Caroline Charlier1, Élodie Perrodeau2, Alexandre Leclercq3, Benoît Cazenave4, Benoît Pilmis5, Benoît Henry6, Amanda Lopes7, Mylène M Maury3, Alexandra Moura8, François Goffinet9, Hélène Bracq Dieye3, Pierre Thouvenot3, Marie-Noëlle Ungeheuer10, Mathieu Tourdjman11, Véronique Goulet11, Henriette de Valk11, Olivier Lortholary12, Philippe Ravaud13, Marc Lecuit14. 1. French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: caroline.charlier@pasteur.fr. 2. Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, METHODS Team, UMR 1153, INSERM, Paris Descartes University, Sorbonne Paris Cité, Paris, France. 3. French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France. 4. French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France. 5. French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. 6. Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 7. Denis Diderot University, Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 8. Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France. 9. Paris Descartes University, Sorbonne Paris Cité, Port Royal Maternity, Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 10. Institut Pasteur, Center for Translational Science, ICAReB Biobanking Platform, Paris, France. 11. Infectious Disease Department, The French Public Health Agency, Saint Maurice, France. 12. Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. 13. Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, METHODS Team, UMR 1153, INSERM, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Columbia University, Mailman School of Public Health, New York, NY, USA. 14. French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: marc.lecuit@pasteur.fr.
Abstract
BACKGROUND: Listeriosis is a severe foodborne infection and a notifiable disease in France. We did a nationwide prospective study to characterise its clinical features and prognostic factors. METHODS: MONALISA was a national prospective observational cohort study. We enrolled eligible cases declared to the National Reference Center for Listeria (all microbiologically proven) between Nov 3, 2009, and July 31, 2013, in the context of mandatory reporting. The outcomes were analysis of clinical features, characterisation of Listeria isolates, and determination of predictors of 3-month mortality or persisting impairment using logistic regression. A hierarchical clustering on principal components was also done for neurological and bacteraemic cases. The study is registered at ClinicalTrials.gov, number NCT01520597. FINDINGS: We enrolled 818 cases from 372 centres, including 107 maternal-neonatal infections, 427 cases of bacteraemia, and 252 cases of neurolisteriosis. Only five (5%) of 107 pregnant women had an uneventful outcome. 26 (24%) of 107 mothers experienced fetal loss, but never after 29 weeks of gestation or beyond 2 days of admission to hospital. Neurolisteriosis presented as meningoencephalitis in 212 (84%) of 252 patients; brainstem involvement was only reported in 42 (17%) of 252 patients. 3-month mortality was higher for bacteraemia than neurolisteriosis (hazard ratio [HR] 0·54 [95% CI 0·41-0·69], p<0·0001). For both bacteraemia and neurolisteriosis, the strongest mortality predictors were ongoing cancer (odds ratio [OR] 5·19 [95% CI 3·01-8·95], p<0·0001), multi-organ failure (OR 7·98 [4·32-14·72], p<0·0001), aggravation of any pre-existing organ dysfunction (OR 4·35 [2·79-6·81], p<0·0001), and monocytopenia (OR 3·70 [1·82-7·49], p=0·0003). Neurolisteriosis mortality was higher in blood-culture positive patients (OR 3·67 [1·60-8·40], p=0·002) or those receiving adjunctive dexamethasone (OR 4·58 [1·50-13·98], p=0·008). INTERPRETATION: The severity of listeriosis is higher than reported elsewhere. We found evidence of a significantly reduced survival in patients with neurolisteriosis treated with adjunctive dexamethasone, and also determined the time window for fetal losses. MONALISA provides important new data to improve management and predict outcome in listeriosis. FUNDING: Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.
BACKGROUND: Listeriosis is a severe foodborne infection and a notifiable disease in France. We did a nationwide prospective study to characterise its clinical features and prognostic factors. METHODS: MONALISA was a national prospective observational cohort study. We enrolled eligible cases declared to the National Reference Center for Listeria (all microbiologically proven) between Nov 3, 2009, and July 31, 2013, in the context of mandatory reporting. The outcomes were analysis of clinical features, characterisation of Listeria isolates, and determination of predictors of 3-month mortality or persisting impairment using logistic regression. A hierarchical clustering on principal components was also done for neurological and bacteraemic cases. The study is registered at ClinicalTrials.gov, number NCT01520597. FINDINGS: We enrolled 818 cases from 372 centres, including 107 maternal-neonatal infections, 427 cases of bacteraemia, and 252 cases of neurolisteriosis. Only five (5%) of 107 pregnant women had an uneventful outcome. 26 (24%) of 107 mothers experienced fetal loss, but never after 29 weeks of gestation or beyond 2 days of admission to hospital. Neurolisteriosis presented as meningoencephalitis in 212 (84%) of 252 patients; brainstem involvement was only reported in 42 (17%) of 252 patients. 3-month mortality was higher for bacteraemia than neurolisteriosis (hazard ratio [HR] 0·54 [95% CI 0·41-0·69], p<0·0001). For both bacteraemia and neurolisteriosis, the strongest mortality predictors were ongoing cancer (odds ratio [OR] 5·19 [95% CI 3·01-8·95], p<0·0001), multi-organ failure (OR 7·98 [4·32-14·72], p<0·0001), aggravation of any pre-existing organ dysfunction (OR 4·35 [2·79-6·81], p<0·0001), and monocytopenia (OR 3·70 [1·82-7·49], p=0·0003). Neurolisteriosis mortality was higher in blood-culture positive patients (OR 3·67 [1·60-8·40], p=0·002) or those receiving adjunctive dexamethasone (OR 4·58 [1·50-13·98], p=0·008). INTERPRETATION: The severity of listeriosis is higher than reported elsewhere. We found evidence of a significantly reduced survival in patients with neurolisteriosis treated with adjunctive dexamethasone, and also determined the time window for fetal losses. MONALISA provides important new data to improve management and predict outcome in listeriosis. FUNDING: Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.
Authors: Alexandra Moura; Olivier Disson; Morgane Lavina; Pierre Thouvenot; Lei Huang; Alexandre Leclercq; Maria Fredriksson-Ahomaa; Athmanya K Eshwar; Roger Stephan; Marc Lecuit Journal: Infect Immun Date: 2019-03-25 Impact factor: 3.441
Authors: Juno Thomas; Nevashan Govender; Kerrigan M McCarthy; Linda K Erasmus; Timothy J Doyle; Mushal Allam; Arshad Ismail; Ntsieni Ramalwa; Phuti Sekwadi; Genevie Ntshoe; Andronica Shonhiwa; Vivien Essel; Nomsa Tau; Shannon Smouse; Hlengiwe M Ngomane; Bolele Disenyeng; Nicola A Page; Nelesh P Govender; Adriano G Duse; Rob Stewart; Teena Thomas; Deon Mahoney; Mathieu Tourdjman; Olivier Disson; Pierre Thouvenot; Mylène M Maury; Alexandre Leclercq; Marc Lecuit; Anthony M Smith; Lucille H Blumberg Journal: N Engl J Med Date: 2020-02-13 Impact factor: 91.245