Esra Konca
Case Study 4
ID: 000501849-8
Clinical Aspects
The patient is a 21 year old migrant farmworker who is 27 weeks pregnant. She was brought
to hospital for the following clinical manifestations: fever, headaches, chills, frequency
urgency of urination, and decreased appetite and1 day history of diarrhoea as well as
deceased foetal movement as this can be indicated in figure 1.
Figure 1: Illustration of possible occurrence of symptoms in Listeriosis infection and pregnancy.
Fever is a body immune response in order to aid to kill and help phagocytic cells killing the
bacterium. Fever causes high body temperature; this indicates the infection fighting cells of the
immune system such as phagocytes etc. Due to the infection further symptoms such as headaches and
chills can be caused due to the weak immune system and bacterial infection. Diarrhoea is also present
and can cause dehydration due to the loss of electrolytes. In relation to the pregnancy, symptoms of
frequency and urgency of urination can be due to the affects and symptoms of pregnancy in which a
further study by Iqbal et al (2005) has result that frequency and urgency of urination is a universal
symptom during pregnancy. High white blood cell count is an indication of infection and its normal
range is between 4,200 to 10,800cmm (UVA School of Medicine Webmaster .2010). The likely chances
of the high WBC is due to the existence of bacterial infection which activates the immune system of the
patient. Therefore relating the symptoms of Listeriosis to the patient’s symptoms it is highly likely that
the disease is Listeriosis. This can be also concluded from the most common clinical manifestation
diarrhoea.
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Esra Konca
Case Study 4
ID: 000501849-8
Accounting the life style of the patient as a migrant farmworker as well as the symptoms of
the patient, it is likely that the cause of the stillbirth is due to the bacterial infection called
Listeriosis. Listeriosis is caused by bacteria of the genus Listeria (mainly listeria
monocytogenes) (Jewell et al.2003). Listeria monocytogenes belongs to a gram-positive
foodborne bacterium and is a bacterial pathogen and is factitively intracellular foodborne
pathogen which induces its own uptake into on-pathogen cells (Cresence et al .2007). The
bacterium
affects
primarily
pregnant
women,
neonates,
elderly
adults
and
immunocompromised individuals who subsequently have supressed immune system. The
bacterium can precede more serious dilemmas of the disease such as meningitis,
meningoencephalitis, Septicaemia and cervical infectious.
Figure 3: Demonstration of Listeria monocytogenes using TEM. The appearance of listeria
monocytogenes is described as rod shaped motile, non-sporeforming pathogenic bacterium
and has aerobic and anaerobic characteristics. It is capable of growing at -18 oC to 10oC.
REFERENCE
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Esra Konca
Case Study 4
ID: 000501849-8
A conclusive diagnostic test will rely upon the isolation of the L. monocytogenes. Clinically
the organism can be isolated from blood, cerebrospinal fluid or placenta (CFSPH, 2012).
However the human infection is commonly involved in the central nervous system. L.
monocytogenes can be identified in tissues.
Further diagnosis will depend on the confirmation of the isolation from CSF, blood, amniotic
fluid, placenta, meconium, lochia and other infection locations (Alberta Health and Wellness,
2011). The colonies on the blood culture represent a narrow band of beta (β)-haemolysis
resembling that of β-streptococci (Cresence et al .2007). The infection can be detected with
range of methods based upon the biochemical tests as well as enzyme reactions (Alberta
Health and Wellness, 2011).
Acheson et al 2000 has stated that the clinical appearance and identification of the organism
can be late recognised, especially in the absence of fever which can lead to late treatment.
Listeriosis has become a common clinical syndrome identified in humans. The symptom will
resemble gastrointestinal illness. Other diseases like listeria monocytogenes and salmonella
campylobacter causes foodborne gastroenteritis.
Listeriosis has 2 types of illnesses. Early-onset Listeriosis develops maternal sepsis and
choriomnionitis. This type of Listeriosis causes abortion, stillbirth or premature delivery of
severely affected infants which may cause “granulomatosis infantiseptica”. Recent studies
show that only 20% of the infants are born alive, whereas the abortion and stillbirths rate
increases by 150%. Late-onset Listeriosis usually features meningitis and occurs in infants.
