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GASTROENTERITIS CAUSED BY LISTERIA MONOCYTOGENES IN A PRIVATE DAY-CARE FACILITY

1997; Lippincott Williams & Wilkins; Volume: 16; Issue: 8 Linguagem: Inglês

10.1097/00006454-199708000-00025

1532-0987

Marianne Heitmann, Peter Gerner‐Smidt, Ole Heltberg,

Essential Oils and Antimicrobial Activity

To The Editors: Listeria monocytogenes is a foodborne potential pathogen that causes invasive disease, usually presenting as septicemia and/or meningitis affecting all age groups, or a generalized infection in the newborn.1 Noninvasive disease caused by this organism is rarely reported. It is well-known that invasive disease may be preceded by gastrointestinal symptoms but L. monocytogenes has not generally been accepted as a cause of gastroenteritis.2 In recent years, however, two outbreaks of gastroenteritis caused by L. monocytogenes have been encountered in Italy3 and the US.4 We report a small outbreak of gastroenteritis caused by this bacterium in a Danish private day-care setting. The index patient, a 2-year, 7-month-old boy, was admitted to the hospital because of high fever (41.3°C) for 12 h. Initially there were no focal signs but in the following hours watery diarrhea developed and the fever subsided. Blood culture was drawn on admission and a stool culture was performed on the same day. Laboratory findings from the second day showed an elevated C-reactive protein of 177 mg/l (normal, ≤5 mg/l) and a normal blood leukocyte count. The child received symptomatic treatment only and was discharged after 2 days in good clinical condition. After his discharge growth of L. monocytogenes from the blood culture was detected and the patient was reexamined at the hospital on the fourth day. At that time the child had no fever or other signs and the C-reactive protein had dropped to 27 mg/l. The leukocyte count remained normal. A new blood culture was sterile. On the same day that the index patient was hospitalized, two other children who were cared for in the same private day-care facility were admitted to the hospital with almost identical clinical symptoms. Both children, both 2 years and one 2 months old, had sudden onset of vomiting and fever. After a few hours the vomiting stopped and watery diarrhea developed. Stool cultures were performed. No blood tests were done. Both children were treated symptomatically without antibiotics, and because they were in a good clinical condition they were discharged to be observed in their homes. When listeriosis was diagnosed in the index patient they were readmitted. Both were clinically well, except for mild intermittent diarrhea in one of them. Blood cultures taken at that time were sterile, leukocyte counts were normal and C-reactive protein values were marginally elevated. The stools that were negative for usual enteric pathogens were cultured specifically for Listeria on PALCAM5 agar (Statens Serum Institut, Copenhagen, Denmark). Abundant growth was observed from the stools of all three children. All isolates were identified as L. monocytogenes serogroup 4 with identical phage type and DNA fingerprint by restriction enzyme analysis. Stool cultures from the members of the children's families and the day-care family did not reveal other infected persons. There were no leftover foods in the day-care facility, and a thorough investigation of food from the shops that supplied the facility was negative. Thus a source of the outbreak was not established. A fourth child in the day-care facility did not become ill. That child was not present in the day-care facility the day before symptoms appeared in the other three children. This may indicate that the diseased children were infected on that day. An incubation period of 1 day was also observed in the Italian outbreak.3 Listeria does not grow on ordinary enteric media. If a selective medium such as PALCAM agar is not used Listeria will be overlooked. Thus Listeria may be an underestimated diarrheal pathogen. The present outbreak suggests that one should look for L. monocytogenes in clustered cases of unexplained gastroenteritis not only in adults but also in children. Marianne Heitmann, M.D. Peter Gerner-Smidt, M.D., D.Sci. Ole Heltberg, M.D. Department of Pediatrics; Nykøbing Falster Hospital; Nykøbing Falster (MH) Department of Gastrointestinal Infections; Statens Serum Institut; Copenhagen (PGS) Department of Clinical Microbiology; Næstved Hospital; Næstved (OH) Denmark