Büla C J, Bille J, Glauser M P
Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Clin Infect Dis. 1995 Jan;20(1):66-72. doi: 10.1093/clinids/20.1.66.
This article describes 57 cases of listeriosis that occurred in adults in western Switzerland during an outbreak associated with the consumption of a soft cheese. Twenty-one percent of the cases were of bacteremia, 40% were of meningitis, and 39% were of meningoencephalitis. Overall, 42% of the patients had an underlying disease and 54% were > 65 years of age. Patients with bacteremia were significantly older than those with meningitis or meningoencephalitis (median ages, 75, 69, and 55 years, respectively). The epidemic strain, defined by phage typing, was isolated in three-quarters of the listerial cases observed during the epidemic period and did not appear to differ significantly from the nonepidemic strains in terms of virulence. The overall mortality associated with the 57 cases was 32%. Among the patients' characteristics, age and type of clinical presentation were independent predictors of death in a multivariate logistic regression model (pseudo-r2 [coefficient of determination], .26; both P values < .05), and a presentation of meningoencephalitis was associated with an increased death risk (odds ratio, 6.5; 95% confidence interval, 1.1-39.5; P < .05). Neurological sequelae developed in 30% of the survivors of CNS listeriosis.
本文描述了瑞士西部一次因食用软奶酪引发的疫情期间发生在成人中的57例李斯特菌病病例。21%的病例为菌血症，40%为脑膜炎，39%为脑膜脑炎。总体而言，42%的患者有基础疾病，54%的患者年龄超过65岁。菌血症患者的年龄显著高于脑膜炎或脑膜脑炎患者（中位年龄分别为75岁、69岁和55岁）。通过噬菌体分型确定的流行菌株，在疫情期间观察到的四分之三的李斯特菌病例中分离得到，在毒力方面似乎与非流行菌株没有显著差异。57例病例的总体死亡率为32%。在患者特征中，年龄和临床表现类型是多变量逻辑回归模型中死亡的独立预测因素（伪r2[决定系数]，0.26；两个P值均<0.05），脑膜脑炎表现与死亡风险增加相关（比值比，6.5；95%置信区间，1.1 - 39.5；P<0.05）。30%的中枢神经系统李斯特菌病幸存者出现了神经后遗症。
