift from L. monocytogenes serovar 4b to serovar 1/2a causing human listeriosis occurred, and serovar 1/2a is becoming more frequently linked to outbreaks of listeriosis, particularly in Europe and Northern America. Consumer lifestyle has changed, and less time is available for food preparation. Modern lifestyle has markedly changed eating habits worldwide, with a consequent increased demand for RTE foods; therefore, more RTE and take away foods are consumed. There is a concern that many Listeria outbreaks are reported from hospitals. Therefore, it is vitally important that foods (especially cooked and chilled) delivered to hospitals and residential homes for senior citizens and elderly people are reheated to at least 72°C: cold food, such as turkey deli meat and cold-smoked and gravad salmon should be free from L. monocytogenes. Several countries have zero tolerance for RTE foods that support the growth of Listeria.

Listeria monocytogenes-associated respiratory infections: a study of 38 consecutive cases

OBJECTIVES

Listeria monocytogenes (Lm) is a foodborne human pathogen responsible for severe infections, including septicaemia, neurolisteriosis, and maternal-foetal and focal infections. Little is known about Lm-associated respiratory tract or lung infections.

METHODS

We conducted a retrospective study of culture-proven cases of Lm pleural infections and pneumonia reported to the French National Reference Centre for Listeria from January 1993 to August 2016.

RESULTS

Thirty-eight consecutive patients with pleural infection (n = 32), pneumonia (n = 5), or both (n = 1) were studied; 71% of these were men. Median age was 72 (range 29-90). Two patients presented with concomitant neurolisteriosis. All patients but one reported at least one immunosuppressive condition (97%), with a median number of 2 (range 0-5), including 29% (8/28) with current exposure to immunosuppressive therapy and 50% (17/34) with ongoing neoplasia; 75% (21/28) reported previous pleural or pulmonary disease. Antibiotic therapy mostly consisted in amoxicillin (72%) associated with aminoglycoside in 32%. Chest-tube drainage was performed in 7/19 patients with empyema (37%); 25% of the patients (7/30) required intensive care management. In-hospital mortality reached 35% and occurred after a median time interval of 4 days (range 1-33 days). Three patients had recurrence of empyema (time interval of 1 week to 4 months after treatment completion). Altogether, only 13/31 patients (42%) diagnosed with Lm respiratory infection experienced an uneventful outcome at 2-year follow-up.

CONCLUSION

Lm is a rare but severe cause of pneumonia and pleural infection in older immunocompromised patients, requiring prompt diagnosis and adequate management and follow-up.

Listeria monocytogenes-associated biliary tract infections: a study of 12 consecutive cases and review

At present, little is known regarding Listeria monocytogenes-associated biliary tract infection, a rare form of listeriosis.In this article, we will study 12 culture-proven cases reported to the French National Reference Center for Listeria from 1996 to 2013 and review the 8 previously published cases.Twenty cases were studied: 17 cholecystitis, 2 cholangitis, and 1 biliary cyst infection. Half were men with a median age of 69 years (32-85). Comorbidities were present in 80%, including cirrhosis, rheumatoid arthritis, and diabetes. Five patients received immunosuppressive therapy, including corticosteroids and anti-tumor necrosis factor biotherapies. Half were afebrile. Blood cultures were positive in 60% (3/5). Gallbladder histological lesions were analyzed in 3 patients and evidenced acute, chronic, or necrotic exacerbation of chronic infection. Genoserogroup of the 12 available strains were IVb (n=6), IIb (n=5), and IIa (n=1). Their survival in the bile was not enhanced when compared with isolates from other listeriosis cases. Adverse outcome was reported in 33% (5/15): 3 deaths, 1 recurrence; 75% of the patients with adverse outcome received inadequate antimicrobial therapy (P=0.033).Biliary tract listeriosis is a severe infection associated with high mortality in patients not treated with appropriate therapy. This study provides medical relevance to in vitro and animal studies that had shown Listeria monocytogenes ability to survive in bile and induce overt biliary infections.

