Listeriosis in pregnancy: survey of British Columbia practitioners' knowledge of risk factors, counseling practices, and learning needs.

OBJECTIVE: To determine the knowledge, counseling practices, and learning needs of practitioners in British Columbia regarding risk factors for listeriosis in pregnancy. DESIGN: A 1-page, mailed, self-administered, anonymous questionnaire. SETTING: British Columbia. PARTICIPANTS: A total of 827 practitioners (614 family physicians, 93 midwives, and 120 family practice residents) were sent the questionnaire. MAIN OUTCOME MEASURES: Awareness of listeriosis, knowledge of the risk factors for listeriosis, practices for counseling pregnant women, practitioners' learning needs, and provider and practice characteristics. RESULTS: A total of 340 practitioners (41%) completed the questionnaire. While most (88%) physicians and midwives had heard of listeriosis, few (18%) were aware that infection was more common during pregnancy. One-third (33%) of practitioners counseled pregnant women about the risk factors for listeriosis. The main reasons for not providing such counseling were lack of knowledge and the perception that listeriosis was rare and not an important concern for pregnant women. Rates of counseling were highest among midwives (84%) and lowest among physicians practising outside the Lower Mainland of British Columbia (12%). Of those practitioners providing prenatal care, 47% counseled pregnant women about the risks of unpasteurized milk and 41% counseled women about the risks of consuming soft cheese; few counseled about the risks of consuming deli meat or raw hot dogs (25%), unwashed fruit and vegetables (12%), or refrigerated smoked seafood (6%). CONCLUSION: Most prenatal care providers in British Columbia are unaware of the risk factors for listeriosis or its propensity for pregnant women and do not counsel their pregnant patients about these risks.

Listeriosis in patients at a comprehensive cancer center, 1955-1997.

Listeria monocytogenes infection occurred in 94 patients during 1955-1997 at Memorial Sloan-Kettering Cancer Center. The incidence was 0.5 (1955-1966), 0.96 (1970-1979), and 0.14 (1985-1997) cases per 1000 new admissions. Eighty-five patients (90%) were bacteremic, and 34 (36%) had evidence of intracranial infection. In 91 patients with cancer, 70 (77%) received chemotherapy for advanced or relapsed malignancy (n=51; 56%); 64 (68%) received corticosteroids. Breast cancer was the most common solid-organ cancer (n=14; 45%), and 34 (36%) had preexisting advanced liver disease. In 14 (39%) of 37 patients who died of listeriosis, death occurred within 48 h of L. monocytogenes isolation. Four (80%) of 5 patients with extracranial foci of infection died of their infection, compared with 33 (37%) of 89 patients with isolated bacteremia and/or intracranial infection (odds ratio, 2.34; P=.05). Most infections (60%) were due to L. monocytogenes serotype 1/2, and the remainder (40%) were due to serovar 4b. Listeriosis in these patients with cancer occurred most often in individuals receiving antineoplastic therapy for advanced or relapsed malignancy and systemic corticosteroids. The presence of advanced liver disease may have increased the risk of systemic listeriosis in susceptible patients with underlying cancer.

Protective effect of a traditional Japanese medicine, Bu-zhong-yi-qi-tang (Japanese name: Hochu-ekki-to), on the restraint stress-induced susceptibility against Listeria monocytogenes.

In this study, the effect of traditional Japanese (Chinese) medicine, Bu-zhong-yi-qi-tang (Japanese name: Hochu-ekki-to, HOT), on the restraint stress treatment (RST)-induced susceptibility against Listeria monocytogenes (L. monocytogenes) was examined. When RST was performed every day for 10 h from the day of infection, the bacterial numbers were increased at 3 and 5 days after the infection. Oral pretreatment with HOT for 7 days prevented such increases. Pretreatment with HOT prevented the suppression of antigen-specific IFN-gamma production by RST. HOT also prevented suppression of macrophage accumulation, including MHC-class II positives, in the peritoneal cavity and their bactericidal activity by RST. HOT suppressed the serum corticosterone level elevated by RST in infected mice. Taken together, the suppression of corticosterone using HOT participates in the prevention of suppressions of the bactericidal activity of macrophages, migration of macrophages and antigen-specific IFN-gamma production of Th1 cells by RST. Our findings suggest that HOT is a useful drug for patients suffering from stress disease to reduce the susceptibility to bacterial infection.

Listeria awareness among new mothers in Western Australia.

OBJECTIVE: To assess awareness, knowledge and behaviour relating to Listeria among recent mothers (12 weeks post-partum) in Western Australia and determine the usefulness of a Listeria information pamphlet. METHOD: A postal survey of a random 10% sample of Western Australian mothers whose babies were born between 1 January and 13 April 1997. RESULTS: Of the 680 women surveyed, 509 (75%) responded and 451 (89%) respondents had heard of Listeria. The 11% who had not heard of Listeria had higher odds of living in a rural area, speaking a foreign language at home, having less formal education, being younger, having had an unplanned pregnancy, and having not taken folic acid supplements. Respondents who had seen the Listeria pamphlet had greater odds of correctly identifying foods at risk of Listeria. Of the women who had heard of Listeria, 90% had avoided certain foods during their pregnancy. Risk factors for not changing eating behaviour were similar to those for not having heard of Listeria. CONCLUSIONS: Factors associated with not having heard of Listeria, not having seen the pamphlet and not having changed behaviour were similar, suggesting that there may be a group of women who are less likely to be aware of Listeria or other health issues and/or may be resistant to health-related behaviour changes. IMPLICATIONS: The Listeria pamphlet is an effective medium for educating pregnant women about Listeria. Rural, young, single and non-English speaking background women may require a different or supplementary approach.