After overseeing a routine, uneventful liver transplant in a 52-year-old man in July 2013 at a hospital in Marseille, France, Dr. Catherine Sartor and her colleagues expected him to fully recover without complications. When the patient’s liver condition began worsening five days after surgery, they suspected his body was rejecting the new organ and adjusted his treatment accordingly. But just nine days after surgery, the patient passed away. Blood samples revealed that he was suffering from a post-surgery invasive infection of Listeria monocytogenes, a deadly bacteria most commonly associated with foodborne illness. Surprised by the revelation, the doctors tested any possible source of Listeria from the hospital, including the food served to the patient and blood cultures from the donor liver. When all of those tests came back negative, the hospital staff was left to conclude that the man came in contact with Listeria outside of the hospital — almost certainly from a food source. He was either a carrier of Listeria who wasn’t showing symptoms, or he had been infected just prior to surgery and his symptoms had not yet developed. Since the French patient’s death, Sartor and her colleagues have found four other confirmed cases of invasive Listeria infections in liver transplant recipients within a week of surgery. At the same time, the national surveillance system in the U.K. has identified liver disease as a “major risk factor” for Listeria infection, and the European Centre for Disease Prevention and Control has tracked a rise in Listeria infection across Europe between 2008 and 2012. As a result, the doctors have begun to recommend food safety advice to all patients on the wait list for a liver transplant and for the first six months following surgery, according to a paper they published in the medical journal The Lancet. Sartor told Food Safety News they’re recommending that doctors in the U.S. and around the world also start supplying food safety advice to liver transplant patients if they aren’t already doing so. That food safety advice includes avoiding foods considered high-risk for Listeria contamination, according to the U.S. Centers for Disease Control and Prevention (CDC):
- Uncooked meats and vegetables
- Raw milk or cheese made from raw milk
- Certain soft cheeses made from pasteurized milk, such as queso fresco
- Processed or ready-to-eat deli meats, including hot dogs
- Smoked seafood
The advice is similar to warnings given to pregnant women looking to avoid Listeria due to its high fatality rate in unborn children. “In our experience, transplant candidates accepted and applied these measures well,” Sartor said. “These food safety measures can easily be explained by transplant specialists to any patient.” CDC estimates that Listeria monocytogenes causes approximately 1,600 illnesses and 260 deaths in the U.S. each year. It’s widely considered one of the most deadly foodborne pathogens.