Pregnancy-related listeriosis in France, 1984 to 2011, with a focus on 606 cases from 1999 to 2011

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[Listeriosis and pregnancy]

Listeria monocytogenes is a ubiquitous Gram-positive bacillus widespread in nature. It is responsible for febrile abortion and encephalitis in cattle. It survives and multiplies at 4°C and does not alter the taste of food. Listeria monocytogenes is able to cross 3 host barriers: the intestinal, blood-brain and placental barriers. Maternal infection is rare but still severe in France, with 30 to 50 annual cases. Maternal infection is frequently asymptomatic, or manifests as isolated fever, whereas fetal and neonatal infection is severe and have a poor prognosis, with up to 25-35 % fetal/neonatal mortality. Amoxicillin is the reference antibiotic for listeriosis treatment and should be administered to every pregnant patient with unexplained fever, particularly in case of consumption of at risk food. Prevention in pregnant women relies on adherence to strict diet recommendations such as reheating of leftovers until steaming and avoidance of unpasteurized dairy products, cold delicatessen, meat spreads and pâtés. Listeriosis is a notifiable disease in France.

Human isolates ofListeria monocytogenesin Sweden during half a century (1958–2010)

Isolates ofListeria monocytogenes(n = 932) isolated in Sweden during 1958–2010 from human patients with invasive listeriosis were characterized by serotyping and pulsed-field gel electrophoresis (PFGE) (AscI). Of the 932 isolates, 183 different PFGE types were identified, of which 83 were each represented by only one isolate. In all, 483 serovar 1/2a isolates were distributed over 114 PFGE types; 90 serovar 1/2b isolates gave 32 PFGE types; 21 serovar 1/2c isolates gave nine PFGE types; three serovar 3b isolates gave one PFGE type; and, 335 serovar 4b isolates gave 31 PFGE types. During the 1980s in Sweden, several serovar 4b cases were associated with the consumption of European raw soft cheese. However, as cheese-production hygiene has improved, the number of 4b cases has decreased. Since 1996, serovar 1/2a has been the dominantL. monocytogenesserovar in human listeriosis in Sweden. Therefore, based on current serovars and PFGE types, an association between human cases of listeriosis and the consumption of vacuum-packed gravad and cold-smoked salmon is suggested.

Listeria monocytogenes-associated joint and bone infections: a study of 43 consecutive cases

BACKGROUND

Little is known about Listeria monocytogenes-associated bone and joint infections. Only case reports of this infection have been published.

METHODS

Retrospective study of culture-proven bone and joint cases reported to the French National Reference Center for Listeria from 1992 to 2010.

RESULTS

Forty-three patients were studied: 61% were men, and the median age was 72 (range, 16-89); 24 patients exhibited comorbidities (56%). Thirty-six patients (84%) had orthopedic implant devices: prosthetic joints (n = 34) or internal fixation (n = 2); the median time after insertion was 9 years (0.1-22). Subacute infection was more frequent (median, 4 weeks [range, 2-100], 74%) than acute infection (<7 days, 23%), with nonspecific clinical features; 45% of patients had no fever. Blood cultures were positive in 3 of 19 cases. Isolate polymerase chain reaction genogrouping revealed 4 patterns: IVb (21 of 42, 50%), IIa (17 of 42, 40%), IIb (2 of 42, 5%), and IIc (2 of 42, 5%). Five groups of strains with similar pulsotype patterns were identified without an epidemiological link. Antibiotics, primarily amoxicillin (80%) with aminoglycosides (48%), were prescribed for a median duration of 15 weeks (range, 2-88). Eighteen patients (50%) underwent prosthesis replacement; all were successful after median follow-up of 10 months (range, 1-75). Five of 13 patients for whom material was not removed had protracted infection despite prolonged antibiotherapy; 3 of these patients later underwent prosthesis replacement with sustained recovery.

CONCLUSIONS

Osteoarticular listeriosis primarily involves prosthetic joints and occurs in immunocompromised patients. It requires intensive treatment with antibiotherapy and usually requires implant removal or replacement for cure.

