WEBVTT - Ep 114 Listeria: It put dairy on the map

0:00:00.320 --> 0:00:03.840
<v Speaker 1>Hey, everyone, just wanted to give you a quick content

0:00:04.000 --> 0:00:07.160
<v Speaker 1>warning here that the first hand account for this episode

0:00:07.520 --> 0:00:10.559
<v Speaker 1>does include the death of a parent, so if you

0:00:10.560 --> 0:00:13.440
<v Speaker 1>would like to move past that, you can skip ahead

0:00:13.440 --> 0:00:16.279
<v Speaker 1>to about eleven minutes and fifteen seconds in.

0:00:19.560 --> 0:00:23.000
<v Speaker 2>Hi. My name is Denise, and I'm here today to

0:00:23.079 --> 0:00:26.320
<v Speaker 2>talk about the story of my mom and what she

0:00:26.400 --> 0:00:30.880
<v Speaker 2>went through with listeria. As a little backstory, my mom

0:00:31.120 --> 0:00:35.120
<v Speaker 2>turned eighty years old in June of twenty twenty two.

0:00:35.360 --> 0:00:40.199
<v Speaker 2>She was very, very vibrant. She still worked, she golfed,

0:00:40.880 --> 0:00:44.919
<v Speaker 2>she was exceptionally active. She some more backstory. She had

0:00:45.000 --> 0:00:48.600
<v Speaker 2>a regular, routine, normal colonoscopy in June that showed no

0:00:48.760 --> 0:00:52.919
<v Speaker 2>ulcerations at all. This is important. A little later in August,

0:00:53.440 --> 0:00:57.319
<v Speaker 2>she started having some excruciating headaches after she would eat,

0:00:57.840 --> 0:01:01.560
<v Speaker 2>and when she saw her doctor, they diagnosed her with

0:01:01.560 --> 0:01:05.080
<v Speaker 2>a condition called temporal arteritis and started her on high

0:01:05.080 --> 0:01:08.480
<v Speaker 2>dose steroids and methotrex eight. At the same time, she

0:01:08.640 --> 0:01:12.640
<v Speaker 2>had a long standing trip planned August eighteenth through October

0:01:12.720 --> 0:01:15.360
<v Speaker 2>ninth to go up to Washington to visit some friends

0:01:15.360 --> 0:01:18.640
<v Speaker 2>and escape the heat of the Palm Springs desert. I'm

0:01:18.640 --> 0:01:21.160
<v Speaker 2>a nurse. I've been a nurse for twenty seven years.

0:01:21.640 --> 0:01:24.320
<v Speaker 2>I talked to her about the risks of continuing to

0:01:24.360 --> 0:01:27.039
<v Speaker 2>go on this vacation because of the immunosuppression that the

0:01:27.080 --> 0:01:29.880
<v Speaker 2>steroids were causing, and I think because of the COVID

0:01:29.880 --> 0:01:33.080
<v Speaker 2>fatigue for the past several years and not seeing her friends.

0:01:33.560 --> 0:01:36.840
<v Speaker 2>She wasn't really interested in putting that off. She had

0:01:36.840 --> 0:01:39.240
<v Speaker 2>people to see, things to do, and golf to play,

0:01:39.760 --> 0:01:44.679
<v Speaker 2>and away she went fast forward up until September twenty fourth.

0:01:45.040 --> 0:01:48.640
<v Speaker 2>She texted me that she had gained two pounds, She'd

0:01:48.680 --> 0:01:50.760
<v Speaker 2>eaten a great big bowl of ice cream, and was

0:01:50.800 --> 0:01:53.880
<v Speaker 2>having some macaroni and cheese for dinner. On the twenty eighth,

0:01:54.000 --> 0:01:55.960
<v Speaker 2>she called because she said that she had started not

0:01:56.040 --> 0:01:58.920
<v Speaker 2>feeling so good. So then the next day was Thursday,

0:01:58.960 --> 0:02:01.120
<v Speaker 2>the twenty ninth, she called me in the morning and

0:02:01.160 --> 0:02:03.800
<v Speaker 2>said that she was feeling worse, and she did go

0:02:03.800 --> 0:02:06.960
<v Speaker 2>ahead and cancel her lunch date that day. So Friday,

0:02:07.000 --> 0:02:10.280
<v Speaker 2>September thirtieth, I received a call at three o'clock in

0:02:10.320 --> 0:02:14.200
<v Speaker 2>the afternoon from the people she was staying with. She'd

0:02:14.240 --> 0:02:16.680
<v Speaker 2>been laying on the couch all day, had not eaten

0:02:16.760 --> 0:02:19.440
<v Speaker 2>any food and only taken SIPs of water, had a

0:02:19.480 --> 0:02:23.320
<v Speaker 2>low grade temp, negative COVID tests, and because I'm down

0:02:23.360 --> 0:02:26.000
<v Speaker 2>here outside of Palm Springs, I said it was a

0:02:26.040 --> 0:02:28.760
<v Speaker 2>good idea to take her to Virgin Care. So they

0:02:28.760 --> 0:02:31.440
<v Speaker 2>did take her in. The blood work came back and

0:02:31.560 --> 0:02:36.000
<v Speaker 2>showed that she had some impaired kidney function, borderlining on

0:02:36.080 --> 0:02:39.400
<v Speaker 2>kidney failure. She also had a really high calcium level

0:02:39.520 --> 0:02:42.399
<v Speaker 2>and a low potassium level. The doctor there, though, thought

0:02:42.440 --> 0:02:44.840
<v Speaker 2>that she was stable enough that she could just come

0:02:44.880 --> 0:02:47.200
<v Speaker 2>back in the morning and get some ivy fluids and

0:02:47.240 --> 0:02:51.160
<v Speaker 2>repeat the labs the morning of October first, they went

0:02:51.200 --> 0:02:54.919
<v Speaker 2>to the urgent Care straight away, where she got her fluids.

0:02:55.360 --> 0:02:58.239
<v Speaker 2>The doctor did advise our friends to go ahead and

0:02:58.320 --> 0:03:02.040
<v Speaker 2>take her over to the emergency department. She was checked

0:03:02.080 --> 0:03:06.440
<v Speaker 2>in entriaged about three and then because of just how

0:03:06.520 --> 0:03:08.679
<v Speaker 2>life in the er is these days, she got back

0:03:08.680 --> 0:03:10.920
<v Speaker 2>to a room at like eight thirty at night, and

0:03:10.960 --> 0:03:13.799
<v Speaker 2>the doctor saw her at ten o'clock at night. Luckily,

0:03:13.800 --> 0:03:16.600
<v Speaker 2>our friends were able to stay. They rotated staying with

0:03:16.639 --> 0:03:19.960
<v Speaker 2>her so that she wasn't just by herself, and at

0:03:20.040 --> 0:03:23.280
<v Speaker 2>three point thirty in the morning, she had a sudden

0:03:23.760 --> 0:03:30.160
<v Speaker 2>mental status change where she completely went lethargic, started reaching

0:03:30.160 --> 0:03:35.040
<v Speaker 2>at the air, not communicative, not able to speak. So

0:03:35.240 --> 0:03:38.880
<v Speaker 2>our friend Frank grabbed the nurse. They took her temperature

0:03:38.880 --> 0:03:41.720
<v Speaker 2>rectally and it was one hundred and three point four.

0:03:42.240 --> 0:03:45.200
<v Speaker 2>The staff came and drew blood cultures and she was

0:03:45.240 --> 0:03:49.200
<v Speaker 2>started on an ivy antibiotic cocktail that they do for

0:03:49.280 --> 0:03:52.560
<v Speaker 2>sepsis of unknown origin. I got on the plane to

0:03:52.600 --> 0:03:55.280
<v Speaker 2>go up to Portland at like nine o'clock in the

0:03:55.280 --> 0:03:59.200
<v Speaker 2>morning on Sunday. I arrived at the hospital at eleven am.

0:04:00.080 --> 0:04:02.920
<v Speaker 2>She looked like she was going to die when I

0:04:02.960 --> 0:04:05.560
<v Speaker 2>walked into the room. I worked eleven years in the

0:04:05.600 --> 0:04:08.400
<v Speaker 2>emergency room, and I thought, oh, this is not good.

0:04:08.520 --> 0:04:11.520
<v Speaker 2>It's not good at all. She was not responsive to

0:04:12.200 --> 0:04:15.280
<v Speaker 2>people talking to her, she was not following commands, she

0:04:15.440 --> 0:04:19.960
<v Speaker 2>was pulling at things. On Monday, the third, the infectious

0:04:20.000 --> 0:04:22.880
<v Speaker 2>disease doctor came to me about noon and said that

0:04:23.279 --> 0:04:26.960
<v Speaker 2>three of the four blood culture bottles were showing bacterial

0:04:27.000 --> 0:04:30.400
<v Speaker 2>growth of some sort, but that the microbiology text that

0:04:30.480 --> 0:04:34.240
<v Speaker 2>he knew and really trusted didn't I identify anything. So

0:04:34.360 --> 0:04:37.000
<v Speaker 2>he was really concerned that it was contaminant, which would

0:04:37.000 --> 0:04:40.360
<v Speaker 2>be really highly unusual in three out of four bottles.

0:04:40.520 --> 0:04:43.800
<v Speaker 2>So they ran what they call an extended infectious disease panel.

0:04:44.320 --> 0:04:47.640
<v Speaker 2>After she came back from her lumbar puncture, the infectious

0:04:47.640 --> 0:04:50.800
<v Speaker 2>disease doctor comes down the hall towards me and kind

0:04:50.839 --> 0:04:54.400
<v Speaker 2>of frantically gesturing at me and says, you're not going

0:04:54.480 --> 0:05:00.000
<v Speaker 2>to believe this, but she's actually got listeria and it's

0:05:00.120 --> 0:05:03.560
<v Speaker 2>her blood stream and it's also in her spinal fluid,

0:05:04.000 --> 0:05:06.839
<v Speaker 2>and this is really really bad. And it's bad not

0:05:06.920 --> 0:05:10.960
<v Speaker 2>just because, I mean, the mortality rate is exceptionally high,

0:05:11.040 --> 0:05:14.440
<v Speaker 2>but also because the antibiotics that she had been getting

0:05:14.800 --> 0:05:17.960
<v Speaker 2>are not the ones that are effective at all against lysteria.

