Neonatal listeriosis non-UK 2004-2014 (2023)


Listeria monocytogenes is a Gram-positive bacillus. L. monocytogenes causes listeriosis, an infection predominantly transmitted through consumption of contaminated food. Recent estimates suggest that listeriosis is the most common cause of food-related deaths in the UK (130 deaths in 2005).1The incidence of listeriosis in pregnancy is 12 per 100,000, compared with a rate of 0.7 per 100,000 in the general population.14

For an antibiotic to be effective against L. monocytogenes, the antibiotic must penetrate the host cell, maintain a high concentration, and bind to penicillin-binding protein (PBP), which causes cell death. Penicillin, amoxicillin and ampicillin have been widely used in the treatment of listeriosis, as these drugs block several PBPs and penetrate intracellularly. Some in vitro studies also suggest a synergistic effect when gentamicin is added to the treatment regimen.9Studies in Denmark and northern Italy have found that human isolates of L. monocytogenes are susceptible to ampicillin, amoxicillin, benzylpenicillin, meropenem, erythromycin, and gentamicin.12, 13 L. monocytogenes is inherently resistant to broad-spectrum cephalosporin antibiotics, which are commonly used in the treatment of bacterial infections.6

Neonatal listeriosis occurs due to congenital infection. In the UK, it is the third most common cause of early neonatal infection.3and the fourth most common cause of early neonatal meningitis.7It commonly manifests in the first 24-72 hours of life (62% of cases).3Early-onset neonatal listeriosis can manifest as bacteremia, meningitis, and, less commonly, pneumonia. Late-onset neonatal listeriosis is most commonly associated with meningitis.2

Neonatal listeriosis is associated with high fatality rates. In the UK, between 1967 and 1985, 248 of 722 cases of human listeriosis (34%) were associated with pregnancy, of which 42 cases resulted in intrauterine deaths (19%) and 47 in neonatal deaths (35%), with one case overall lethality of 50%.4

This study aims to define the clinical features, risk factors and outcomes of neonatal listeriosis in a UK neonatal infection network over an 11-year period.

section excerpts

Materials and methods

Cases of neonatal listeriosis were prospectively identified between January 2004 and December 2014 through neonIN, a neonatal infection surveillance network ( Contributing centers voluntarily collect data on culture-positive neonatal infections from the web-based research database, which is also checked against laboratory records to ensure validity and quality.

All UK neonIN centers that contributed data within the study period were contacted and asked to complete


During the 11-year period, 18 neonatal units reported 21 cases of neonatal listeriosis. The overall incidence was 3.4 per 100,000 live births. Of the 21 cases identified, 19 were confirmed and 2 were probable. An overview of maternal and neonatal outcomes can be seen in Table1 and Table2, respectively.


The study highlighted some important lessons for clinicians and public health experts.

The overall incidence of neonatal listeriosis in our study population was 3.4 per 100,000 live births. This is minor when compared to other countries; for example, in the United States of America, the incidence of neonatal listeriosis is 8.6 per 100,000 live births15and in Israel it reaches 25.5 per 100,000 live births.16Neonatal listeriosis is also rarer when compared to the most common cause of

Contributor Statement

Dr. Stefania Vergnano designed and conducted the study, including patient recruitment. Dr. Shari Sapuan conducted the data analysis and prepared the draft manuscript with important intellectual input from Dr. Stefania Vergnano and Dr. Paul Heath. All authors approved the final manuscript. Most authors were involved in data collection. NeonIN provided statistical support in analyzing the data with input from Dr. Stefania Vergnano and Dr. Christina Kortsalioudaki. Dr Shari Sapuan and Dr Stefania


The authors have no financial relationships to disclose. No funding was received for this project.

Conflict of interests



Neonatal Infection Surveillance Network (neonIN).

  • Neonatal encephalopathy: other etiologies besides hypoxic-ischemic encephalopathy

    2021, Seminars in Fetal and Neonatal Medicine

    Quote Excerpt:

    Listeria monocytogenes may present with symptoms of central nervous system disease in the newborn [80]. A recent report by the UK Surveillance Network (neonIN) gives a fatality rate of 21% and an incidence of 3.4 per 100,000 live births [81]. Lee and others. reviewed the results after ECMO for neonatal listeriosis and found 86% survival [82].

    Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that can result from a variety of etiologies. HIE must be differentiated from neonatal encephalopathy of other causes using data collected from the history, physical and neurological examination, and further investigations. Identifying the underlying cause of encephalopathy has important implications for treatment. This review describes conditions that cause EN and may be confused with HIE, along with their distinct clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disorders are discussed.

  • Clinical features of neonatal listeriosis in Taiwan: a hospital study

    2020, Journal of Microbiology, Immunology, and Infection

    Quote Excerpt:

    The dose and choice of antibiotic for the treatment of maternal listeriosis are often inadequate.5,7 Sapuan et al. reported that all mothers of newborns who died of listeriosis in the UK in 2000-2014 did not receive adequate antepartum antibiotics.12 Similarly, in a retrospective study in China in 1999-2011, none of the mothers of cases of neonatal listeriosis had received first-line treatment.38

    Neonatal listeriosis is one of the main causes of mortality in newborns; however, there is limited information about this disease in Taiwan. The aim of our study was to identify the outcome determinants, clinical features, and incidence of pregnancy-associated listeriosis, which includes neonatal and maternal listeriosis.

