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Listeriosis

Consensus Canadian Guidelines for Diagnosis and Management of Listeriosis

The recent nationwide outbreak of listeriosis with ongoing cases and fatalities has heightened physician and patient concerns surrounding this disease, its diagnosis, prevention, and management. Listeriosis is primarily an opportunistic infection targeting high risk groups and is reportable in all provinces and territories in Canada. The Public Health Agency of Canada convened an expert panel to provide information and recommendations to health care professionals and the general public on this disease, its diagnosis and management. The following are recommendations for health care professionals which have been agreed upon by experts and provincial and territorial public health officials. When in doubt, an infectious diseases consultation should be obtained.

High Risk Groups
Pregnant women -	Asymptomatic - no screening or prophylaxis indicated. Symptomatic - sepsis syndrome, febrile flu-like illness where a blood culture would be clinically indicated, pyelonephritis or chorioamnionitis – blood and urine cultures and empiric therapy to include coverage for listeria (ampicillin or in penicillin allergic patients – cotrimoxazole < use with caution in pregnant patients > or vancomycin). Samples for testing – blood and urine cultures. Stool or vaginal swabs – of limited or no value – not recommended. No “blood test” available for listeria except for blood cultures in symptomatic individuals. Neonates with an acute or delayed sepsis disease syndrome should have empiric listeria coverage while undergoing a diagnostic workup for sepsis in the newborn.
Immunocompromised -	Asymptomatic – no screening or prophylaxis indicated. Symptomatic – sepsis syndrome, febrile flu-like illness, meningitis, acute arthritis, etc. – appropriate blood, urine, CSF cultures and empiric therapy to cover listeria (ampicillin or in penicillin allergic patients – cotrimoxazole or vancomycin,). Note that cephalosporins have no activity against listeria. Samples for testing: – blood, urine, sterile body fluid cultures. Stool or vaginal swabs – of limited or no value – not recommended No “blood test” available for listeria except for blood cultures in symptomatic individuals.
Elderly or nursing or personal care home residents -	Asymptomatic – no screening or prophylaxis indicated. Symptomatic – sepsis syndrome, febrile flu like illness, meningitis, etc. appropriate blood, urine, CSF cultures and empiric therapy to cover listeria (ampicillin or in penicillin allergic patients – cotrimoxazole or vancomycin). Again note that cephalosporins have no activity against listeria. Samples for testing: – blood, urine, sterile body fluid cultures. Stool or vaginal swabs – of limited or no value – not recommended. No “blood test” available for listeria except for blood cultures in symptomatic individuals. No risk of nosocomial transmission with standard blood and body fluid precautions.
Low Risk Groups
The normal host -	Asymptomatic – no screening or prophylaxis indicated. Symptomatic – sepsis syndrome, flu-like febrile illness, intra-abdominal infection, etc. Samples and treatment, as per routine management protocols. Empiric listeria therapy not indicated unless a solid link between contaminated food product consumption and disease can be made. Stool samples of limited or no value for listeria diagnosis – not recommended. No “blood test” available for listeria except for blood cultures in symptomatic individuals.