0:05:18.800 --> 0:05:21.600
<v Speaker 2>It took until eleven o'clock at night to finally get

0:05:21.600 --> 0:05:25.680
<v Speaker 2>her started on the ampicillin. But I was still preparing

0:05:25.720 --> 0:05:28.840
<v Speaker 2>myself that my mom was going to pass. So when

0:05:28.839 --> 0:05:31.159
<v Speaker 2>I came in at six point thirty Monday morning, my

0:05:31.240 --> 0:05:35.119
<v Speaker 2>mom had little restraint mittens on her hands, and I thought,

0:05:35.160 --> 0:05:37.680
<v Speaker 2>oh my god, it's gone from bad to worse. And

0:05:37.720 --> 0:05:40.920
<v Speaker 2>she was shaking those little mittens at me, and I said, Mom,

0:05:41.040 --> 0:05:43.599
<v Speaker 2>if I take these off of you, you have to

0:05:44.080 --> 0:05:47.080
<v Speaker 2>leave your things alone. You can't pull on things. And

0:05:47.120 --> 0:05:50.480
<v Speaker 2>she made eye contact with me and she said okay,

0:05:51.400 --> 0:05:54.200
<v Speaker 2>and I thought, oh my god, she's in there. This

0:05:54.240 --> 0:05:56.320
<v Speaker 2>is a glimmer of hope. I think it could be.

0:05:56.400 --> 0:05:59.000
<v Speaker 2>It could be okay, And over the course of the day,

0:05:59.600 --> 0:06:02.719
<v Speaker 2>her mental status actually improved. She was answering yes and

0:06:02.760 --> 0:06:06.159
<v Speaker 2>no questions. I was able to transfer her out of

0:06:06.200 --> 0:06:09.200
<v Speaker 2>bed and get her on the little bedside commode to

0:06:09.279 --> 0:06:12.320
<v Speaker 2>go to the bathroom. We also discovered at that time

0:06:12.400 --> 0:06:14.839
<v Speaker 2>in her MRI that they had done of her brain

0:06:15.040 --> 0:06:17.440
<v Speaker 2>that it showed that she had four areas that were

0:06:17.480 --> 0:06:22.520
<v Speaker 2>possibly like septic ambolai from the infection. So to see

0:06:22.560 --> 0:06:26.039
<v Speaker 2>her mental status also improving like that was really amazing.

0:06:26.720 --> 0:06:30.440
<v Speaker 2>They had given her a medication called Erykstra to prevent

0:06:30.520 --> 0:06:34.320
<v Speaker 2>blood clots, and they also gave her an aspirin because

0:06:34.520 --> 0:06:37.800
<v Speaker 2>of the potential for cardiac strain. So I was a

0:06:37.800 --> 0:06:39.840
<v Speaker 2>little worried about that when they started that the day

0:06:39.880 --> 0:06:43.480
<v Speaker 2>before because of her platelet account was not super low,

0:06:43.520 --> 0:06:45.520
<v Speaker 2>but it was low enough that I was concerned about it.

0:06:45.839 --> 0:06:48.680
<v Speaker 2>So Wednesday morning, when she's talking and moving and she's

0:06:48.720 --> 0:06:50.880
<v Speaker 2>doing great, she told me that she had just never

0:06:50.920 --> 0:06:54.119
<v Speaker 2>felt so awful. And I explained to her that most

0:06:54.200 --> 0:06:57.840
<v Speaker 2>people that get as sick as she is, don't even

0:06:57.839 --> 0:07:01.240
<v Speaker 2>wake up. And she looked at me. She said, you

0:07:01.320 --> 0:07:04.159
<v Speaker 2>mean I could have died And I said, yes, mom,

0:07:04.360 --> 0:07:08.080
<v Speaker 2>it's that serious. You could have died. And she said, well,

0:07:08.120 --> 0:07:11.559
<v Speaker 2>I'm not ready to die. And I said, well, that's great,

0:07:11.640 --> 0:07:14.880
<v Speaker 2>because I'm not ready to be an orphan. Everybody was

0:07:14.920 --> 0:07:18.880
<v Speaker 2>so excited, her doctor's, the hospitalist, and the infectious disease doctor.

0:07:19.000 --> 0:07:21.480
<v Speaker 2>They were just amazed at how good she was doing.

0:07:22.280 --> 0:07:24.600
<v Speaker 2>And then at three point thirty I got her up

0:07:24.600 --> 0:07:27.680
<v Speaker 2>to the commode. As soon as she went to the bathroom,

0:07:28.160 --> 0:07:31.240
<v Speaker 2>I knew right away that there was blood. When somebody

0:07:31.280 --> 0:07:34.800
<v Speaker 2>has an intestinal bleed, it has in a past tool

0:07:34.800 --> 0:07:37.240
<v Speaker 2>it has a very very distinctive smell, and I just

0:07:37.320 --> 0:07:40.080
<v Speaker 2>knew that this was not good. And that was really

0:07:40.880 --> 0:07:43.880
<v Speaker 2>the very beginning of the end. The doctor came back

0:07:43.960 --> 0:07:46.000
<v Speaker 2>up and looked at it and he said, yeah, we're

0:07:46.000 --> 0:07:47.920
<v Speaker 2>going to hold off on transferring her off the floor.

0:07:48.320 --> 0:07:50.400
<v Speaker 2>So they did an upper endoscopy where they looked at

0:07:50.400 --> 0:07:53.880
<v Speaker 2>her stomach on the seventh and that was negative, no ulcers.

0:07:54.440 --> 0:07:58.360
<v Speaker 2>So they did do the colonoscopy and that showed that

0:07:58.520 --> 0:08:01.760
<v Speaker 2>her large intestine and all throughout her large intestine and

0:08:02.000 --> 0:08:04.880
<v Speaker 2>up into what they could see in her small intestine

0:08:05.280 --> 0:08:09.480
<v Speaker 2>was just riddled with ulcers. On the fourteenth, she really

0:08:09.880 --> 0:08:13.640
<v Speaker 2>started bleeding quite heavily and went into shock. And before

0:08:13.680 --> 0:08:17.000
<v Speaker 2>she actually went into full blown shock from this, I

0:08:17.040 --> 0:08:20.000
<v Speaker 2>had to call my daughter and tell her that if

0:08:20.000 --> 0:08:23.080
<v Speaker 2>this scan that they had just taken her for did

0:08:23.080 --> 0:08:26.440
<v Speaker 2>not show any bleeding that we could do anything about that,

0:08:26.560 --> 0:08:29.400
<v Speaker 2>her grandma was most likely going to pass away. That

0:08:29.520 --> 0:08:31.560
<v Speaker 2>was the hardest phone call I've ever had to make.

0:08:32.200 --> 0:08:34.480
<v Speaker 2>The results of that scan came back and they finally

0:08:34.480 --> 0:08:36.960
<v Speaker 2>did see that there was bleeding coming out of an

0:08:37.040 --> 0:08:41.320
<v Speaker 2>artery in her small intestine, so interventional radiology was called

0:08:41.360 --> 0:08:44.600
<v Speaker 2>in and off she went for procedure and off to ICU.

0:08:45.080 --> 0:08:48.680
<v Speaker 2>That procedure we thought was good, but then in the

0:08:48.720 --> 0:08:52.640
<v Speaker 2>morning it turned out that they had maybe stopped the

0:08:52.679 --> 0:08:55.960
<v Speaker 2>bleeding a little too well and some of her small

0:08:55.960 --> 0:08:58.880
<v Speaker 2>intestine was starting to die. So this led down the

0:08:58.960 --> 0:09:04.360
<v Speaker 2>course of a bowel resection and then reattachment, which she

0:09:04.480 --> 0:09:07.720
<v Speaker 2>did great came out of that very well. By the

0:09:07.720 --> 0:09:11.320
<v Speaker 2>twenty sixth she had had twelve units of blood, two

0:09:11.360 --> 0:09:16.720
<v Speaker 2>failed interventional radiology procedures, and three surgeries. Throughout this time,

0:09:16.760 --> 0:09:19.840
<v Speaker 2>with her in Washington with when the bleeding would stop

0:09:19.880 --> 0:09:23.520
<v Speaker 2>and it would start. Our only goal was to get

0:09:23.559 --> 0:09:27.600
<v Speaker 2>her home, to get her back to California, and trying

0:09:27.720 --> 0:09:32.200
<v Speaker 2>to navigate that when you're at a hospital system that

0:09:32.320 --> 0:09:36.599
<v Speaker 2>so eleven hundred miles from your home is exceptionally difficult.

0:09:37.240 --> 0:09:39.920
<v Speaker 2>But throughout the whole time that was our single focus,

0:09:40.280 --> 0:09:42.160
<v Speaker 2>get her home so that she could pass at her

0:09:42.240 --> 0:09:45.240
<v Speaker 2>home when it became obvious that she was not probably

0:09:45.480 --> 0:09:48.480
<v Speaker 2>going to pull through this, and thankfully we were able

0:09:48.520 --> 0:09:52.360
<v Speaker 2>to do that. On the second of November, I was

0:09:52.400 --> 0:09:54.840
<v Speaker 2>finally able to get her on an air ambulance home

0:09:55.520 --> 0:09:57.760
<v Speaker 2>to get her admitted down here at the hospital system

0:09:57.760 --> 0:10:01.199
<v Speaker 2>that I work in. I was able to have hospice

0:10:01.240 --> 0:10:04.280
<v Speaker 2>come out bring the bed and all of the equipment

0:10:04.320 --> 0:10:07.640
<v Speaker 2>here on the fourth and my dear, dear friend Julie

0:10:07.679 --> 0:10:10.080
<v Speaker 2>was with her at the hospital in the morning and

0:10:10.160 --> 0:10:13.800
<v Speaker 2>she called me and she said she's ready. She was alert,

0:10:14.320 --> 0:10:16.880
<v Speaker 2>and she knew she was in the hospital and she

0:10:17.000 --> 0:10:19.960
<v Speaker 2>was ready to come home. She has a beautiful view

0:10:20.120 --> 0:10:22.040
<v Speaker 2>at her condo here and.

0:10:21.920 --> 0:10:23.040
<v Speaker 1>She was able to see that.