Epidemiology of invasive Streptococcus pyogenes infections in France in 2007

Invasive group A streptococcal (GAS) infections cause significant morbidity and mortality. A national survey was initiated to assess the burden of invasive GAS infections in France, describe their clinical characteristics, and assess the molecular characteristics of GAS strains responsible for these infections. The survey was conducted in 194 hospitals, accounting for 51% of acute care hospital admissions in France. Clinical data, predisposing factors, and demographic data were obtained, and all GAS isolates were emm sequence typed. We identified 664 cases of invasive GAS infections, with an annual incidence of 3.1 per 100,000 population. The case-fatality ratio was 14% and rose to 43% in the case of streptococcal toxic shock syndrome. Bacteremia without identified focus (22%) and skin/soft tissue infections (30%) were the most frequent clinical presentations. Necrotizing fasciitis was frequent in adults (18%) and uncommon in children (3%). The 3 predominant emm types were emm1, emm89, and emm28, accounting for 33%, 16%, and 10% of GAS isolates, respectively. The emm1 type was associated with fatal outcomes and was more frequent in children than in adults. Six clusters of cases were identified, with each cluster involving 2 invasive cases due to GAS strains which shared identical GAS emm sequence types. Four clusters of cases involved eight postpartum infections, one family cluster involved a mother and child, and one cluster involved two patients in a nursing home. Invasive GAS infection is one of the most severe bacterial diseases in France, particularly in persons aged ≥ 50 years or when associated with toxic shock syndrome.

Isolation and characterization of Listeria monocytogenes and other Listeria species in foods of animal origin in Addis Ababa, Ethiopia

Listeriosis is a disease of humans and animals, in which it is one of the important emerging bacterial zoonotic diseases worldwide. Among the different species of the genus Listeria, Listeria monocytogenes (L. monocytogenes) is known to cause listeriosis in humans and animals with low incidence but high case fatality rate. Information on the occurrence and distribution of L. monocytogenes and other Listeria species is very limited both in the veterinary and public health sectors in Ethiopia. The objective of this study was to isolate and characterize L. monocytogenes and other Listeria species from foods of animal origin (cottage cheese, raw beef, raw milk and liquid whole egg) in Addis Ababa, Ethiopia. A total of 391 food samples of animal origin were collected randomly, using a cross-sectional study design from November 2008 to March 2009. L. monocytogenes isolation and characterization were performed according to mainly the United States Food and Drug Administration procedures. Of the samples examined, 102 (26.1%) were found to be positive for Listeria. Listeria species were isolated in 39 (51.3%), 37 (32.2%), 22 (22%) and 4 (4%) of the raw beef, liquid whole egg, raw milk and cottage cheese samples respectively. L. monocytogenes was detected in 5.4% of the samples analyzed. It was isolated mainly from raw milk (13%) and liquid whole egg (4.3%) followed by raw beef (2.6%) and cottage cheese (1%). In addition to L. monocytogenes, other Listeria species were identified as L. innocua (60.8%), L. welshimeri (6.9%), L. seeligeri (3.9%), L. murrayi (2.9%) and L. grayi (2.9%) and L. ivanovii (1.9%). It was shown that L. monocytogenes and other Listeria species are widely spread in occurrence in foods of animal origin in Addis Ababa, Ethiopia.

Listeriosis in Norway 1977–2003

In Europe, the incidence of invasive listeriosis has increased substantially during the last decades. We here present data from 289 listeriosis cases reported in Norway during the period 1977-2003, of which 12 cases were associated with 2 outbreaks and 39 cases were pregnancy-related. Medical records were obtained from 209 cases with listeriosis reported in 1977-2000. While the incidence of pregnancy-related listeriosis has remained stable at an average rate of 34 per million pregnant women per y during the period, the incidence of sporadic, non-pregnancy-related cases has increased from 1.1 to 3.7 per million per y. The present Norwegian incidence of reported cases is lower than in Denmark, but the case fatality rate is higher, indicating a possible under-reporting of mild listeriosis cases in Norway. We discuss how preventive measures, case identification and surveillance may have influenced listeriosis incidence in Norway.

Quantitative risk assessment of Listeria monocytogenes in French cold-smoked salmon: II. Risk characterization

