RISK FACTORS: Age - fetus, neonates, elderly, Metastatic malignant disease, HIV infection,
Alcoholism, Renal hemodialysis, Pregnancy, Immunosuppressed, Exposure to infected animals (veterinarians, butchers, etc.).Animal-to-human transmission is rare
GENERAL MEASURES
β’ Bedrest
β’ Isolation if immunosuppressed
β’ Secretion precautions
β’ Respiratory assistance (if apneic, or CNS depressed)
SURGICAL MEASURES N/A
ACTIVITY Bedrest
DIET
β’ Acute case, total parenteral nutrition, nasogastric tube, or softer diet if tolerated
β’ As a preventive, avoid eating raw or partially cooked foods and soft cheeses. Warm leftovers thoroughly and
wash raw vegetables before cooking.
β’ If high risk patient consumes recalled product, but does not develop symptoms within 1 month, no further
treatment is needed. AN updated list of recalled food products can be found at the USDA website: www.fsis.
usda.gov/OA/recalls/rec_intr.htm
DRUG(S) OF CHOICE
. Neonates - IV treatment 14-21 days:
. Meningitis - for infants older than one month: ampicillin 300-400 mg/kg/day IV
. Meningitis - neonate doses: < 2000 grams, less than 1 week old: ampicillin 50 mg/kg q12h. Older than 1 week: ampicillin 50 mg/kg every 8 hours. Plus gentamicin 7.5 mg/kg/day IV for 14 days. Discontinue
gentamicin when cerebro-spinal fluid is sterile.
. Alternate therapy for neonates - penicillin G 100,000-200,000 units/kg/d IV x 14-21 days plus gentamicin as above
. Bacteremia or pneumonia - ampicillin 100-150 mg/kg/day (or penicillin G 200,000 units/kg/d IV) plus
gentamicin 5.0 mg/kg/day. Discontinue gentamicin when blood cultures become negative.
. Pregnant women:
. Ampicillin 2 gm IV q4h for 14-21 days plus gentamicin 120 mg IV q8h. Adjust for peak 5-6 mcg/mL.
. Immunocompromised/elderly patients:
. Ampicillin 2 gm IV q4h plus ceftriaxone 2 gm IV q12h or cefotaxime 2 gm IV q6h plus vancomycin 500 mg
IV q6h and dexamethasone .4 mg/kg IV q12h x 2 days; give fi rst dose with first dose of antibiotic
. For endocarditis and typhoidal listeriosis:
. Penicillin G 75,000-100,000 units/kg IV q4h and continue for 14 days after defervescence. plus tobramycin
2 mg/kg load, then adjust based on levels. Aim for peak at 5-6. Continue for 4 weeks after defervescence.
. For oculoglandular:
. Erythromycin 30 mg/kg/day as 4 equal doses q6h and continue for 1 week after defervescence
ALTERNATIVE DRUGS
β’ Trimethoprim-sulfamethoxazole may be the most effective treatment for adults because of its ability to penetrate cells. Total dose 10 mg/kg (based on trimethoprim component) in divided doses.
β’ Clarithromycin
β’ Ciprofloxacin
PATIENT MONITORING
β’ Frequent arterial blood gases during acute phase
β’ Repeat lumbar puncture at 24-48 hours and at the end of treatment
PREVENTION/AVOIDANCE
β’ If pregnant, elderly or immune compromised: check
USDA website for recalled foods
β’ Avoid handling livestock
β’ Avoid contaminated silage
β’ Avoid contaminated sewage
β’ Avoid raw or contaminated milk products
β’ Avoid soft cheeses (Mexican and feta)
β’ Wash carefully all raw vegetables
β’ Keep uncooked meats separate from vegetables
β’ Wash hands after handling uncooked foods
β’ Avoid foods from deli counter
β’ Cook leftovers, hot dogs, cold cuts, and deli meats until
steaming hot before eating
POSSIBLE COMPLICATIONS
β’ Premature delivery
β’ Amnionitis
β’ Meningitis
β’ Septicemia
β’ Pulmonary abscess
β’ Hepatic abscess
β’ Placental abscess
β’ Splenic abscess
β’ Lymph node abscess
β’ Endocarditis
β’ Peritonitis
β’ Abortion
β’ Stillbirth
β’ Neonatal death
EXPECTED COURSE/PROGNOSIS
High mortality if symptomatic