0:10:24.240 --> 0:10:31.439
<v Speaker 2>And she passed away on the ninth. So we don't

0:10:31.480 --> 0:10:34.320
<v Speaker 2>know what the source was we don't know what she

0:10:34.600 --> 0:10:38.600
<v Speaker 2>ate or how she contracted this. It was a very

0:10:39.120 --> 0:10:43.200
<v Speaker 2>long month of stops and starts where we would think

0:10:43.240 --> 0:10:46.360
<v Speaker 2>the bleeding had maybe stopped, and then to have it

0:10:46.400 --> 0:10:49.360
<v Speaker 2>start again. When I told her that we had gotten

0:10:49.360 --> 0:10:51.280
<v Speaker 2>the air ambulance that we were going to be flying

0:10:51.280 --> 0:10:55.720
<v Speaker 2>home to California, she said, oh, Denise, that's wonderful. And

0:10:55.760 --> 0:10:58.959
<v Speaker 2>when she saw her sun set, she said, it's so

0:10:59.040 --> 0:11:05.080
<v Speaker 2>beautiful and she's missed every day. And thank you for

0:11:05.160 --> 0:11:47.600
<v Speaker 2>letting me share her story.

0:11:54.559 --> 0:11:58.360
<v Speaker 1>Thank you so much, Denise, like I can't imagine, and

0:11:59.000 --> 0:12:01.920
<v Speaker 1>we really appreciate you being willing to share that story,

0:12:02.080 --> 0:12:05.000
<v Speaker 1>and we know it couldn't have been easy to do,

0:12:05.320 --> 0:12:07.360
<v Speaker 1>so thank you. Yeah, thank you.

0:12:07.600 --> 0:12:12.160
<v Speaker 3>I being able to hear a story of how this

0:12:12.480 --> 0:12:15.840
<v Speaker 3>disease can really affect people and their families. It's just

0:12:15.880 --> 0:12:18.720
<v Speaker 3>so powerful, and thank you so much for being willing

0:12:18.800 --> 0:12:21.200
<v Speaker 3>to be so vulnerable and share that with us.

0:12:22.040 --> 0:12:22.240
<v Speaker 2>Hi.

0:12:22.720 --> 0:12:25.679
<v Speaker 3>I'm Aaron Welsh and I'm Erin Alman Updike and.

0:12:25.800 --> 0:12:27.840
<v Speaker 1>This is this podcast will kill you.

0:12:28.640 --> 0:12:32.239
<v Speaker 3>Today's a heavy duty topic. M hm, listeria.

0:12:32.559 --> 0:12:38.960
<v Speaker 1>Yeah, more heavy duty than I realized. It is so gnarly,

0:12:39.679 --> 0:12:43.959
<v Speaker 1>so I feel like probably many other people can relate

0:12:44.000 --> 0:12:46.800
<v Speaker 1>to this when I say that, until doing this episode,

0:12:46.840 --> 0:12:49.199
<v Speaker 1>lysteria to me was just one of those things that

0:12:49.320 --> 0:12:52.840
<v Speaker 1>pops up occasionally with like, oh, lysteria detected in this

0:12:52.920 --> 0:12:56.040
<v Speaker 1>food or that food, and be careful if you are

0:12:56.160 --> 0:12:58.720
<v Speaker 1>pregnant or you know. But it was just sort of

0:12:58.920 --> 0:13:03.040
<v Speaker 1>another food born pathogen, which is, you know, they can

0:13:03.080 --> 0:13:05.400
<v Speaker 1>be very bad. But I just sort of had lumped

0:13:05.440 --> 0:13:08.240
<v Speaker 1>it all in together with some of the other culprits

0:13:08.400 --> 0:13:10.600
<v Speaker 1>and I had no idea.

0:13:10.800 --> 0:13:14.760
<v Speaker 3>Right, I did not know the extent of it either,

0:13:15.400 --> 0:13:20.000
<v Speaker 3>even having been pregnant now twice and been like, I'm not.

0:13:19.920 --> 0:13:20.840
<v Speaker 1>Allowed to eat turkey.

0:13:20.880 --> 0:13:24.600
<v Speaker 3>I'm so upset about it. But that's what it was

0:13:24.679 --> 0:13:26.600
<v Speaker 3>to me, right, It was just like, oh, I can't

0:13:26.640 --> 0:13:30.600
<v Speaker 3>eat turkey and I'm annoyed. But I also did not

0:13:30.880 --> 0:13:37.360
<v Speaker 3>realize the extent of why, just how scary it really is.

0:13:37.600 --> 0:13:40.720
<v Speaker 3>So yeah, we're going to get into it today, we

0:13:41.000 --> 0:13:41.559
<v Speaker 3>really are.

0:13:42.880 --> 0:13:47.280
<v Speaker 1>But first things first, feels very strange to dive into

0:13:47.320 --> 0:13:51.440
<v Speaker 1>like a cocktail or quarantin any time. But yet here

0:13:51.480 --> 0:13:53.760
<v Speaker 1>we go. That's what time it is, It's what time

0:13:53.760 --> 0:13:56.080
<v Speaker 1>it is, What are we drinking this week?

0:13:56.400 --> 0:13:58.559
<v Speaker 3>We're drinking the Coldest of Cuts.

0:14:00.679 --> 0:14:03.080
<v Speaker 1>We toyed with a lot of different names for this

0:14:03.880 --> 0:14:07.640
<v Speaker 1>last episode was a dairy filled cocktail because we did

0:14:07.720 --> 0:14:10.679
<v Speaker 1>vitamin D so we couldn't do dairy again. Although my

0:14:11.160 --> 0:14:14.880
<v Speaker 1>second favorite name was don't you Dairy, which is very

0:14:14.960 --> 0:14:17.600
<v Speaker 1>good by the way I do. And then there was

0:14:17.640 --> 0:14:21.480
<v Speaker 1>like the Salami sling or the Salami sour or the

0:14:21.480 --> 0:14:25.080
<v Speaker 1>cold cut Collins. But I think I like the coldest

0:14:25.080 --> 0:14:26.880
<v Speaker 1>of cuts. I love it.

0:14:26.960 --> 0:14:29.760
<v Speaker 3>I love it, Aaron, what is in the coldest of cut?

0:14:30.280 --> 0:14:34.920
<v Speaker 1>It is a slushy or blended Arnold palmer with some

0:14:35.640 --> 0:14:37.400
<v Speaker 1>rum in there, some spiced rum.

0:14:37.840 --> 0:14:40.040
<v Speaker 3>Serve it alongside a nice turkey sandwich.

0:14:40.160 --> 0:14:41.280
<v Speaker 1>Yeah, don't.

0:14:41.880 --> 0:14:44.440
<v Speaker 3>We'll post the full recipe for that quarantini as well

0:14:44.440 --> 0:14:47.080
<v Speaker 3>as the non alcoholic Plasy Brita on our website This

0:14:47.160 --> 0:14:49.400
<v Speaker 3>podcast would kill You dot com and all of our

0:14:49.440 --> 0:14:52.920
<v Speaker 3>social media channels, ah more.

0:14:53.040 --> 0:14:58.440
<v Speaker 1>Podcast business, website stuff. We've got lots of website stuff.

0:14:58.480 --> 0:15:03.200
<v Speaker 1>We have transfer, we have all of our references. We

0:15:03.320 --> 0:15:06.840
<v Speaker 1>have links to merch to our music by bloodmobile, to

0:15:06.920 --> 0:15:10.640
<v Speaker 1>our Goodreads list, to our bookshop dot org affiliate account.

0:15:11.200 --> 0:15:14.120
<v Speaker 1>You know, we've got lots of stuff. Patreon, I think

0:15:15.280 --> 0:15:18.040
<v Speaker 1>I should have impressed used it. It's not here anymore.

0:15:18.080 --> 0:15:19.520
<v Speaker 1>I lost it in the break.

0:15:19.920 --> 0:15:21.760
<v Speaker 3>I'm impressed that you went through a list at all,

0:15:21.840 --> 0:15:22.440
<v Speaker 3>quite honestly.

0:15:22.960 --> 0:15:25.960
<v Speaker 1>So you win. Yeah, yeah, well thank you?

0:15:26.520 --> 0:15:31.320
<v Speaker 3>All right, well with that, shall we get into this episode?

0:15:31.400 --> 0:15:34.440
<v Speaker 1>We shall okay, right after this break.

0:16:08.280 --> 0:16:13.840
<v Speaker 3>So, the genus Listeria includes at least seventeen different species

0:16:13.880 --> 0:16:16.760
<v Speaker 3>of bacteria, but the main one that we're focusing on

0:16:16.800 --> 0:16:23.760
<v Speaker 3>today is Listeria monocytogenes because that's the main positive agent

0:16:23.880 --> 0:16:27.880
<v Speaker 3>of listeriosis, which is the disease that we're talking about today.

0:16:29.240 --> 0:16:32.800
<v Speaker 3>Listeria in general are gram positive. This is a gram

0:16:32.880 --> 0:16:38.160
<v Speaker 3>positive rod shaped, so a little bacillus, or sometimes it's

0:16:38.200 --> 0:16:40.960
<v Speaker 3>called a coxobacillus because it's like a short rod.

0:16:41.000 --> 0:16:41.400
<v Speaker 1>I don't know.

0:16:42.640 --> 0:16:46.480
<v Speaker 3>They are a facultative anaerobe, which means that they can

0:16:46.560 --> 0:16:51.040
<v Speaker 3>grow both with and without the presence of oxygen. Already

0:16:51.640 --> 0:16:56.440
<v Speaker 3>cool little bug. They can survive even at very low temperatures,

0:16:56.520 --> 0:16:59.200
<v Speaker 3>like in the refrigerator or the freezer, and they can

0:16:59.240 --> 0:17:04.320
<v Speaker 3>continue to grow under those conditions. And they're very resistant

0:17:04.600 --> 0:17:09.679
<v Speaker 3>to other extreme environmental conditions like low pH very acidic environments,

0:17:10.080 --> 0:17:12.040
<v Speaker 3>or high salt concentrations.

0:17:12.720 --> 0:17:13.359
<v Speaker 1>So these are.

0:17:13.480 --> 0:17:17.680
<v Speaker 3>Very hardy little bugs. Most of the time they're found

0:17:17.800 --> 0:17:23.840
<v Speaker 3>living free living in soil or detritus or water. And

0:17:24.400 --> 0:17:29.600
<v Speaker 3>they also readily form biofilms, right, so they can form

0:17:29.640 --> 0:17:32.399
<v Speaker 3>this entire biofilm that's really hard to get rid of.

0:17:33.040 --> 0:17:36.800
<v Speaker 1>Aaron, what other episode were we talking about biofilms in.