A model for the assessment of exposure to Listeria monocytogenes from cold-smoked salmon consumption in France was presented in the first of this pair of articles (Pouillot et al., 2007, Risk Analysis, 27:683-700). In the present study, the exposure model output was combined with an internationally accepted hazard characterization model, adapted to the French situation, to assess the risk of invasive listeriosis from cold-smoked salmon consumption in France in a second-order Monte Carlo simulation framework. The annual number of cases of invasive listeriosis due to cold-smoked salmon consumption in France is estimated to be 307, with a very large credible interval ([10; 12,453]), reflecting data uncertainty. This uncertainty is mainly associated with the dose-response model. Despite the significant uncertainty associated with the predictions, this model provides a scientific base for risk managers and food business operators to manage the risk linked to cold-smoked salmon contaminated with L. monocytogenes. Under the modeling assumptions, risk would be efficiently reduced through a decrease in the prevalence of L. monocytogenes or better control of the last steps of the cold chain (shorter and/or colder storage during the consumer step), whereas reduction of the initial contamination levels of the contaminated products and improvement in the first steps of the cold chain do not seem to be promising strategies. An attempt to apply the recent risk-based concept of FSO (food safety objective) on this example underlines the ambiguity in practical implementation of the risk management metrics and the need for further elaboration on these concepts.

[These infectious diseases imported with food]

People are sometimes frightened by food scares and foodstuffs are increasingly suspected of containing dangerous substances or infectious agents, as a result of the unprecedented development of the industry and food trade in the world. Rightly or wrongly, imported food is held responsible for the greatest risks. Importing an infectious disease along with food can be a source of danger, involving multiple agents, mainly bacterial (Salmonella, Campylobacter, Verotoxin producing Escherichia coli, Listeria...), but also parasitic (Toxoplasma gondii, Cyclospora cayetanensis, Trichinella spp...), and viral (Norovirus, hepatitis A virus), as well as non conventional communicable agents and mycotoxins. Prevention of food risks means enforcing international regulations on the part of the 149 member states of the WTO, increasing vigilance with regard to illegal imports of food, systematically investigating collective food-borne outbreaks, and finally implementing controls according to the hazard analysis and critical control point (HACCP) method.

Increasing incidence of listeriosis in France and other European countries

From 1999 through 2005, the incidence of listeriosis in France declined from 4.5 to 3.5 cases/million persons. In 2006, it increased to 4.7 cases/million persons. Extensive epidemiologic investigations of clusters in France have ruled out the occurrence of large foodborne disease outbreaks. In addition, no increase has occurred in pregnancy-associated cases or among persons <60 years of age who have no underlying disease. Increases have occurred mainly among persons >or=60 years of age and appear to be most pronounced for persons >or=70 years of age. In 8 other European countries, the incidence of listeriosis has increased, or remained relatively high, since 2000. As in France, these increases cannot be attributed to foodborne outbreaks, and no increase has been observed in pregnancy-associated cases. European countries appear to be experiencing an increased incidence of listeriosis among persons >or=60 years of age. The cause of this selective increased incidence is unknown.

Human listeriosis and animal models

Human listeriosis is a potentially fatal foodborne infection caused by Listeria monocytogenes, an opportunistic psychrophile bacterium that is widespread in the environment. It has only recently emerged as a significant cause of human infection in industrialized countries, owing to appearance of a vulnerable population of immunocompromised individuals, and the concomitant development of large-scale agro-industrial plants and refrigerated food. Here we review the main clinical features of human listeriosis and highlight specificities and similarities with animal listeriosis in diverse species. Finally, we present some of the critical determinants for the choice of an appropriate animal model to study human listeriosis.

The epidemiology of human listeriosis

Listeriosis is a serious invasive disease that primarily afflicts pregnant women, neonates and immunocompromised adults. The causative organism, Listeria monocytogenes, is primarily transmitted to humans through contaminated foods. Outbreaks of listeriosis have been reported in North America, Europe and Japan. Soft cheeses made from raw milk and ready-to-eat meats are high risk foods for susceptible individuals. Efforts by food processors and food regulatory agencies to aggressively control L. monocytogenes in the high risk foods have resulted in significant decreases in the incidence of sporadic listeriosis.

Genetic diversity of Listeria monocytogenes recovered from infected persons and pork, seafood and dairy products on retail sale in France during 2000 and 2001

