title: Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study.
abstract: Listeriosis is a severe foodborne infection and a notifiable disease in France. We did a nationwide prospective study to characterise its clinical features and prognostic factors.
  
  
  
  MONALISA was a national prospective observational cohort study. We enrolled eligible cases declared to the National Reference Center for Listeria (all microbiologically proven) between Nov 3, 2009, and July 31, 2013, in the context of mandatory reporting. The outcomes were analysis of clinical features, characterisation of Listeria isolates, and determination of predictors of 3-month mortality or persisting impairment using logistic regression. A hierarchical clustering on principal components was also done for neurological and bacteraemic cases. The study is registered at ClinicalTrials.gov, number NCT01520597.
  
  
  
  We enrolled 818 cases from 372 centres, including 107 maternal-neonatal infections, 427 cases of bacteraemia, and 252 cases of neurolisteriosis. Only five (5%) of 107 pregnant women had an uneventful outcome. 26 (24%) of 107 mothers experienced fetal loss, but never after 29 weeks of gestation or beyond 2 days of admission to hospital. Neurolisteriosis presented as meningoencephalitis in 212 (84%) of 252 patients; brainstem involvement was only reported in 42 (17%) of 252 patients. 3-month mortality was higher for bacteraemia than neurolisteriosis (hazard ratio [HR] 0·54 [95% CI 0·41-0·69], p<0·0001). For both bacteraemia and neurolisteriosis, the strongest mortality predictors were ongoing cancer (odds ratio [OR] 5·19 [95% CI 3·01-8·95], p<0·0001), multi-organ failure (OR 7·98 [4·32-14·72], p<0·0001), aggravation of any pre-existing organ dysfunction (OR 4·35 [2·79-6·81], p<0·0001), and monocytopenia (OR 3·70 [1·82-7·49], p=0·0003). Neurolisteriosis mortality was higher in blood-culture positive patients (OR 3·67 [1·60-8·40], p=0·002) or those receiving adjunctive dexamethasone (OR 4·58 [1·50-13·98], p=0·008).
  
  
  
  The severity of listeriosis is higher than reported elsewhere. We found evidence of a significantly reduced survival in patients with neurolisteriosis treated with adjunctive dexamethasone, and also determined the time window for fetal losses. MONALISA provides important new data to improve management and predict outcome in listeriosis.
  
  
  
  Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: caroline.charlier@pasteur.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Charlier
authors.affiliation: Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, METHODS Team, UMR 1153, INSERM, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: Élodie
authors.initials: É
authors.lastname: Perrodeau
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Leclercq
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Cazenave
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Pilmis
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Henry
authors.affiliation: Denis Diderot University, Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lopes
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France.
authors.forename: Mylène M
authors.initials: MM
authors.lastname: Maury
authors.affiliation: Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Moura
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Port Royal Maternity, Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France.
authors.forename: Hélène Bracq
authors.initials: HB
authors.lastname: Dieye
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Thouvenot
authors.affiliation: Institut Pasteur, Center for Translational Science, ICAReB Biobanking Platform, Paris, France.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Ungeheuer
authors.affiliation: Infectious Disease Department, The French Public Health Agency, Saint Maurice, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Tourdjman
authors.affiliation: Infectious Disease Department, The French Public Health Agency, Saint Maurice, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Goulet
authors.affiliation: Infectious Disease Department, The French Public Health Agency, Saint Maurice, France.
authors.forename: Henriette
authors.initials: H
authors.lastname: de Valk
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, METHODS Team, UMR 1153, INSERM, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: French National Reference Center and WHO Collaborating Center for Listeria, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Paris, France; Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: marc.lecuit@pasteur.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005517:Foodborne Diseases / Q000382:microbiology; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology; D018445:Infectious Disease Transmission, Vertical; D008089:Listeria monocytogenes / Q000145:classification / Q000302:isolation & purification*; D008088:Listeriosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D019221:Mandatory Reporting; D008590:Meningoencephalitis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors