Download Exposure Response Plan for Laboratory Handling of Listeria

OccupationalMedicine
201Plageman,Corvallis,OR97331-5801
Phone541-737-7566Confidentialfax541-737-9694
Email:[email protected]
ExposureResponsePlanforLaboratoryHandlingofListeriamonocytogenes
BackgroundInformation:
L.monocytoenesisamotilegram-positiverod.Itproducesdiseaseandasymptomaticcarriersinboth
humansandanimals.Theorganismhasbeenisolatedfromsoil,animalfeedaswellascontaminated
humanfoodandsurfacesoffoodprocessingequipment.Thediseaseistermedlisteriosis.Mosthuman
infectionsfollowconsumptionofcontaminatedrawfoods.Refrigerationdoesnotslowgrowthof
bacteriasignificantly.Skinandeyecontacthaveledtooccupationallyacquiredinfections.Transplacental
infectionscanresultinmiscarriage,prematuredelivery,stillbirthorneonataldeath.
Listeriosisinpregnancy:Occursmostlyduringthethirdtrimester,andischaracterizedbya“flulike”
illnesswithsymptomssuchasfever,chills,malaise,arthralgia,backpain,anddiarrhea.Inmanycases
theinfectionissubclinicalorunapparent;however,intrauterineinfectionofthefetuscanleadtofetal
death,spontaneousabortion,prematuredelivery,orthebirthofafetusthatdiesshortlyafterbirth.
Survivingnewbornswithlisteriosisareoftenclassifiedas“earlyonset”or“lateonset”.Earlyonset
neonatallisteriosisduetotransplacentalinfectionoftenpresentsaspneumoniaand/orsepsis.Severe
diseasecanresultinwidespreadgranulomas(granulomatosisinfantisepticum).Lateonsetneonatal
listeriosisoccursfrominfectionduringbirth,withneonatesshowingsymptomsofmeningitisoneto
severalweeksafterbirth.Inbothearlyandlateonsetneonatallisteriosis,themortalityraterangesfrom
20to30%.
ListeriosisoftheCNS:Meningitisisthemostfrequentlyrecognizedlisterialinfection.Common
symptomsoflisteriosisoftheCNSincludehighfever,nuchalrigidity,tremorand/orataxia,andseizures.
Themostcommonformofnon-meningiticformofCNSlisteriosisisencephalitisinvolvingthebrainstem
(rhombencephalitis).
Febrilegastroenteritis:Anon-invasiveformoflisteriosisthatmanifestsassymptomstypicalof
gastroenteritis,forexample,fever,diarrhea,andvomiting.
Glandularlisteriosis:Resemblesinfectiousmononucleosiswithswellingofthesalivaryglandsandnuchal
lymphnodes.
Locallisteriosis:Canmanifestaspapulesandpustulesonthehandsandarmsfollowingdirectcontact
withinfectiousmaterial,andcanbeaccompaniedbyconstitutionalsymptoms(fever,myalgia,and/or
headache).
Typhoidlisteriosis:Characterizedbyhighfeverandisparticularlyfrequentinimmunocompromised
individuals.
Atypicallisteriosis:Rarecasesofhavebeendescribedwithsymptomssuchasendocarditis,purulent
(mononuclear)pleuralexudates,pneumonia,urethritis,andabscesses.
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ExposureIncident:Anyexposureoftheagenttotheeyes,noseormouth,nonintactskinorinhalationof
aersols.Diagnosisisoftendelayedbecausesymptomsaresimilartootheragents.Ifyouworkwithor
arearoundthisagent,bringthistoyourhealthcareprovider’sattention.Theinfectiousdoseisunknown
andisbelievedtovarywithbothstrainandhostsusceptibility.Labacquiredinfectionshaverarelybeen
reported.
ReportingExposureIncidents:AllexposureincidentsmustbereportedimmediatelytothePrincipal
Investigator/labsupervisorandseekimmediatemedicalevaluation.Wheneverthereisanaccident
involvingListeria,theBiosafetyOfficermustbenotified.
Pre-exposureHealthScreening:
PriortobeginningworkwithoraroundListeria,thePIoranEmployeeHealthProfessionalwillinform
theworkeroftherisksandsymptomsofexposure.Listeriosisprimarilyaffectsolderadults,pregnant
women,newborns,andadultswithweakenedimmunesystems.Basedontheseriousnessoftheeffects,
pregnantwomenmayconsideravoidingoccupationalexposure.Workerswithadditionalconcernsabout
pre-existingmedicalconditionsshouldscheduleanindividualappointmentwiththeOccupational
Medicinephysicianbycalling541-737-7566.Note:ImmunizationforListeriaisnotavailable.
ThefollowingdiseasesandmedicationsareriskfactorsforListeriainfection,mostofwhichare
associatedwithatleastsomedegreeofimmunosuppression:
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Glucocorticoidtherapy
Hematologicmalignancies
Solidtumors
Organtransplantation(especiallyrenal)
AIDS
Treatmentwithtumornecrosisfactor-alphaantagonists
Diabetesmellitus
End-stagerenaldisease(includinghemodialysisandperitonealdialysis)
Ironoverload
Collagen-vasculardiseases
Otherseriouschronicnonmalignantdiseases
Liverdiseaseandalcoholism
Pregnantwomenare20timesmorelikelytobecomeinfectedthannon-pregnanthealthyadults.
Infectioncanoccuratanytimeduringpregnancy,butitismostcommonduringthethirdtrimester
whentheimmunesystemissomewhatsuppressed.Discussionwithahealthcareprovidedis
recommended.Useofantacidsandmedicationsthatblockgastricacidproductionincreasestheriskof
infection.Self-identificationandsubsequentdiscussionasnotedaboveshouldbeconsidered.
Precautions:
Labcoat.Gloveswhendirectskincontactwithinfectedmaterialsoranimalsisunavoidable.Eye
protectionmustbeusedwherethereisaknownorpotentialriskofexposuretosplashes.Allprocedures
thatmayproduceaerosols,orinvolvehighconcentrationsorlargevolumesshouldbeconductedina
biologicalsafetycabinet(BSC).Theuseofneedles,syringes,andothersharpobjectsshouldbestrictly
limited.Additionalprecautionsshouldbeconsideredwithworkinvolvinganimalsorlargescale
activities.
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AfteranExposureIncidentOccurs:
ImmediateActionbyRouteofExposure:
• Needlestick,AnimalBiteorLaceration:Washtheareawithsoapandrunningwater.
• Mucousmembranes(eye,nose,mouth):Ifcontaminatedmaterialissplashedorsprayed
contaminatingtheeyes,noseormouth:Flushtheeyesfor10-15minutes.Rinsemouthoutwith
cleanwateranddonotswallow.
• Inhalation:Ifcontaminatedmaterialsareaerosolizedoutsideofprimarycontainmentand
potentiallyinhaled,rinsemouthtwiceexpellingtherinsate.Donotswallow.
MedicalEvaluationandFollow-up:
• Followingtheexposureandimmediateactionsstatedabove,facultyandstaffshouldcontactthe
CorvallisClinicduringbusinesshoursat541-753-1785or1-866-209-7711afterbusinesshours.
StudentworkersshouldbeevaluatedatStudentHealthServicesassoonaspossiblebythe
OccupationalHealthPhysicianandcontactOSUOccupationalMedicineat541-737-7566.Suchcases
willbehandledasapossiblelaboratory-acquiredlisteriosis.
SignsandSymptomsofDisease:
• Influenzalikesymptomsincludingfeverandchills
• Nausea/vomiting
• Pregnantwomenmayexperiencemildflu-likesymptoms,headaches,muscleaches,fever,
nausea,andvomiting.Iftheinfectionspreadstothenervoussystemitcancausestiffneck,
disorientation,orconvulsions.
Theincubationperiodisvariablewithamedianof3weeksandarangeof3-70days.
PLEASENOTE:Workersmustbeawareoftheremarkablylongincubationperiodoflisteriosis,as
symptomsmayoccurmonthsafteranexposure.Ifanexposedindividualexperiencessignsorsymptoms
oflisteriosis,immediatelynotifythePIandthecampusBiosafetyOfficerandbeevaluatedbya
physician.Themoreseriouscasesoflisteriosismaytakeonetosixweekstodevelop.Thesecasesmay
resultinmeningitis(braininfections)andsepticemia(bacteriainthebloodstream).Bothhaveahigh
mortalityrate.
Post-exposureProphylaxis:
Thereiscurrentlynopostexposurepre-symptomprophylaxisforlisteriosis.
OregonDepartmentofPublicHealthclassifieslisteriosisasareportabledisease.Itmustbereportedto
theLocalBoardofHealthimmediatelybytheattendingphysician.Thisdiseaseisalsoreportableonthe
nationallevel.IfanemployeedevelopssignsandsymptomsassociatedwithListeriaexposureinthe
absenceofanexposureincident,thePIandBiosafetyOfficershallbenotifiedimmediately.Isolated
infectionwillbeconsideredlaboratory-acquireduntilprovenotherwise.
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