Growth of the food-borne human pathogen Listeria monocytogenes to large numbers in ready-to-eat food products greatly increases the risk of disease for susceptible consumers. A better knowledge of the population structure of L. monocytogenes present in retailed food could allow better prevention strategies to be developed. We present the analysis of 450 L. monocytogenes isolates, 179 responsible for sporadic human cases of listeriosis and 271 isolated from foods collected from retailers. All isolates were investigated by multiplex PCR (food isolates), allowing serovar predictions, or serotyped (human isolates), and DNA macrorestriction patterns were determined. Isolates from different sources were significantly differently distributed into PCR groups. PCR group IIa, corresponding to serovars 1/2a and 3a, was predominant in food isolates (58%; OR=3.19; P<1 x 10(-7)). A larger proportion of human isolates belonged to PCR group IVb, corresponding to serovars 4b, 4d and 4e (44%; OR=5.69; P<1 x 10(-7)). DNA macrorestriction pattern analysis of PCR group IIa isolates showed that isolates from pork products had a very low diversity (ID=0.905) whereas isolates from humans were more diverse (ID=0.976). Furthermore, 78% of the pork product isolates belonging to PCR group IIa exhibited only two AscI profiles, a(1) and a(2), which were very similar (94%). DNA array analysis of representative isolates showed that isolates with a(1) and a(2) profiles constitute a homogeneous population, whereas isolates exhibiting non a(1)-a(2) profiles are more diverse. Six of the isolates with a(1) and a(2) profiles were selected and investigated for their gene content using a DNA array. With respect to 295 strains present in our data collection, a specific pattern of the presence and absence of 15 genes was identified. Five are predicted to encode internalins and cell surface proteins, and eight of the genes were missing in this group. They code for cell surface proteins, transcriptional regulators, an acylase, a sugar phosphorylase and proteins of unknown functions. The ability of strains to multiply in different niches may be determined by the presence or absence of these genes.

Invasive Listeria monocytogenes infections in the Netherlands, 1995-2003

In order to add to the limited data available about the incidence of invasive Listeria monocytogenes infection in the Netherlands, two studies were conducted. In the first study, data on hospital patients with listeriosis in the period 1995-2003 were obtained from the National Medical Registration (study 1). In the second study, hospital discharge letters for patients whose Listeria isolates were received by the Netherlands Reference Laboratory for Bacterial Meningitis (NRLBM) in the period 1999-2003 were retrieved (study 2). Serotyping and pulsed-field gel electrophoresis (PFGE) were used to subtype the various strains of Listeria. These reviews revealed 283 hospital patients and 159 patients with Listeria isolates. Discharge letters were received for 107 (67%) patients. The mean annual incidence of listeriosis in both studies was 2.0 per million inhabitants. The main clinical manifestations were meningitis (incidence: 0.9 and 1.0 per million in studies 1 and 2, respectively) and septicaemia (incidence: 0.08 and 1.0 per million, respectively). Listeriosis in pregnancy was rare (incidence: 1.3 and 2.4 per 100,000 pregnancies over 24 weeks of gestation, respectively). Predisposing conditions were present in 47 and 71% of the patients in studies 1 and 2, respectively. The mortality due to listeriosis was 18%. Serotypes 4b, 1/2a, and 1/2b were responsible for 96% of the cases of human listeriosis. Listeriosis is rare in the Netherlands, but its clinical course is severe and the resulting mortality is high. Therefore, the current recommendations for pregnant women to avoid high-risk foods should be continued. These dietary recommendations should also be given to individuals with predisposing conditions, since they, too, are at risk of Listeria infection.

Listeria monocytogenes food monitoring data and incidence of human listeriosis in Hungary, 2004

Food samples were monitored for contamination with Listeria monocytogenes, and the incidence of human listeriosis was evaluated according to the data obtained in Hungary in the year 2004. Of the food samples tested, the bacterium was most often detectable in milk and dairy products, as 72.1% of all L. monocytogenes strains were isolated from these samples. The food samples most commonly yielded strains of serotype 1/2a (45.1%) and 4b (27.0%). In 2004, 3 perinatal and 14 nonperinatal human listeriosis cases were diagnosed in Hungary. These disease cases were most often caused by strains belonging to serotype 4b (52.8%) and serotype 1/2a (23.5%). On the basis of the antibiotic sensitivity test results of strains isolated from the disease cases, penicillin and aminoglycoside antibiotics or a combination thereof were found to be effective.