0:17:37.440 --> 0:17:41.760
<v Speaker 3>I honestly have no idea. Okay, I would I would

0:17:41.800 --> 0:17:44.800
<v Speaker 3>have to google through our transcripts. Yeah yeah, yeah, but yes,

0:17:45.000 --> 0:17:48.920
<v Speaker 3>So that's a lot already that we've already talked about

0:17:49.000 --> 0:17:53.119
<v Speaker 3>when it comes to this little bacterium. And because of

0:17:53.160 --> 0:17:57.520
<v Speaker 3>all of these reasons, this bacterium poses a really big

0:17:57.640 --> 0:18:03.400
<v Speaker 3>risk to the food industry because they can survive despite

0:18:03.680 --> 0:18:06.720
<v Speaker 3>a lot of things that our food industry does to

0:18:06.840 --> 0:18:13.920
<v Speaker 3>try to decontaminate everything, right, like refrigeration, like acidic cleaning

0:18:13.960 --> 0:18:19.320
<v Speaker 3>solutions like high salt to preserve foods, et cetera. And

0:18:19.359 --> 0:18:21.840
<v Speaker 3>then on top of that, you have this biofilm formation

0:18:22.080 --> 0:18:26.360
<v Speaker 3>which can form on food production equipment and be really

0:18:26.440 --> 0:18:27.560
<v Speaker 3>difficult to get rid of.

0:18:28.320 --> 0:18:31.119
<v Speaker 1>First of all, it's really scary. Second of all, I

0:18:31.320 --> 0:18:35.760
<v Speaker 1>just did a search through our transcripts and Legionnaire's disease.

0:18:36.000 --> 0:18:38.200
<v Speaker 3>Ooh, yes, okay, that does make sense because they little

0:18:38.200 --> 0:18:40.520
<v Speaker 3>biofilms in the like ac equipment.

0:18:42.240 --> 0:18:45.359
<v Speaker 1>If any of you listeners got that without having to

0:18:45.400 --> 0:18:52.720
<v Speaker 1>search our transcripts, you are better than us. You win. Okay.

0:18:52.760 --> 0:18:55.760
<v Speaker 3>But this bacterium gets even cooler, or rather it gets

0:18:55.760 --> 0:19:00.639
<v Speaker 3>even more terrifying, because while Listeria is a free living

0:19:00.920 --> 0:19:06.399
<v Speaker 3>environmental microbe, it also can oscillate between being one of

0:19:06.440 --> 0:19:09.639
<v Speaker 3>those something hanging out in the soil, living and replicating

0:19:09.760 --> 0:19:15.359
<v Speaker 3>just fine, and then switch to being an intracellular bacterium

0:19:15.840 --> 0:19:22.280
<v Speaker 3>that invades mammalian host cells and survives and replicates inside

0:19:22.440 --> 0:19:26.840
<v Speaker 3>of our cells. So it's also found as a transient

0:19:26.880 --> 0:19:31.680
<v Speaker 3>inhabitant of both animal and human guts. And so there's

0:19:31.720 --> 0:19:34.800
<v Speaker 3>a lot of evidence that we are all probably exposed

0:19:34.920 --> 0:19:39.040
<v Speaker 3>to Listeria monocytogenies on a relatively regular basis, and it's

0:19:39.040 --> 0:19:42.120
<v Speaker 3>a really common pathogen in the environment because of this.

0:19:43.000 --> 0:19:46.520
<v Speaker 1>Again, I had no idea. I know, I know, I know,

0:19:46.600 --> 0:19:46.800
<v Speaker 1>I know.

0:19:47.760 --> 0:19:50.439
<v Speaker 3>So the way that we get exposed to this in

0:19:50.480 --> 0:19:53.600
<v Speaker 3>general is through our food. The way that this becomes

0:19:53.600 --> 0:19:57.000
<v Speaker 3>a pathogen is it's a food borne pathogen, which means

0:19:57.000 --> 0:20:00.520
<v Speaker 3>that we eat this bacterium we ingest it on our

0:20:00.560 --> 0:20:04.480
<v Speaker 3>food and it travels through our guts. But from there

0:20:04.880 --> 0:20:09.440
<v Speaker 3>it's actually quite different from most any other food born

0:20:09.480 --> 0:20:10.960
<v Speaker 3>illness that we've talked about.

0:20:11.320 --> 0:20:11.920
<v Speaker 1>Here's why.

0:20:12.880 --> 0:20:16.480
<v Speaker 3>In general, and this really did surprise me, the symptoms

0:20:16.560 --> 0:20:22.920
<v Speaker 3>either go incredibly severe disseminated infection that we're going to

0:20:22.960 --> 0:20:28.560
<v Speaker 3>talk about in detail, or mild, if any symptoms, and

0:20:28.640 --> 0:20:31.440
<v Speaker 3>we might never know that you had this as an illness.

0:20:32.240 --> 0:20:37.960
<v Speaker 3>So let me explain when you ingest listeria on your food,

0:20:38.280 --> 0:20:43.720
<v Speaker 3>let's say, on your turkey, or your cheese, or your lettuce.

0:20:43.440 --> 0:20:47.720
<v Speaker 1>Even anything really, which is just adds to the scary column.

0:20:49.400 --> 0:20:52.680
<v Speaker 3>If you have a fully competent immune system, fully competent

0:20:52.800 --> 0:20:58.040
<v Speaker 3>gut lining, no major risk factors, you may or may

0:20:58.080 --> 0:21:02.520
<v Speaker 3>not get exposed to enough bacteria a high enough bacterial

0:21:02.640 --> 0:21:07.200
<v Speaker 3>load to cause an infection that's limited to your gastrointestinal

0:21:07.280 --> 0:21:11.639
<v Speaker 3>tract a gastro enteritis. So that might mean that you

0:21:11.840 --> 0:21:17.359
<v Speaker 3>have some diarrhea or some nausea vomiting. If that's the case,

0:21:17.560 --> 0:21:21.240
<v Speaker 3>then those symptoms would generally start within about twenty four

0:21:21.280 --> 0:21:25.200
<v Speaker 3>hours of exposure and last for about one to three days,

0:21:25.240 --> 0:21:29.359
<v Speaker 3>which is a really common time frame, and set of

0:21:29.400 --> 0:21:36.280
<v Speaker 3>symptoms for a food born gastroenteritis, but we have essentially

0:21:36.440 --> 0:21:40.200
<v Speaker 3>no clue how often this happens or what's the likelihood

0:21:40.200 --> 0:21:42.680
<v Speaker 3>that if you're exposed to contaminated food that you get

0:21:42.680 --> 0:21:45.320
<v Speaker 3>this kind of infection in the absence of any other

0:21:45.440 --> 0:21:50.120
<v Speaker 3>risk factors for invasive affection, which we'll get to because

0:21:50.280 --> 0:21:52.680
<v Speaker 3>we just don't have data on it. Most of the

0:21:52.720 --> 0:21:55.080
<v Speaker 3>people that are getting food borne illness of any kind,

0:21:55.280 --> 0:21:59.280
<v Speaker 3>we're never detecting what that pathogen actually is, and they.

0:21:59.160 --> 0:22:00.600
<v Speaker 1>Recover with issues.

0:22:02.320 --> 0:22:05.320
<v Speaker 3>What we worry about with listeria, the disease we know

0:22:05.400 --> 0:22:11.639
<v Speaker 3>of as listeriosis is an invasive infection, and when that happens,

0:22:12.200 --> 0:22:17.199
<v Speaker 3>the symptoms are different entirely, which I think is one

0:22:17.280 --> 0:22:21.240
<v Speaker 3>of the most interesting parts of the listeria story because

0:22:21.280 --> 0:22:26.400
<v Speaker 3>it doesn't mean that it starts with this food born infection.

0:22:27.280 --> 0:22:31.080
<v Speaker 3>Think of it as two different diseases entirely. Does that

0:22:31.080 --> 0:22:31.560
<v Speaker 3>make sense?

0:22:32.359 --> 0:22:35.800
<v Speaker 1>Yeah, so you don't have the one to three day

0:22:35.920 --> 0:22:42.280
<v Speaker 1>GI symptoms, not necessarily, Okay, tell me why? Why?

0:22:42.520 --> 0:22:48.160
<v Speaker 3>I don't know, But from what I can gather, there

0:22:48.200 --> 0:22:51.040
<v Speaker 3>are three major disorders that we worry about that are

0:22:51.040 --> 0:22:55.440
<v Speaker 3>all classified under this umbrella of listeriosis three like manifestations.

0:22:55.960 --> 0:22:59.800
<v Speaker 3>One are maternal fetal infections, and this encompasses a lot

0:22:59.840 --> 0:23:01.480
<v Speaker 3>of different possibilities that.

0:23:01.440 --> 0:23:02.119
<v Speaker 1>We'll get into.

0:23:02.920 --> 0:23:07.919
<v Speaker 3>Two bacteremia or septicemia, so infection of this bacteria in

0:23:07.960 --> 0:23:13.640
<v Speaker 3>the bloodstream. And three neurolisteriosis or a meningitis picture infection

0:23:13.840 --> 0:23:17.840
<v Speaker 3>of our central nervous system. We've talked about other food

0:23:17.840 --> 0:23:21.760
<v Speaker 3>borne illnesses before, some of which can pose a risk

0:23:21.840 --> 0:23:25.520
<v Speaker 3>of invasive infection, like E. Coli one, five, seven, for example.

0:23:26.600 --> 0:23:29.080
<v Speaker 3>But with those, what we tend to see is a

0:23:29.160 --> 0:23:34.360
<v Speaker 3>GI infection. You have these diarrhea, nausea, vomiting, fever, You're

0:23:34.400 --> 0:23:38.800
<v Speaker 3>feeling crappy. With a GI infection, your guts are a mess,

0:23:39.480 --> 0:23:43.520
<v Speaker 3>and then this leads to an invasive infection. But that

0:23:43.680 --> 0:23:47.080
<v Speaker 3>is often not the case when it comes to listeriosis.

