Preußel Karina, Milde-Busch Astrid, Schmich Patrick, Wetzstein Matthias, Stark Klaus, Werber Dirk
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
PLoS One. 2015 Nov 23;10(11):e0142986. doi: 10.1371/journal.pone.0142986. eCollection 2015.
Non-pregnancy associated (N-PA) listeriosis, caused by Listeria monocytogenes, is a rare but severe disease, and is predominantly food-borne. Most cases appear sporadic and their infection vehicle remains unknown. Incidence has increased since 2008 in Germany. We aimed to identify underlying conditions and foods associated with sporadic N-PA listeriosis in Germany. We performed a nationwide case-control study from March 2012-December 2013. Cases were sporadic N-PA listeriosis patients notified to public health. Control subjects were age (40-65 years, 66-75 years, ≥ 76 years) frequency-matched persons from a nationwide random telephone sample. A structured questionnaire collected information on underlying diseases, therapies and >60 food items. We conducted multivariable logistic regression analysis, adjusting for host factors identified by causal diagram theory, and calculated population attributable fractions. We enrolled 109 cases and 1982 controls. Cases' median age was 69 years, 55% were male, 44% received immunosuppressive therapy within 3 months prior to illness onset; a further 28% had at least one immunocompromising disease. In multivariable analysis, immunosuppressive therapy (OR 8.8, 95%CI 4.9-15.6), immunocompromising disease (OR 2.7; 95%CI 1.4-5.2), gastric acid suppression (OR 3.0; 95%CI 1.4-6.3), the consumption of cold cooked sausages (OR 2.6; 95%CI 1.6-4.4), the preferred consumption of packaged cheese (OR 2.1; 95%CI 1.3-3.5) and pre-sliced cheese (OR 2.2; 95%CI 1.3-3.7) were significantly associated with N-PA listeriosis. These foods accounted for 59% of all cases. Typical high risk foods, e.g. cold seafood, certain types of cheeses, tended to be negatively associated with disease. In conclusion, immunosuppressive therapy and frequently consumed ready-to-eat foods are the main risk factors for sporadic N-PA listeriosis in Germany. To reduce their risk, immunocompromised persons should consume the identified foods well before the 'use-by' date. The microbiological criteria for Listeria monocytogenes in ready-to-eat foods may insufficiently protect persons who are markedly immunocompromised.
由单核细胞增生李斯特菌引起的非妊娠相关（N-PA）李斯特菌病是一种罕见但严重的疾病，主要通过食物传播。大多数病例呈散发性，其感染源尚不清楚。自2008年以来，德国的发病率有所上升。我们旨在确定与德国散发性N-PA李斯特菌病相关的潜在状况和食物。我们在2012年3月至2013年12月期间进行了一项全国性病例对照研究。病例为向公共卫生部门报告的散发性N-PA李斯特菌病患者。对照对象是来自全国随机电话样本中按年龄（40 - 65岁、66 - 75岁、≥76岁）频率匹配的人员。一份结构化问卷收集了有关基础疾病、治疗方法和60多种食物的信息。我们进行了多变量逻辑回归分析，根据因果图理论调整宿主因素，并计算人群归因分数。我们纳入了109例病例和1982例对照。病例的中位年龄为69岁；55%为男性；44%在发病前3个月内接受过免疫抑制治疗；另有28%患有至少一种免疫功能低下疾病。在多变量分析中，免疫抑制治疗（比值比8.8，95%置信区间4.9 - 15.6）、免疫功能低下疾病（比值比2.7；95%置信区间1.4 - 5.2）、胃酸抑制（比值比3.0；95%置信区间1.4 - 6.3）、食用冷熟香肠（比值比2.6；95%置信区间1.6 - 4.4）、偏好食用包装奶酪（比值比2.1；95%置信区间1.3 - 3.5）和预切片奶酪（比值比2.2；95%置信区间1.3 - 3.7）与N-PA李斯特菌病显著相关。这些食物占所有病例的59%。典型的高风险食物，如冷海鲜、某些类型的奶酪，往往与疾病呈负相关。总之，免疫抑制治疗和经常食用即食食品是德国散发性N-PA李斯特菌病的主要危险因素。为降低风险，免疫功能低下的人应在“保质期”之前尽早食用已确定的食物。即食食品中单核细胞增生李斯特菌的微生物标准可能不足以保护明显免疫功能低下的人群。
