An Outbreak of Type 4b Listeria monocytogenes Infection Involving Patients From Eight Boston Hospitals

doi:10.1001/archinte.1986.00360150134016

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Vol. 146 No. 3, March 1986

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An Outbreak of Type 4b Listeria monocytogenes Infection Involving Patients From Eight Boston Hospitals

John L. Ho, MD; Kathryn N. Shands, MD; Gerald Friedland, MD; Paul Eckind, MPH; David W. Fraser, MD

Arch Intern Med. 1986;146(3):520-524.

Abstract

• During September and October 1979,23 patients admittedto hospitals in the Boston area had systemic Listeria monocytogenesinfection. Twenty (87%) of these isolates were L monocytogenestype 4b, whereas only nine (33%) of the isolates serotyped duringthe preceding 26 months had been 4b. Patients with type 4b Listeriainfection during the epidemic period (case patients) differedfrom patients with sporadic Listeria infection in the precedingtwo years in that more of the case patients had hospital-acquiredinfection (15/20 vs 4/18), had received antacids or cimetidinebefore the onset of listeriosis (12/20 vs 3/18), and had gastrointestinaltract symptoms that began at the same time as fever (17/20 vs4/18). In addition, more case patients took antacids or cimetidinecompared with patients matched for age, sex, and date of hospitalization(12/20 vs 10/40). Three foods were preferred by case patientsmore frequently than by control patients: tuna fish, chickensalad, and cheese. However, the only common feature appearedto be the serving of these foods with raw celery, tomatoes,and lettuce. The raw vegetables may have been contaminated withListeria, which was able to survive ingestion because of gastricacid neutralization and subsequently to cause enteritis, bacteremia,and meningitis in susceptible hosts. However, we cannot excludepasteurized milk as a source of this outbreak.

(Arch Intern Med 1986;146:520-524)

Author Affiliations

From the Bacterial Diseases Division and Hospital Infections Program, Center for Infectious Disease, Centers for Disease Control, Atlanta (Dr Ho); Emory University School of Medicine, Atlanta (Dr Shands); Montefiore Hospital, Albert Einstein College of Medicine, Bronx, NY (Dr Friedland); Massachusetts State Department of Public Health, Boston (Mr Eckind); and Swarthmore (Pa) College (Dr Fraser). Dr Ho is now with the Department of Medicine, New England Medical Center, Boston.

Footnotes

Accepted for publication May 28, 1985.

Reprint requests to Epidemic Investigations Branch, HospitalInfections Program, Bldg 1, Room 5044, Center for InfectiousDisease, Centers for Disease Control, Atlanta, GA 30333 (DrWilliam Martone).

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