0:23:47.400 --> 0:23:52.160
<v Speaker 3>So while we can see this gaster enteritis, nausea, vomiting, diarrhea,

0:23:52.200 --> 0:23:57.040
<v Speaker 3>maybe fever, you're feeling crappy, but the cases that we

0:23:57.160 --> 0:24:02.520
<v Speaker 3>worry about are actually separate entire and the incubation period

0:24:02.640 --> 0:24:06.399
<v Speaker 3>for these is not twenty four hours. It's one to

0:24:06.680 --> 0:24:11.600
<v Speaker 3>four weeks or more. Whoa, yeah, So it's separated in

0:24:11.640 --> 0:24:14.480
<v Speaker 3>time entirely. And so that's why I say, was there

0:24:14.520 --> 0:24:19.800
<v Speaker 3>a preceding diarrhea? Maybe would we even remember it? Maybe not?

0:24:20.680 --> 0:24:23.920
<v Speaker 3>But most of the data that I see doesn't even

0:24:24.160 --> 0:24:27.000
<v Speaker 3>mention whether or not there was a preceding gast or enteritis.

0:24:27.080 --> 0:24:32.800
<v Speaker 1>Picture that makes things so difficult, I imagine for intervention

0:24:33.000 --> 0:24:37.879
<v Speaker 1>because with something like ecola, it's clearly a gi bug

0:24:37.960 --> 0:24:42.280
<v Speaker 1>that's then moving into disseminated infection and more severe infection.

0:24:42.359 --> 0:24:47.359
<v Speaker 1>And this is like, suddenly, here's this disseminated infection, but

0:24:47.480 --> 0:24:50.199
<v Speaker 1>we don't there's nothing that tips you off as to

0:24:50.280 --> 0:24:53.160
<v Speaker 1>what it could be beyond the usual suspects, and listeria

0:24:53.240 --> 0:24:57.680
<v Speaker 1>is not necessarily a usual suspect. Now that aaron one

0:24:57.720 --> 0:25:01.040
<v Speaker 1>to four weeks, so is there like a threshold response

0:25:01.080 --> 0:25:05.000
<v Speaker 1>where it's like the bacteria you know, replicate in high

0:25:05.119 --> 0:25:10.520
<v Speaker 1>enough numbers, that's suddenly they're systemic Because it seems very sudden. Yeah,

0:25:10.600 --> 0:25:15.719
<v Speaker 1>let's talk about it, Okay, getting like very excited, like

0:25:15.880 --> 0:25:19.400
<v Speaker 1>not excited, but like intense about this, and I can

0:25:19.440 --> 0:25:21.280
<v Speaker 1>dial it back. No, I love it.

0:25:21.320 --> 0:25:22.359
<v Speaker 3>I love the intensity.

0:25:22.480 --> 0:25:23.239
<v Speaker 1>It's it is.

0:25:23.320 --> 0:25:25.600
<v Speaker 3>I was feeling honestly the exact same way, and that's

0:25:25.640 --> 0:25:29.040
<v Speaker 3>I couldn't even wrap my brain around how interesting that

0:25:29.320 --> 0:25:32.920
<v Speaker 3>that part of the listeria story is. So let's first

0:25:32.920 --> 0:25:39.639
<v Speaker 3>talk about the three major manifestations of listeriosis perinatal infections, bacteremia,

0:25:39.680 --> 0:25:43.600
<v Speaker 3>and the CNS, the nervous system infections. We'll talk about

0:25:43.640 --> 0:25:46.679
<v Speaker 3>what those look like, how they present, how somebody would

0:25:46.760 --> 0:25:49.840
<v Speaker 3>show that they have this infection, and what the results

0:25:49.920 --> 0:25:54.000
<v Speaker 3>tend to be, which are spoilers not good, And then

0:25:54.119 --> 0:25:56.919
<v Speaker 3>we'll talk about the path of physiology that kind of

0:25:57.000 --> 0:26:01.000
<v Speaker 3>unites them about this bacteria. So when it comes to

0:26:01.040 --> 0:26:06.520
<v Speaker 3>perinatal or neonatal infections, overall, on average, they account for

0:26:06.640 --> 0:26:11.840
<v Speaker 3>an estimated ten percent plus or minus of all listeriosis cases.

0:26:11.880 --> 0:26:14.320
<v Speaker 3>And again, when I say listeriosis, I just mean these

0:26:14.400 --> 0:26:17.880
<v Speaker 3>three invasive infections. Think of the food borne illness as

0:26:17.960 --> 0:26:23.560
<v Speaker 3>totally separate. Oh okay, m But perinatal infections are a

0:26:23.680 --> 0:26:27.119
<v Speaker 3>huge cause of morbidity and mortality, especially of neonates. So

0:26:27.280 --> 0:26:30.720
<v Speaker 3>I'm going to talk about that first. So, a perinatal

0:26:30.760 --> 0:26:35.480
<v Speaker 3>infection means infection with listeria during pregnancy, and the symptoms

0:26:35.520 --> 0:26:40.200
<v Speaker 3>here tend to be very non specific. It's often what's

0:26:40.240 --> 0:26:47.160
<v Speaker 3>called a flu like illness. So fever, chills, malaise, muscle aches,

0:26:47.520 --> 0:26:51.199
<v Speaker 3>your overall feeling really crappy. Some of the papers that

0:26:51.240 --> 0:26:55.800
<v Speaker 3>I read described it as sometimes being mistaken for pylo nephritis,

0:26:55.880 --> 0:26:57.480
<v Speaker 3>which is infection of the kidneys.

0:26:58.240 --> 0:26:59.520
<v Speaker 1>So really that could.

0:26:59.280 --> 0:27:02.600
<v Speaker 3>Just be like back pain along with a fever and

0:27:02.680 --> 0:27:08.919
<v Speaker 3>evidence of an infection. Okay, but with infection during pregnancy.

0:27:09.440 --> 0:27:12.840
<v Speaker 3>While the infection for the pregnant person is very rarely

0:27:13.040 --> 0:27:18.520
<v Speaker 3>severe or life threatening, the problem is that for the fetus,

0:27:19.080 --> 0:27:23.240
<v Speaker 3>infection almost inevitably eighty percent of the time or more

0:27:23.400 --> 0:27:27.320
<v Speaker 3>leads to severe complications because this is a bacteria that's

0:27:27.440 --> 0:27:32.600
<v Speaker 3>crossing over the placental barrier very easily infecting the fetus

0:27:33.040 --> 0:27:36.280
<v Speaker 3>and can lead to early pregnancy loss or still birth,

0:27:36.440 --> 0:27:40.320
<v Speaker 3>depending on how far along you are in pregnancy. It

0:27:40.359 --> 0:27:43.720
<v Speaker 3>can lead to premature labor and delivery, which can have

0:27:43.840 --> 0:27:49.200
<v Speaker 3>a whole host of complications arising from that prematurity, and

0:27:49.359 --> 0:27:53.680
<v Speaker 3>it can also lead to a both an early neonatal

0:27:53.880 --> 0:27:56.960
<v Speaker 3>infection right when that baby is born, they can become

0:27:57.119 --> 0:28:01.320
<v Speaker 3>infected and have signs of either sepsis or meningite, or

0:28:01.400 --> 0:28:04.960
<v Speaker 3>if infection happens around the time of delivery, it can

0:28:05.040 --> 0:28:08.439
<v Speaker 3>lead to a late onset meningitis. So a few days

0:28:08.560 --> 0:28:11.960
<v Speaker 3>or weeks after delivery, the baby can end up super

0:28:12.000 --> 0:28:14.320
<v Speaker 3>sick from listeriosis as well.

0:28:14.760 --> 0:28:17.439
<v Speaker 1>So this is another thing where we're seeing a delay

0:28:17.520 --> 0:28:22.920
<v Speaker 1>between exposure and ramping up and then severe complications.

0:28:23.119 --> 0:28:26.879
<v Speaker 3>Potentially, it all just depends on the timing of the

0:28:26.960 --> 0:28:28.399
<v Speaker 3>infection during pregnancy.

0:28:28.600 --> 0:28:31.959
<v Speaker 1>So, okay, speaking of the timing of infection during pregnancy,

0:28:32.200 --> 0:28:36.680
<v Speaker 1>are their highest risk periods and how long is someone

0:28:36.920 --> 0:28:40.760
<v Speaker 1>infected with listeria? And I guess that's such a that

0:28:40.920 --> 0:28:42.680
<v Speaker 1>answer is probably super variable.

0:28:43.120 --> 0:28:47.360
<v Speaker 3>Yeah, it's really variable and even variable in terms of

0:28:47.720 --> 0:28:51.880
<v Speaker 3>the timing of infection. Infection at any point during pregnancy

0:28:52.640 --> 0:28:56.240
<v Speaker 3>eighty percent of the time has severe complications. What those

0:28:56.240 --> 0:28:59.200
<v Speaker 3>complications are going to be will depend on the timing

0:28:59.200 --> 0:29:02.560
<v Speaker 3>of pregnancy. So more likely to lead to early pregnancy

0:29:02.600 --> 0:29:06.280
<v Speaker 3>loss if you're earlier in the course of pregnancy, more

0:29:06.400 --> 0:29:08.960
<v Speaker 3>likely to lead to a neonatal infection if you're very

0:29:08.960 --> 0:29:11.760
<v Speaker 3>close to the end, et cetera. But at any time

0:29:11.840 --> 0:29:15.600
<v Speaker 3>point we see severe complications for the fetus. Okay, so

0:29:15.720 --> 0:29:19.640
<v Speaker 3>it's always super high risk, always super high risk, yeah,

0:29:19.680 --> 0:29:23.560
<v Speaker 3>which is terrifying. Yeah, and again here we tend to

0:29:23.600 --> 0:29:26.760
<v Speaker 3>see a delay of one to four weeks between exposure

0:29:26.880 --> 0:29:29.720
<v Speaker 3>for the pregnant person and when they start to have

0:29:29.800 --> 0:29:34.120
<v Speaker 3>these symptoms of fever chills, that mean that they have

0:29:34.240 --> 0:29:37.160
<v Speaker 3>listeriosis and now the fetus is also infected.

0:29:37.880 --> 0:29:42.600
<v Speaker 1>These symptoms are not super severe, like I'm sure that

0:29:42.640 --> 0:29:47.440
<v Speaker 1>they are extremely uncomfortable and painful, but they're not necessarily

0:29:47.480 --> 0:29:52.120
<v Speaker 1>something that's going to look like sepsis or whatever. So

0:29:52.680 --> 0:29:55.520
<v Speaker 1>how does someone get tested for listeriosis?

0:29:55.920 --> 0:29:58.760
<v Speaker 3>Yeah, that's a really good question, and it's likely when

0:29:58.800 --> 0:30:02.080
<v Speaker 3>there's a complication with the pregnancy. That's when someone is

0:30:02.080 --> 0:30:04.640
<v Speaker 3>more likely to seek care when something is going wrong

0:30:04.760 --> 0:30:08.480
<v Speaker 3>with the pregnancy, if they haven't already sought care when

0:30:08.480 --> 0:30:11.000
<v Speaker 3>they had these flu like symptoms. And I don't want

0:30:11.000 --> 0:30:15.400
<v Speaker 3>to downplay how sick someone would likely feel when they

0:30:15.440 --> 0:30:20.040
<v Speaker 3>have listeriosis during pregnancy. They're feeling really sick, so it's

0:30:20.120 --> 0:30:22.480
<v Speaker 3>very likely that they may go in and seek care

0:30:22.560 --> 0:30:24.800
<v Speaker 3>and you would see that they have signs of an infection.

0:30:26.360 --> 0:30:32.560
<v Speaker 3>But it's generally not life threatening for the pregnant person, right, Okay,

0:30:33.000 --> 0:30:37.320
<v Speaker 3>that's the big difference. Yeah, it is, though life threatening

0:30:37.720 --> 0:30:41.520
<v Speaker 3>for adults who are not pregnant. In the other cases

0:30:41.600 --> 0:30:43.200
<v Speaker 3>that we'll talk about. So let's get to that, shall

0:30:43.240 --> 0:30:45.600
<v Speaker 3>we h. And by the way, when I'm talking about

0:30:45.680 --> 0:30:49.280
<v Speaker 3>groups who are at highest risk for infection aside from

0:30:49.600 --> 0:30:53.080
<v Speaker 3>during pregnancy, there are a few groups that we see

0:30:53.080 --> 0:30:57.440
<v Speaker 3>that are at highest risk. Primarily it's those of older age,

0:30:57.600 --> 0:31:01.280
<v Speaker 3>especially over age sixty five, whether or not they have

0:31:01.440 --> 0:31:05.600
<v Speaker 3>any immunal compromising conditions, but especially if they do have

0:31:05.720 --> 0:31:10.480
<v Speaker 3>things like diabetes or perhaps we're on steroids for one

0:31:10.520 --> 0:31:14.920
<v Speaker 3>reason or another. So older age is the primary risk factor.

0:31:15.240 --> 0:31:18.240
<v Speaker 3>We also see it like with neonatal infections in the

0:31:18.360 --> 0:31:21.280
<v Speaker 3>very very young, as well as in people who are

0:31:21.320 --> 0:31:25.240
<v Speaker 3>immunal compromised for one reason or another, which includes poorly

0:31:25.280 --> 0:31:29.320
<v Speaker 3>controlled HIV infection or progression to AIDS, which we actually

0:31:29.320 --> 0:31:34.040
<v Speaker 3>see as a really big risk factor for listeriosis. So

0:31:34.840 --> 0:31:38.000
<v Speaker 3>what are these other infections look like outside of pregnancy.

0:31:39.320 --> 0:31:42.760
<v Speaker 3>So in the case of a bloodstream infection with listeria,

0:31:43.120 --> 0:31:46.320
<v Speaker 3>which by the way, accounts for anywhere from thirty to

0:31:46.360 --> 0:31:49.960
<v Speaker 3>fifty percent of cases of listeriosis, which is a.

0:31:49.800 --> 0:31:51.200
<v Speaker 1>Lot, a lot.

0:31:51.360 --> 0:31:58.800
<v Speaker 3>Yeah, with this infection, the symptoms are incredibly nonspecific, and

0:31:59.080 --> 0:32:03.040
<v Speaker 3>when you read them, they really are just the symptoms

0:32:03.120 --> 0:32:07.200
<v Speaker 3>of sepsis, which we covered in detail in our sepsis episode.

0:32:08.080 --> 0:32:13.760
<v Speaker 3>So it often starts with fevers, feeling overall really bad,

0:32:13.880 --> 0:32:18.440
<v Speaker 3>like you're just not feeling like yourself. You often have chills,

0:32:19.800 --> 0:32:24.240
<v Speaker 3>and because this is a cause of sepsis, then it's

0:32:24.280 --> 0:32:27.720
<v Speaker 3>going to go on to develop the same severe complications

0:32:27.720 --> 0:32:30.840
<v Speaker 3>and outcomes that we see in sepsis from any other

0:32:31.360 --> 0:32:36.600
<v Speaker 3>bacterial organism, that is, multi organ failure and eventually death

0:32:36.920 --> 0:32:41.280
<v Speaker 3>from an overwhelming bacterial load in the bloodstream. But what's

0:32:41.360 --> 0:32:46.560
<v Speaker 3>interesting is that there often isn't like a single presenting

0:32:46.760 --> 0:32:50.240
<v Speaker 3>organ that you might suspect as the ideology of this infection,

0:32:51.840 --> 0:32:56.800
<v Speaker 3>because while you got infected through your guts several weeks

0:32:57.000 --> 0:33:03.360
<v Speaker 3>prior to presenting with these symptoms of bacterymia or septicemia,

0:33:03.560 --> 0:33:07.440
<v Speaker 3>you may not have ever even had gastroenteritis symptoms. So

0:33:07.920 --> 0:33:10.160
<v Speaker 3>in that way, it's different than when we talked about

0:33:10.160 --> 0:33:12.800
<v Speaker 3>sepsis and you're trying to think of like what is

0:33:12.880 --> 0:33:16.120
<v Speaker 3>the source, This would probably be a case where you'd

0:33:16.120 --> 0:33:18.800
<v Speaker 3>have a really hard time identifying what is the source

0:33:18.880 --> 0:33:22.520
<v Speaker 3>of this infection. Yeah, and when it comes to bacteremia

0:33:22.560 --> 0:33:26.320
<v Speaker 3>and septicemia, the mortality rate is twenty to thirty percent,

0:33:26.520 --> 0:33:28.520
<v Speaker 3>and that is even with treatment.

0:33:29.360 --> 0:33:31.960
<v Speaker 1>It's so scary, it's so awful, terrifying.

0:33:32.240 --> 0:33:37.880
<v Speaker 3>Yeah. Finally, listeria can also cause a meningitis or, in

0:33:37.920 --> 0:33:43.680
<v Speaker 3>some cases a new word, a rhomb encephalitis. Okay, we'll

0:33:43.720 --> 0:33:46.640
<v Speaker 3>talk more about because that includes the disease known as

0:33:46.640 --> 0:33:48.280
<v Speaker 3>circling disease in animals.

0:33:48.320 --> 0:33:52.080
<v Speaker 1>Oh thank goodness. I had that written down in my

0:33:52.160 --> 0:33:55.600
<v Speaker 1>notes and then it just stayed circling like that was

0:33:55.600 --> 0:33:56.960
<v Speaker 1>all that I Yeah.

0:33:57.200 --> 0:34:02.840
<v Speaker 3>Yeah, So meningitis or infection of the central nervous system,

0:34:03.160 --> 0:34:06.920
<v Speaker 3>accounts for, by most studies that I saw, about thirty

0:34:06.960 --> 0:34:10.560
<v Speaker 3>percent of cases of listeriosis in adults. So if you've

0:34:10.560 --> 0:34:14.080
<v Speaker 3>been adding this up as we go, perinatal infection accounts

0:34:14.120 --> 0:34:19.280
<v Speaker 3>for about ten percent, bacterymia about fifty percent, meningitis about

0:34:19.320 --> 0:34:22.719
<v Speaker 3>thirty percent, and we're left with an extra about ten

0:34:22.840 --> 0:34:26.040
<v Speaker 3>percent of cases that are very very rare, and we'll

0:34:26.040 --> 0:34:27.160
<v Speaker 3>talk about in a minute.

0:34:27.280 --> 0:34:31.120
<v Speaker 1>And are these mutually exclusive categories?

0:34:31.520 --> 0:34:35.040
<v Speaker 3>Great question. No, okay, no they're not. You can certainly

0:34:35.160 --> 0:34:42.280
<v Speaker 3>have a bacterymia and a meningitis picture at the same time. Okay, yep, yeah, yeah, yeah, definitely.

0:34:42.840 --> 0:34:45.600
<v Speaker 3>So in adults who end up with a meningitis or

0:34:45.760 --> 0:34:50.759
<v Speaker 3>a meningo encephalitis from listeria. Again, the symptoms are like

0:34:50.960 --> 0:34:56.360
<v Speaker 3>another meningitis from a viral cause or a bacterial cause.

0:34:57.000 --> 0:35:02.160
<v Speaker 3>So what that means is fever, headache, stiff neck. If

0:35:02.200 --> 0:35:05.880
<v Speaker 3>it's infecting the brain itself, you might have things like

0:35:05.960 --> 0:35:12.960
<v Speaker 3>confusion or even disruption in consciousness. Usually the onset is

0:35:13.120 --> 0:35:16.640
<v Speaker 3>a little bit less abrupt than some other more common

0:35:16.719 --> 0:35:22.480
<v Speaker 3>causes of bacterial meningitis like numacoccle or meninchoccle meningitis. And

0:35:22.719 --> 0:35:27.759
<v Speaker 3>it's often harder to detect listeria in for example, a

0:35:27.760 --> 0:35:33.120
<v Speaker 3>spinal tap, because this is an intracellular bacterium, so you

0:35:33.160 --> 0:35:35.640
<v Speaker 3>have to wait until cell culture results because it's not

0:35:35.680 --> 0:35:40.560
<v Speaker 3>gonna show up on a gram stain necessarily. Okay, But

0:35:40.840 --> 0:35:44.920
<v Speaker 3>one thing that's also interesting and seems to happen with listeria,

0:35:45.000 --> 0:35:47.840
<v Speaker 3>and I don't know the frequency because some papers were like,

0:35:48.000 --> 0:35:51.000
<v Speaker 3>this isn't specific to listeria, and some were like, yes

0:35:51.040 --> 0:35:54.319
<v Speaker 3>it is. But it's a specific and bizarre form of

0:35:54.360 --> 0:35:59.160
<v Speaker 3>meningitis that infects the cerebellum, the back part of our brain,

0:35:59.280 --> 0:36:01.040
<v Speaker 3>like the and you look at a picture of a

0:36:01.040 --> 0:36:03.600
<v Speaker 3>brain it's like the two tiny balls on the back,

0:36:04.880 --> 0:36:08.440
<v Speaker 3>and this is a romb encephalitis. You see similar signs

0:36:08.480 --> 0:36:13.239
<v Speaker 3>as a typical encephalitis fever, headache, but more often you'll

0:36:13.280 --> 0:36:17.480
<v Speaker 3>also see a lot of nausea and vomiting, and then

0:36:17.640 --> 0:36:21.160
<v Speaker 3>signs of what we call cerebellar dysfunction, like not being

0:36:21.160 --> 0:36:23.839
<v Speaker 3>able to walk in a straight line, what we call

0:36:23.920 --> 0:36:28.799
<v Speaker 3>a taxia. You might see cranial nerve abnormalities because you're

0:36:28.840 --> 0:36:31.960
<v Speaker 3>cranial nerves that innervate the muscles and sensory system of

0:36:32.000 --> 0:36:36.080
<v Speaker 3>your face and neck come out in our brain stem

0:36:36.239 --> 0:36:41.160
<v Speaker 3>near the cerebellum, and so you might see various palsies

0:36:41.239 --> 0:36:44.959
<v Speaker 3>or abnormalities in the function of those nerves. And this

0:36:45.280 --> 0:36:49.279
<v Speaker 3>is what we see in animals, especially ruminants who get

0:36:49.320 --> 0:36:53.480
<v Speaker 3>infected with listeria. This exact same type of infection a

0:36:53.600 --> 0:36:57.319
<v Speaker 3>romb encephalitis, and it can lead to very odd behaviors,

0:36:57.360 --> 0:37:01.920
<v Speaker 3>including circling, where animals walk in unidirectional circle and they

0:37:01.920 --> 0:37:04.759
<v Speaker 3>have like head and neck deviation to one side. And

0:37:04.800 --> 0:37:07.160
<v Speaker 3>it's all because of this infection in the back part

0:37:07.160 --> 0:37:08.239
<v Speaker 3>of the brain and the brainstem.

0:37:08.560 --> 0:37:12.440
<v Speaker 1>Okay, so many thoughts. Number one, I remember seeing a

0:37:12.520 --> 0:37:15.600
<v Speaker 1>video of circling ruminants of some kind. I can't remember

0:37:15.640 --> 0:37:19.400
<v Speaker 1>what it was going around like last fall, and I

0:37:19.400 --> 0:37:21.759
<v Speaker 1>think that's when we added lysteria as a topic or

0:37:21.760 --> 0:37:24.680
<v Speaker 1>we were like, oh, for sure, what's going on here?

0:37:26.200 --> 0:37:30.480
<v Speaker 3>So here's the thing. That video almost certainly not listeria.

0:37:30.680 --> 0:37:32.480
<v Speaker 1>What is it? Don't know.

0:37:33.440 --> 0:37:36.400
<v Speaker 3>There was a lot of explanations that I found online,

0:37:36.520 --> 0:37:38.640
<v Speaker 3>and I am not a veterinarian, so I'm not going

0:37:38.680 --> 0:37:40.640
<v Speaker 3>to try and delve into the nitty gritty of what

0:37:40.719 --> 0:37:43.960
<v Speaker 3>those are. But the reason that it most likely was

0:37:43.960 --> 0:37:46.640
<v Speaker 3>not listeria is because, first of all, you're right, I

0:37:46.680 --> 0:37:49.520
<v Speaker 3>wouldn't expect that an entire herd is going to get

0:37:49.560 --> 0:37:51.719
<v Speaker 3>infected in the exact same way at the exact same

0:37:51.760 --> 0:37:55.520
<v Speaker 3>time with a pathogen that's an opportunistic pathogen that's not

0:37:55.600 --> 0:37:57.600
<v Speaker 3>infecting everyone equally well.

0:37:57.640 --> 0:38:00.640
<v Speaker 1>And so that's my other question about that, because ruminants,

0:38:00.680 --> 0:38:06.120
<v Speaker 1>because livestock can be infected and be totally fine, and

0:38:06.160 --> 0:38:10.880
<v Speaker 1>they just shed listeria into the environment just like us. Okay,

0:38:10.920 --> 0:38:12.960
<v Speaker 1>So this would be a case this would be an

0:38:13.040 --> 0:38:17.239
<v Speaker 1>individual more likely, okay, And this would be an individual

0:38:17.440 --> 0:38:20.480
<v Speaker 1>that had something else going on that was you know,

0:38:20.560 --> 0:38:21.520
<v Speaker 1>suppressed in some.

0:38:21.440 --> 0:38:25.359
<v Speaker 3>Way exactly, Yes, And it wouldn't be walking in a

0:38:25.400 --> 0:38:29.880
<v Speaker 3>perfect unidirectional circle with all of your friends like that

0:38:30.000 --> 0:38:34.279
<v Speaker 3>video of the sheep that was going around virally. It

0:38:34.320 --> 0:38:38.160
<v Speaker 3>would be a lot more of that a taxic gate.

0:38:38.200 --> 0:38:40.520
<v Speaker 3>It would be a lot more like stumbling, kind of

0:38:40.640 --> 0:38:43.680
<v Speaker 3>confused gait. Would it still be unidirectional?

0:38:43.880 --> 0:38:44.120
<v Speaker 1>Likely?

0:38:44.239 --> 0:38:48.040
<v Speaker 3>Yes, because it often what we see in animals is

0:38:48.080 --> 0:38:51.840
<v Speaker 3>this asymmetric infection. So you're damaging one side of the

0:38:51.880 --> 0:38:54.160
<v Speaker 3>brainstem more than the other, and that's why you see

0:38:54.200 --> 0:38:57.760
<v Speaker 3>like a unilateral picture of infection.

0:38:58.640 --> 0:39:03.320
<v Speaker 1>Okay, so let's talk about why the heck it happens there?

0:39:04.080 --> 0:39:05.200
<v Speaker 1>Do you have an answer.

0:39:05.680 --> 0:39:07.279
<v Speaker 3>That we don't have an answer to it?

0:39:07.400 --> 0:39:07.640
<v Speaker 1>Okay?

0:39:07.760 --> 0:39:09.960
<v Speaker 3>Like why that part of the brain? I don't know?

0:39:10.080 --> 0:39:14.280
<v Speaker 1>And why one side? Yeah, I don't know. A great question. Okay.

0:39:15.280 --> 0:39:16.960
<v Speaker 3>So those are all of the different ways that you

0:39:16.960 --> 0:39:18.480
<v Speaker 3>can get listeriosis.

0:39:19.040 --> 0:39:19.640
<v Speaker 1>I did mention.

0:39:19.880 --> 0:39:25.120
<v Speaker 3>The remaining ten percent of cases are often localized infections.

0:39:25.160 --> 0:39:28.240
<v Speaker 3>So you can actually see skin infections, especially maybe among

0:39:28.320 --> 0:39:33.600
<v Speaker 3>people who get exposed from livestock, or rarely other specific

0:39:33.800 --> 0:39:37.960
<v Speaker 3>organ infections like an endocarditis infection of the heart or

0:39:38.360 --> 0:39:42.880
<v Speaker 3>a liver infection or infection of the wall of the abdomen,

0:39:42.960 --> 0:39:46.880
<v Speaker 3>so we can also see potentially infection in specific organs,

0:39:47.120 --> 0:39:49.640
<v Speaker 3>but this tends to be very, very rare compared to

0:39:49.680 --> 0:39:52.480
<v Speaker 3>the other manifestations of listeriosis.

0:39:52.719 --> 0:39:59.399
<v Speaker 1>Okay, so how does this happen? Why does this happen? Yeah,

0:39:59.719 --> 0:40:04.360
<v Speaker 1>it's crossing the placenta, it's crossing blood brain barrier. This

0:40:05.320 --> 0:40:08.320
<v Speaker 1>bacterium has a lot of tricks up its sleeve. You

0:40:08.920 --> 0:40:09.439
<v Speaker 1>nailed it.

0:40:10.120 --> 0:40:12.600
<v Speaker 3>I didn't realize something that I didn't realize at all

0:40:12.719 --> 0:40:16.680
<v Speaker 3>before researching for this episode is that because of these traits,

0:40:17.239 --> 0:40:22.640
<v Speaker 3>listeria has actually become a model organism of infection and

0:40:22.880 --> 0:40:28.239
<v Speaker 3>invasion because it is so good at invading across our

0:40:28.400 --> 0:40:33.319
<v Speaker 3>normal protective barriers. So in the case of a person

0:40:33.400 --> 0:40:39.520
<v Speaker 3>who's immunocompromised and exposed to listeria, listeria can then cross

0:40:39.680 --> 0:40:44.280
<v Speaker 3>three you named them, very important structures that we usually

0:40:44.400 --> 0:40:49.440
<v Speaker 3>use to keep pathogens out. First, it's crossing over our

0:40:49.480 --> 0:40:53.960
<v Speaker 3>intestinal epithelium, so it's no longer just limited to our guts.

0:40:54.360 --> 0:40:58.520
<v Speaker 3>It has a really easy time penetrating these tight barriers.

0:40:59.400 --> 0:41:02.120
<v Speaker 3>It makes its way into our lymph system and our

0:41:02.120 --> 0:41:04.840
<v Speaker 3>blood stream, where It can then travel to our liver

0:41:05.360 --> 0:41:09.719
<v Speaker 3>and our spleen and in theory any organ but primarily

0:41:09.760 --> 0:41:14.440
<v Speaker 3>the liver and spleen, and continue to grow and progress

0:41:14.719 --> 0:41:18.080
<v Speaker 3>to infection. It can then also, like you said, aaron,

0:41:18.160 --> 0:41:20.959
<v Speaker 3>cross our blood brain barrier, so it can cross through

0:41:21.000 --> 0:41:26.000
<v Speaker 3>these other really tight cell to cell junctions made to

0:41:26.120 --> 0:41:30.040
<v Speaker 3>keep bacteria out, and then it very easily crosses the

0:41:30.080 --> 0:41:33.280
<v Speaker 3>placental barrier and is able to infect a developing fetus.