Stochastic, compartmental, and dynamic modeling of cross-contamination during mechanical smearing of cheeses

Cheese smearing is a complex process and the potential for cross-contamination with pathogenic or undesirable microorganisms is critical. During ripening, cheeses are salted and washed with brine to develop flavor and remove molds that could develop on the surfaces. Considering the potential for cross-contamination of this process in quantitative risk assessments could contribute to a better understanding of this phenomenon and, eventually, improve its control. The purpose of this article is to model the cross-contamination of smear-ripened cheeses due to the smearing operation under industrial conditions. A compartmental, dynamic, and stochastic model is proposed for mechanical brush smearing. This model has been developed to describe the exchange of microorganisms between compartments. Based on the analytical solution of the model equations and on experimental data collected with an industrial smearing machine, we assessed the values of the transfer parameters of the model. Monte Carlo simulations, using the distributions of transfer parameters, provide the final number of contaminated products in a batch and their final level of contamination for a given scenario taking into account the initial number of contaminated cheeses of the batch and their contaminant load. Based on analytical results, the model provides indicators for smearing efficiency and propensity of the process for cross-contamination. Unlike traditional approaches in mechanistic models, our approach captures the variability and uncertainty inherent in the process and the experimental data. More generally, this model could represent a generic base to use in modeling similar processes prone to cross-contamination.

Quantification of Listeria monocytogenes in salads by real time quantitative PCR

A real time quantitative PCR (RTQ-PCR) was carried out purifying DNA extracts of Listeria monocytogenes using a High Pure Listeria Sample Preparation Kit and quantifying in a LightCycler system with hybridisation probes. A standard curve was constructed with serial dilutions. A range linear relationship, from 10 to 10(5)L. monocytogenes colony forming units (CFU), was observed between threshold cycle (Ct) and logarithmic concentration of the serial dilutions. The assay was linear in a range from 10 to 10(5)L. monocytogenes CFU and the coefficient of determination (r2) was >0.98. RTQ-PCR presented an efficiency of >85%. The accuracy of the PCR-based assay, expressed as % bias, ranged from 9% to 26% and the precision, expressed as % CV, ranged 9-22%. Intraday and interday variabilities were studied at 10(2) CFU/g and resulted in 12% and 14%, respectively. The proposed RTQ-PCR method and classical cultural methods were applied to analyse 77 salads from restaurants in Valencia (Spain). All culture positive samples were also RTQ-PCR positive.

An outbreak of food-borne listeriosis due to cheese in Japan, during 2001

Food-borne outbreaks caused by Listeria monocytogenes have been recognized in US and European countries. Only sporadic cases, of neonatal listeriosis, have been reported in Japan. Since L. monocytogenes has been often isolated from foods in Japan, food-borne outbreaks potentially could have occurred. In February 2001, L. monocytogenes serotype 1/2b was isolated from a washed-type cheese during routine Listeria monitoring of 123 domestic cheeses. Further samples from products and the environments at the plant that produced the contaminated cheese were examined for L. monocytogenes. L. monocytogenes serotype 1/2b was detected in 15 cheese samples, at most probable number that ranged from <30 to 4.6 x 10(9)/100 g, and in environmental samples. Studies with people who had consumed cheese from the plant revealed 86 persons who had been infected with L. monocytogenes. Thirty-eight of those people had developed clinical symptoms of gastroenteritis or the common cold type after the consumption of cheese. Isolates from those patients exhibited the same serotype, pathogenicity for mice and HeLa cells, DNA fingerprinting patterns and PCR amplification patterns. From the epidemiological and genetic evidence, it appeared that the outbreak was caused by cheese. This is the first documented incidence of food-borne listeriosis in Japan.

[Emergent infectious diseases: importance for public health, epidemiology, promoting factors, and prevention]

À la fin des années 1970 on a parlé « de la fin des maladies infectieuses ». Avec l'apparition du sida et la découverte de nouveaux agents infectieux le « retour des maladies infectieuses » a été prononcé 15 à 20 ans après, donnant naissance aux « infections émergentes ». L'émergence est ce qui « dépasse le niveau moyen, retient l'attention ou sort du lot… ». En terme épidémiologique il s'agit d'une maladie qui apparaît ou dont l'incidence augmente en un lieu donné. Les infections dont l'incidence pourrait augmenter du fait de conditions propices à leur transmission doivent y être ajoutées. Différents scénarios peuvent être proposés selon que la maladie apparaît de novo (sida ou SRAS) ; apparaît là où elle n'existait pas (West Nile aux États-Unis) ; existait sans pouvoir être diagnostiquée de manière précise ou être rattachée à un agent infectieux donné (hépatite C avant la découverte du VHC) ; sort plus ou moins rapidement des fluctuations habituelles (épidémie) ; est causée par un agent dont les conditions de transmission sont propices à sa résurgence (baisse de la couverture vaccinale...). Le bioterrorisme fait partie des scénarios d'émergence. Des modifications qualitatives des agents infectieux (résistance aux anti-infectieux…) peuvent par un mécanisme de sélection donner lieu à des émergences. Les émergences infectieuses résultent de l'interaction entre l'agent, l'hôte et l'environnement qui évolue avec l'activité humaine. La lutte contre les infections émergentes est fondée sur la surveillance, l'expertise microbiologique de haut niveau et la capacité de réponse du système de santé publique.