    We retrospectively analyzed the charts of neonatal and maternal patients with pregnancy-associated listeriosis at two hospitals in Taiwan from January 2000 to December 2018. Listeriosis was indicated by positive culture for Listeria monocytogenes.

    Our study examined 18 neonates and 19 mothers. The neonatal and fetal mortality rate was 24%. All five cases of fetal loss or neonatal death occurred before 29 weeks of gestational age. The annual incidence of confirmed neonatal listeriosis increased significantly from 0.94/10,000 neonatal patients admitted in 2000-2011 to 5.45/10,000 neonatal patients admitted in 2012-2018 (p = 0.026). Clinical presentations of neonatal listeriosis included respiratory distress (85%), leukocytosis or leukopenia (77%), bandemia (69%), thrombocytopenia (77%), hypocalcemia (100%) and elevated levels of C-reactive protein (CRP) ( 92 %). Smaller pregnancy correlated with higher mortality rate (p=0.002). Among the investigated maternal cases, 67% were diagnosed with listeriosis and 72% had fever. However, only 21% of the 19 mothers received complete ampicillin treatment before delivery.

    The incidence of neonatal listeriosis is increasing, especially in preterm infants. Maternal listeriosis should be adequately treated with appropriate empiric antibiotics.

  • Neonatal cross-infection with Listeria monocytogenes

    2022, Epidemiology and Infection

  • Presentation and outcomes of Listeria-affected pregnancies in Johannesburg tertiary hospitals: a 2-year review

    2023, International Journal of Gynecology and Obstetrics

  • Human Listeria

    2023, Clinical Microbiology Reviews

  • Neurological Outcome of Neonatal Listeriosis: A Prospective Case-Control Study.

    2023, SSRN

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  • Research Article

    Pyelonephritis with bacteremia caused by Listeria monocytogenes: case report

    Journal of Infection and Chemotherapy, Volume 23, Edição 2, 2017, pp. 111-113

    Listeria monocytogenes is a well-known cause of meningitis, colitis, and bacteremia; however, obstructive pyelonephritis caused by L.monocytogenes has never been reported. We report the case of a 90-year-old Japanese woman with obstructive pyelonephritis and bacteremia due to uterine carcinoma invading the ureter. She was admitted to our hospital complaining of fever and chills, and her physical examination revealed left costovertebral angle tenderness. Computed tomography showed hydronephrosis and complete ureteral obstruction due to tumor invasion. Blood and urine cultures after nephrostomy revealed the growth of L.monocytogenes. We treated the patient with two weeks of intravenous ampicillin and an additional one week treatment with oral trimethoprim/sulfamethoxazole. This case shows the importance of recognizing L.monocytogenes as a potential causative agent of urinary tract infection.

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    Determination of Etest vancomycin MICs in patients with MRSA bloodstream infection does not support switching antimicrobials

    Journal of Infection, Volume 74, Issue 3, 2017, pp. 248-259

    Elevated minimum inhibitory concentrations (MICs) of vancomycin have been reported to adversely affect clinical outcome in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI). Therefore, we examined the association between vancomycin MIC and outcome, considering several potential confounders.

    Clinical data and bacterial isolates were collected prospectively from patients with MRSA BSI from 2006 to 2012 as part of the Invasive Staphylococcus aureus Infection Cohort (INSTINCT) study. Antimicrobial susceptibility was assessed by Etest, broth microdilution (BMD) and VITEK 2. Bacterial genotypes were determined by spa typing. Using univariate and Cox regression analyses, we investigated the impact of low (≤1.0mg/L) and high (≥1.5mg/L) vancomycin Etest MIC on clinical outcomes.

    Ninety-one episodes of MRSA BSI were included, of which 79 (86.8%) were caused by spa types t003, t032 and t045. High vancomycin MICs were only observed using Etest, but not confirmed using standard reference BMD. When episodes were stratified into vancomycin Etest low and high MIC groups, the overall 30-day mortality was 34.5% and 27.3%, respectively (P = 0.64, OR 0.71; confidence interval of 95% [CI] 0.27–1.79). Variables significantly associated with all-cause mortality in the Cox model were age (P=0.003), acute physiology score (P=0.0006), and Charlson comorbidity index (P=0.018).

    Vancomycin MICs may vary depending on testing methodologies and local epidemiology of MRSA. Patients' underlying disease and individual comorbidities, rather than elevated vancomycin MICs, determine adverse clinical outcomes in MRSA BSI. Routine Etest MIC testing of MRSA isolates is of limited value for treatment decisions.

