Læknablaðið - 15.08.1995, Page 9

LÆKNABLAÐIÐ 1995; 81
589
Listeríósis í mönnum á íslandi
á árunum 1978-1994
Ólafur Steingrímsson11, Ýr Sigurðardóttir21, Kristín E. Jónsdóttir11, Karl G. Kristinsson11,
Sigurður B. Þorsteinsson2’
Steingrímsson Ó, Sigurðardóttir Ý, Jónsdóttir KE,
Kristinsson KG, Þorsteinsson SB
Human listeriosis diagnosed in Iceland 1978-1994
Læknablaðið 1995; 81: 589-93
Listeriosis has been recognised in Iceland, as a dis-
tinct disease entity in sheep called silage disease
(votheysveiki), since 1910. The use of silage was
introduced in Iceland in the latter part of the 19th
century. Because of the climatic conditions it came
into widespread use and the connection between
silage and listeriosis was first demonstrated in Ice-
land by Pálsson et al. The first case of human liste-
riosis was diagnosed in 1961. The diease was not
diagnosed again untill 1978 when four cases were
identified. In the period between 1978 and 1994 L.
monocytogenes was isolated from 36 patients, 11
males and 25 females. During this period the pop-
ulation of Iceland grew from 224.384 to 264.919. If
mother and child are counted as one the incidence is
approximately 8.3 per million per year. There were
nine cases of neonatal infections, nine cases involv-
ing pregnant women, 13 cases of immunosuppressed
patients and five patients were previously healthy.
There were four miscarriages. The patients received
conventional treatment of ampicillin and aminogly-
coside or in one case chloramphenicol. All neonates
but two survived. One older patient with meningitis
died and 3 severely immunocompromised patients
died. All of the strains were of the most common
serotypes, 4b, l/2a and l/2b. The different serotypes
were not evenly distributed during the study period.
During the years 1978-1984 only one of 13 isolates
was serotype l/2a and the rest was 4b. On the other
hand all but three strains isolated since 1985 were
either l/2a or l/2b. During the first part of the study
Frá 11 sýklafræðideild og 21 lyflækningadeild Landspítalans.
Fyrirspurnir, bréfaskrittir: Ólafur Steingrímsson, sýklafræði-
deild Landspítalans, Pósthólf 1465,101 Reykjavík.
period the majority of cases involved neonates or
pregnant women but during the second part most of
the patients were old or immunocompromised.
Nothing is known about the source of the infection
in any of the patients except in one neonate which
was considered to be nosocomially infected.
Aknowledgement
The authors would like to thank Professor Jac-
ques Bille at the National Reference Center for
Listeria in Lausanne, Switzerland, for serotyping
the Listeria monocytogenes strains.
Ágrip
Listeríósis er þekktur sjúkdómur í sauðfé á
íslandi frá því snemma á þessari öld. Fyrstu
sýkingu í mönnum hér á landi var lýst 1961, en
frá árinu 1978 hafa mörg tilfelli greinst.
Markmið þessarar rannsóknar var að meta
tíðni sjúkdómsins á Islandi og kanna afdrif
sjúklinganna. A þeim 17 árum sem rannsóknin
náði til, var Listeria monocytogenes einangruð
frá 36 einstaklingum, sem teljast 34 tilfelli ef
nýfætt barn og móðir eru talin sem eitt. Sam-
kvæmt því telst nýgengi tæplega 8,3 á hverja
milljón íbúa á ári. Karlar voru 11 en konur 25.
Níu sýkingar voru í nýburum (sex fyrirburar),
níu á meðgöngu og 11 í ónæmisbældum sjúk-
lingum. Fimm sjúklinganna höfðu áður verið
hraustir. Árangur meðferðar þeirra, sem ekki
höfðu alvarlega ónæmisbælingu, var góður,
dánartíðni var lág og aðeins tveir nýburanna
dóu. Þrír sjúklingar með ónæmisbælingu og
einn aldraður sjúklingur með heilahimnubólgu
af völdum L. monocytogenes létust.
Allir L. monocytogenes stofnar nema einn,
sem ræktuðust á íslandi á árunum 1978-1993,
voru stofngreindir í Sviss. Þeir voru af þeim
þremur stofngerðum sem eru algengastar: 4b,
l/2a og l/2b. Ekki er enn vitað hvaða stofn-
gerðir greindust 1994. Athyglisvert er hve mikil
breyting varð á stofngerðum á tímabilinu sem