Pregnant women who have early-onset Listeriosis, usually suffers non-specific flu like
symptoms which can be misdiagnosed as influenza or pyelonephritis. Early detection of
Listeriosis in pregnant females using blood culture can be an opportunity to treat the infant
(Schlech et al 1996).
The main developments in rapid identification methods have been ruled to be immunological
and nucleic acid-based detection systems. Such other developments have been made in other
areas such as impedance and conductance, bacteriophages, biosensors, microscopy and
miniaturized and automated biochemical detection kits (Foley et al .2006).
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Esra Konca
Case Study 4
ID: 000501849-8
Table 1: Table below demonstrates the variable methods and techniques used to identify the
pathogen. Various techniques have been established and undertaken. These detection
methods
include
the
following,
fluorescence,
or
chemiluminescence,
impedance,
immunochromatography and immunomagnetic separation taken from (Foley et al. 2006).
Technique
Explanation
Immunological
Immunological technique has been a major impact in the progression of food
assay
pathogens. One of the most common immunoassay in detection of food
pathogen has been enzyme-linked immunsorbent assay (ELISA).
PCR
PCR method was used to detect pathogenic microorganisms and was a
known as a nucleic-acid amplification technique. The technique was rapid,
specific and sensitive in the analysis of food pathogens. The PCR process
targets a specific region of nucleic acid and amplifies up to a billion fold.
PCR process does not confirm the specific gene fragment. The specific DNA
region is targeted through hybridization. PCR is a rapid, specific and
sensitive method for detecting food pathogens.
Nucleic acid
This technique since the 1980’s had been the type of technology which
technologies
detects high levels of specificity due to the detection of specific nucleic-acid
sequences. Furthermore to the methodology had been either developed or
were being developed for the use of rapid methods i.e. amplification,
microarrays and chips. Nucleic acid methodology was an attractive method
Figure 4: Further diagnoses have been recently developed for fast, reliable and high specific
detection of Listeria. Vermicon solution for microbiology have developed a VIT- Listeria kit
which unequivocally detects Listeria monocytogenes and Listeria genera. Investigations
provide the existence of the bacteria and whether the pathogen L. monocytogenes is amongst
them (Vermicon Solution for microbiology- VIT ® gene probe technology).
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Esra Konca
Case Study 4
ID: 000501849-8
Conclusion
In conclusion, referring to the symptoms and tests carried out, the basic symptoms can be
caused indirectly from the bacterial infection Listeriosis which is present in the patient.
Whereas the patient has been examined for Chlamydia trachomatis. Referring to the
laboratory studies undertaken, a cervical specimen assayed for Chlamydia trachomatis using
PCR was negative and cervical culture for Neisseria gonorrhoea was not preformed. I believe
the symptoms have misled the physician who undertook a cervical specimen assay for
Chlamydia trachomatis.
Considering the patient’s job and background history I believe the physician should have
given an assumption of Listeriosis rather than sexual related disease. Moreover studies have
stated that some of Listeriosis cases are not diagnosed because the correct microbiological
investigations are not preformed and foetal loss early in gestation is rarely microbiologically
investigated and additionally can be mistake for streptococci or contaminants such
as corynebacteria McLauchlin et al .1988).
Two blood cultures were drawn, and the patient was begun on ampicillin-sulbactam and
gentamicin. The next morning the patient complained of right costovertebral tenderness and
abdominal pain. On ultrasound, there was no fetal movement, and intrauterine fetal demise
was suspected. Labour was induced, and a stillborn infant was delivered vaginally.
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Esra Konca
Case Study 4
ID: 000501849-8
References
Books:
WEB site:
 Alberta
Health
and
Wellness
(2011).
Listeriosis
Available
at
http://www.health.alberta.ca/documents/Guidelines-Listeriosis-2011.pdf
(Accessed on 3rd January 2012)
 Queen’s printer for Ontario, ministry of health and long term care (2011) Listeriosis
Available
at
www.health.gov.on.ca/english/providers/pub/disease/listeroa/listeriosis_clinical_qa_0
1_20080902.pdf (Accessed on 30th October 2011)
 Hospitality Institute of Technology and Management (2011) Listeria monocytogenes
Available at http://www.hi-tm.com/1908/SECTION-2-D-1908.pdf
(Accessed on 30th October 2011)
 MediResource
Inc
(2011)
Fever
Available
at:
http://bodyandhealth.canada.com/channel_condition_info_details.asp?disease_id=158
&channel_id=1020&relation_id=10884
(Accessed on 10th October 2011)
 NetDoctor.co.uk.
(2011)
Diarrhoea
Available
at:
http://www.netdoctor.co.uk/diseases/facts/diarrhoea.htm
(Accessed on 13th October 2011)
 State
Government
of
Victoria.
(2010)
Diarrhoea
Available
at:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/diarrhoea?open
(Accessed on 13th October 2011)
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Esra Konca
Case Study 4
ID: 000501849-8
 UVA School of Medicine Webmaster (2010). Hematology Lab Differentials
Available at: http://www.med-ed.virginia.edu/pda/refcards/HemLab/index.htm
(Accessed on 15th October 2011)
 WebMD
LLC
(2012).
Listeria
monocytogenes
Available
at
http://emedicine.medscape.com/article/220684-overview
(Accessed on 3rd January 2012).
 Vermicon Solution for microbiology (2012) Listeria monocytogenes Available at:
http://www.vermicon.com/en/en/products/VIT-Listeria-44
(Accessed on 3rd January 2012)
 World Organisation for Animal Health (Oie) (2012). Listeria monocytogenes
Available
at:
http://www.oie.int/fileadmin/Home/eng/Health_standards/tahm/2.09.07_LISTERIA_
MONO.pdf (Accessed on 3rd January 2012)
Journals
1. Acheson, D. Schlech, W.F. (2000) Foodborne Listeriosis. Clinical Infectious Diseases
(September), p. 770–775
2. Aziz, F. Dodi, S. Grigoriu, A. Penupolu, S. (2011) Listeria peritonitis; common
presentation of an uncommon organism. Professional Med J (March), p. 163-166
3. Cresence, V.M. Dharsana, K.S. Lekshmi, M.U. Prasad, S.P. Ramaswamy, V. Rejitha,
J.S. Vijila, H.M. (2007) Listeria- review of epidemiology and pathogenesis. J
Microbiology Immunol Infect (January), p. 4 – 13
4. Donachie, W. Low, J.C. (1997) A Review of Listeria monocytogenes and
Listeriosis.The I"eterinau.]ournal (153), p. 9-29
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Esra Konca
Case Study 4
ID: 000501849-8
5. Foley. S.L. Grant, K. (2006) Molecular Techniques of Detection and Discrimination
of Foodborne Pathogens and Their Toxins. Molecular Techniques to Detect
Pathogens. p. 485- 510
6. Iqbal, J. Jammul, A. Razzaq, N. Salick, A. Sheikh, S. Wazir, S. (2005) Frequency of
urinary symptoms in pregnancy. Biomedica/Vol. 21 (June)
7. Jewell, K. McLauchlin, J. Mitchell, R.T. Smerdon, W.J. (2004) Listeria
monocytogenes and listeriosis: a review of hazard characterisation for use in
microbiological risk assessment of foods. International Journal of Food Microbiology
92 (May), p. 15– 33
8. Kuukankorpi, A. Miettinen, A. Pasternack, R. Pitkajarvi, T. Vuorinen, P. (1996).
Detection of Chlamydia trachomatis Infections in Women by Amplicor PCR:
Comparison of Diagnostic Performance with Urine and Cervical Specimens. Journal
of clinical microbiology. (April), p. 995-998
9. Loomis, W.P. Starnbach, M.N. (2006) Chlamydia trachomatis Infection Alters the
Development of Memory CD8_ T Cells. The Journal of Immunology. (June), p. 40214027
10. Schlech, W.F. (1996) Overview of Listeriosis. Food Control (Vol 7), p. 183- 186
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