  • Research Article

    The evolution of bacteremia in an HIV-1 positive cohort in the UK

    Journal of Infection, Volume 74, Issue 3, 2017, pp. 325-328

  • Research Article

    4CMenB multicomponent vaccine serogroup B meningococcal strain coverage with corresponding regional distribution and clinical features in England, Wales and Northern Ireland, 2007–08 and 2014–15: a qualitative and quantitative assessment

    The Lancet Infectious Diseases, Volume 17, Issue 7, 2017, pp. 754-762

    The UK introduced 4CMenB - a multicomponent vaccine against serogroup B meningococcal disease - into the national childhood immunization program in September 2015. The Meningococcal Antigen Typing System (MATS) was used to estimate 4CMenB coverage of invasive meningococcal isolates from the group B obtained during 2007–08 in England and Wales (MATS coverage). We aimed to repeat the MATS survey for group B invasive meningococcal isolates obtained during 2014–15, prior to the introduction of 4CMenB; compare strain coverage between 2007–08 and 2014–15; and to investigate associations between MATS coverage, age, region, and disease outcomes.

    Serogroup B invasive meningococcal isolates from cases in England, Wales and Northern Ireland during 2014–15 were tested using MATS and compared with data from 2007–08. MATS coverage was assessed by geographic region and age group. Clinical characteristics, risk factors, and outcomes were assessed according to MATS coverage for English cases from 2014–15.

    In 2014–15, 165 of 251 (66%; 95% CI 52–80) group B meningococcal isolates were estimated by MATS to be covered by 4CMenB, compared to 391 of 535 (73%; 95% CI 57–87) in 2007–08. The proportion of MATS-positive isolates with a vaccine antigen increased from 23% (122 of 535) in 2007–08 to 31% (78 of 251) in 2014–15, while the proportion with more than one antigen fell from 50% ( 269 ​​out of 535) to 35% (87 out of 251). This effect reflected changes in circulating strains, particularly strains of the ST-269 clonal complex. MATS coverage increased with age, varied by geographic region, and was associated with more severe disease.

    In 2014–15, two-thirds of group B meningococcal isolates were expected to be covered by 4CMenB. Temporal changes in MATS coverage underscore the need for continuous monitoring of antigen expression and diversity, particularly in countries with 4CMenB programs.

    Public Health England, GlaxoSmithKline.

  • Research Article


    Medicine, Volume 41, Edition 9, 2013, pp. 540-545

    Thyrotoxicosis is the syndrome that arises from an excessive concentration of circulating thyroid hormone and is usually caused by Graves' disease or toxic nodular thyroid disease, both forms of hyperthyroidism. Other causes of thyrotoxicosis (but not hyperthyroidism) include destructive thyroiditis in which the thyroid is damaged, resulting in leakage of stored thyroid hormone into the circulation. Distinguishing the cause of thyrotoxicosis is an essential initial step in treatment once the diagnosis has been biochemically confirmed. In particular, treatment with antithyroid drugs can cure about 50% of patients with Graves' disease, it will only control but not cure nodular thyroid disease, and it is useless in destructive thyroiditis. Radioiodine is generally used to treat patients with toxic nodular goiter and relapsing Graves' disease, but caution is warranted in patients with ophthalmopathy; pregnancy and breastfeeding are absolute contraindications. Surgery is an alternative to radioiodine, but it is less used now that the safety of radioiodine has been established. Special care is needed in the management of Graves' disease in pregnancy; the lowest dose of antithyroid medication should be used, and measurement of maternal thyroid-stimulating hormone receptor antibodies can be used to predict the likelihood that the fetus will develop neonatal hyperthyroidism.

  • Research Article

    Awareness of listeriosis and methylmercury toxicity public health recommendations and diet during pregnancy

    Women and Birth, Volume 32, Issue 1, 2019, pp. e65-e70

    Awareness of listeriosis and methylmercury toxicity recommendations are associated with decreased intake of high-risk foods. It is not known whether knowledge of the recommendations affects the quality of the diet of pregnant women in Australia.

    To assess awareness of listeriosis and methylmercury toxicity recommendations during pregnancy and their impact on diet quality.

    Pregnant women (n = 81) were recruited from antenatal clinics. Awareness of listeriosis and methylmercury toxicity recommendations and consumption of high-risk foods were assessed using a questionnaire between 10 and 23 weeks of gestation. Diet quality was measured using the 2005 Healthy Eating Index using a validated food frequency questionnaire at 10–23 and 34–36 weeks of gestation.

    A greater proportion of women were aware of methylmercury toxicity compared with listeriosis recommendations (75.3 vs. 59.2%, p<0.001). The proportion of women who reduced or avoided consumption of certain high-risk foods for Listeriosis was greater in those who were aware compared to those who were unaware of the Listeriosis recommendations [raw fish (96.0 vs 69.2%, p= 0.046), ice cream (93.9 vs 58.3%, p=0.004) and alfalfa/bean sprouts (68.7 vs 28.5%, p=0.006)]. A large proportion of women (96.8%) met recommendations to limit consumption of fish high in methylmercury. There was no difference in the change in diet quality during pregnancy, regardless of the women's knowledge of the recommendations.

    Awareness of listeriosis and methylmercury toxicity recommendations have little impact on the diet quality of pregnant women in this small study. More research in a large representative population of pregnant women is needed to confirm our findings and optimize diet quality during pregnancy.

© 2016 British Infections Association. Published by Elsevier Ltd. All rights reserved.

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