Listeria monocytogenes and listeriosis: a review of hazard characterisation for use in microbiological risk assessment of foods

Considerable effort has been put into the application of quantitative microbiological risk assessment for Listeria monocytogenes, and data are available for England and Wales (probably more so than most other countries) on the adverse health effects, together with incidence data on different age and risk groups for human L. monocytogenes infections. This paper reviews aspects of Listeria and human listeriosis, especially from a public health perspective and provide hazard characterisation data, i.e. the qualitative and/or quantitative evaluation of the adverse health effect associated with the hazard, which is the relationship between exposure levels (dose) and frequency of illness. The majority of cases of human listeriosis are food-borne; however, the disease process is complex with multiple routes of infection. The dose-response relationship is poorly understood, and data from human volunteer studies are not available and would be unethical to produce. Data are available from a range of different animal and in vitro models, although these poorly mimic the natural disease process in route of infection, end point, host and history of prior exposure to the bacterium. Epidemiological data provide some information on infective doses and dose responses, but because of the characteristics of the disease (the hugely variable and potentially very long incubation periods, the low attack rates and the rarity of identification of specific food vehicles), this also provides limited data for calculation of dose responses. There is some, albeit limited, evidence for strain variation, but this is an area of considerable uncertainty despite great advances in the genetic basis of the virulence of this bacterium, and almost all strains seem capable of causing serious disease. A variety of mathematical approaches have been used to model dose responses. The review is written to provide a clinical and epidemiological background to the mathematically oriented, as well as to outline the mathematical approaches to those interested in food-borne infection.

Overview of Listeria monocytogenes contamination in Japan

Listeriosis is a relatively rare foodborne illness but can be life threatening with high fatality rates. In Japan, the incidence of listeriosis has been very low for the past 40 years compared with that of Western Europe and North America. We hypothesized that less Listeria monocytogenes contamination in Japanese foods would be related to the lower incidence in Japan. For this purpose, we collected data of Japanese foods contaminated with L. monocytogenes, mainly from Japanese-written reports, and reviewed them. From this review, we found that the proportion of L. monocytogenes, Listeria spp. isolation from foods in Japan is similar to those reported from other countries and that other factors might be responsible for the lower occurrence of listeriosis.

Risk assessment of listeriosis linked to the consumption of two soft cheeses made from raw milk: Camembert of Normandy and Brie of Meaux

This article reports a quantitative risk assessment of human listeriosis linked to the consumption of soft cheeses made from raw milk. Risk assessment was based on data purposefully acquired inclusively over the period 2000-2001 for two French cheeses, namely: Camembert of Normandy and Brie of Meaux. Estimated Listeria monocytogenes concentration in raw milk was on average 0.8 and 0.3 cells/L, respectively, in Normandy and Brie regions. A Monte Carlo simulation was used to account for the time-temperature history of the milk and cheeses from farm to table. It was assumed that cell progeny did not spread within the solid cheese matrix (as they would be free to do in liquid broth). Interaction between pH and temperature was accounted for in the growth model. The simulated proportion of servings with no L. monocytogenes cell was 88% for Brie and 82% for Camembert. The 99th percentile of L. monocytogenes cell numbers in servings of 27 g of cheese was 131 for Brie and 77 for Camembert at the time of consumption, corresponding respectively to three and five cells of L. monocytogenes per gram. The expected number of severe listeriosis cases would be < or =10(-3) and < or =2.5 x 10(-3) per year for 17 million servings of Brie of Meaux and 480 million servings of Camembert of Normandy, respectively.