0:41:34.200 --> 0:41:36.920
<v Speaker 3>So how is it able to do this? How is

0:41:36.960 --> 0:41:40.480
<v Speaker 3>it so easily able to cross these barriers? The truth

0:41:40.560 --> 0:41:44.120
<v Speaker 3>is that it's largely because this bacterium has adapted to

0:41:44.239 --> 0:41:51.560
<v Speaker 3>not just survive, but also divide, continue replicating, and thrive

0:41:52.239 --> 0:41:59.600
<v Speaker 3>within the sidasol of our cells. Both cells like our macrophages,

0:41:59.760 --> 0:42:01.920
<v Speaker 3>which which I talk about a lot, but these are

0:42:01.960 --> 0:42:04.400
<v Speaker 3>the white blood cells whose job it is to go

0:42:04.480 --> 0:42:11.160
<v Speaker 3>out and find and engulf and usually neutralize bacteria. So

0:42:11.480 --> 0:42:17.200
<v Speaker 3>Listeria can survive that normal neutralization process that macrophasias do

0:42:17.960 --> 0:42:24.520
<v Speaker 3>by actually hijacking those macrophasia's machinery and breaking out of

0:42:24.640 --> 0:42:29.560
<v Speaker 3>the vacuoles that we've trapped it in and replicate inside

0:42:29.560 --> 0:42:33.920
<v Speaker 3>of those macrophases. But Listeria can go one step further.

0:42:34.960 --> 0:42:39.360
<v Speaker 3>They can then actually escape sell to sell.

0:42:39.960 --> 0:42:43.840
<v Speaker 1>It is so wild, it's amazing.

0:42:44.320 --> 0:42:47.399
<v Speaker 3>So they're able to spread directly from one of our

0:42:47.480 --> 0:42:51.160
<v Speaker 3>cells to another of our cells without having to leave

0:42:51.320 --> 0:42:54.440
<v Speaker 3>the cell that they've been replicating in. Most of the time,

0:42:55.320 --> 0:42:59.279
<v Speaker 3>when I've talked about intracellular pathogens like viruses and other

0:42:59.320 --> 0:43:03.239
<v Speaker 3>intracellulara I say they replicate and replicate, and then they

0:43:03.280 --> 0:43:05.840
<v Speaker 3>burst out of our cells and they travel through the

0:43:05.840 --> 0:43:09.880
<v Speaker 3>bloodstream to infect another cell. Listeria don't have to do

0:43:10.000 --> 0:43:16.120
<v Speaker 3>that part. They can intentionally travel from cell to cell

0:43:16.280 --> 0:43:19.400
<v Speaker 3>to sell without having to burst out and enter our

0:43:19.440 --> 0:43:24.840
<v Speaker 3>bloodstreams or our lymphatics. And they can do this not

0:43:25.280 --> 0:43:29.880
<v Speaker 3>just in our macrophases, our macrophases and other white blood cells,

0:43:30.280 --> 0:43:35.080
<v Speaker 3>intentionally in gulf bacteria. So bacteria have an easy time

0:43:35.120 --> 0:43:38.279
<v Speaker 3>getting inside of macrophasis. There's a lot of bacteria we've

0:43:38.280 --> 0:43:41.440
<v Speaker 3>talked about on this podcast that can survive inside of macrophage.

0:43:41.480 --> 0:43:47.040
<v Speaker 3>They've evolved to escape that one protective response. But Listeria

0:43:47.120 --> 0:43:50.320
<v Speaker 3>take it one step further. They have a whole host

0:43:50.400 --> 0:43:54.839
<v Speaker 3>of other receptors that allow for them to intentionally enter

0:43:55.080 --> 0:44:00.440
<v Speaker 3>our other cells like our intestinal epithelium like other cells

0:44:00.480 --> 0:44:04.240
<v Speaker 3>in our spleen and our liver and throughout our body

0:44:05.080 --> 0:44:09.799
<v Speaker 3>and survive and replicate within those cells as well. It's

0:44:10.160 --> 0:44:11.000
<v Speaker 3>it's incredible.

0:44:11.120 --> 0:44:20.080
<v Speaker 1>It's incredible. So this bacterium is slowly invading our entire body, Yeah,

0:44:20.160 --> 0:44:25.120
<v Speaker 1>hopping cell to sell or sneaking cell to sell to anthropomorphize,

0:44:25.600 --> 0:44:28.960
<v Speaker 1>and most of the time it's doing this silently more

0:44:29.080 --> 0:44:29.480
<v Speaker 1>or less.

0:44:29.840 --> 0:44:34.640
<v Speaker 3>Right, Well, that's a really good question, Aron. That question

0:44:34.719 --> 0:44:39.080
<v Speaker 3>has a lot to it because the question is what

0:44:39.239 --> 0:44:42.960
<v Speaker 3>percentage of the time, if I'm exposed to listeria in

0:44:43.040 --> 0:44:48.200
<v Speaker 3>my turkey sandwich, is it getting through my guts and

0:44:48.239 --> 0:44:51.040
<v Speaker 3>replicating in my cells without me ever getting sick from it?

0:44:51.080 --> 0:44:52.640
<v Speaker 1>Does that happen question mark?

0:44:53.400 --> 0:44:57.800
<v Speaker 3>Or does it not? Do I have a gut barrier

0:44:57.840 --> 0:45:01.239
<v Speaker 3>that doesn't allow it to penetrate, And in the case

0:45:01.280 --> 0:45:03.839
<v Speaker 3>that it does penetrate, does it just take those one

0:45:03.880 --> 0:45:06.920
<v Speaker 3>to four weeks for the bacteria to replicate to a

0:45:06.960 --> 0:45:10.520
<v Speaker 3>point at which our body recognizes it and now is

0:45:10.560 --> 0:45:15.200
<v Speaker 3>causing a response that is illness, right, and that is

0:45:15.239 --> 0:45:20.160
<v Speaker 3>that overwhelming infection that now we're really sick from. I

0:45:20.239 --> 0:45:23.600
<v Speaker 3>don't know which of those two my suspicion is that

0:45:23.719 --> 0:45:28.560
<v Speaker 3>it is the latter, where in people who don't have

0:45:28.600 --> 0:45:31.239
<v Speaker 3>any risk factors, who are not getting severely ill from

0:45:31.239 --> 0:45:35.719
<v Speaker 3>this most of the time, this bacterium is not establishing

0:45:35.760 --> 0:45:38.800
<v Speaker 3>an infection in our cells for a very long period

0:45:38.840 --> 0:45:39.480
<v Speaker 3>of time.

0:45:39.440 --> 0:45:45.560
<v Speaker 1>Okay, and when our body recognizes it as a pathogen,

0:45:45.880 --> 0:45:49.640
<v Speaker 1>which happens, you know, at a certain point later on

0:45:49.880 --> 0:45:55.279
<v Speaker 1>when things are real bad, what is that response like,

0:45:55.320 --> 0:45:57.719
<v Speaker 1>because it's unusual.

0:45:57.320 --> 0:46:00.440
<v Speaker 3>Right, Yeah, So it seems like one of the biggest

0:46:00.560 --> 0:46:07.080
<v Speaker 3>risk factors for infection with listeria, for listeriosis, these invasive infections,

0:46:07.840 --> 0:46:13.839
<v Speaker 3>is lack of a adequate T cell response. So it is

0:46:14.920 --> 0:46:19.560
<v Speaker 3>T cells that are primarily the ones that are blocking

0:46:19.600 --> 0:46:23.879
<v Speaker 3>this infection from happening and responding to this infection when

0:46:23.920 --> 0:46:28.640
<v Speaker 3>it is established. And so for cases when you lack

0:46:28.680 --> 0:46:32.279
<v Speaker 3>that response for one reason or another, that is when

0:46:32.280 --> 0:46:37.240
<v Speaker 3>you actually see listeriosis manifest itself. And that is largely

0:46:37.280 --> 0:46:40.920
<v Speaker 3>because of the way that it's an intracellular only pathogen.

0:46:41.200 --> 0:46:44.000
<v Speaker 3>Our T cells are much more involved in that part

0:46:44.120 --> 0:46:49.560
<v Speaker 3>of our immune response, like killing infected cells versus antibody

0:46:49.600 --> 0:46:54.000
<v Speaker 3>responding to bacteria that are free floating in our bloodstream. Okay,

0:46:54.440 --> 0:46:57.200
<v Speaker 3>So you don't see a lot of the more antibody

0:46:57.280 --> 0:46:59.040
<v Speaker 3>mediated response with.

0:46:59.080 --> 0:47:02.680
<v Speaker 1>Listeria, which is fascinating.

0:47:03.040 --> 0:47:05.760
<v Speaker 3>It's interesting because it's still a bacterial infection.

0:47:06.080 --> 0:47:11.080
<v Speaker 1>Yeah, yeah, And that means presumably that you know, is

0:47:11.160 --> 0:47:15.319
<v Speaker 1>their sustained immunity to listeria. Probably not.

0:47:16.600 --> 0:47:19.359
<v Speaker 3>I don't think we have any data on that whatsoever, though.

0:47:19.680 --> 0:47:19.919
<v Speaker 1>Yeah.

0:47:20.040 --> 0:47:23.680
<v Speaker 3>Yeah, because mortality is really high and because it's a

0:47:23.840 --> 0:47:29.160
<v Speaker 3>very rare infection still, Oh thank goodness. But that is

0:47:29.400 --> 0:47:34.799
<v Speaker 3>most of the biology of listeria and the disease that

0:47:34.840 --> 0:47:36.800
<v Speaker 3>we know of as listeriosis.

0:47:38.239 --> 0:47:39.080
<v Speaker 1>It's a bad one.

0:47:39.239 --> 0:47:42.360
<v Speaker 3>It's a really bad one. It is treatable with antibiotics,

0:47:42.440 --> 0:47:45.680
<v Speaker 3>and in general, antibiotic resistance has yet to be a

0:47:45.840 --> 0:47:49.880
<v Speaker 3>huge concern in terms of like the normal antibotics that

0:47:49.880 --> 0:47:53.319
<v Speaker 3>we would use to treat it. But it tends to

0:47:53.320 --> 0:47:57.719
<v Speaker 3>respond better to specific antibiotics that maybe aren't used as

0:47:57.800 --> 0:48:02.160
<v Speaker 3>commonly as like mineral antibiotics if someone comes in with

0:48:02.320 --> 0:48:05.320
<v Speaker 3>bacterymia or stept to semia. So a lot of times

0:48:05.360 --> 0:48:09.520
<v Speaker 3>we do see delays in appropriate treatment because it's a

0:48:09.560 --> 0:48:11.600
<v Speaker 3>hard disease to diagnose.

0:48:11.640 --> 0:48:16.279
<v Speaker 1>And which I would guess contributes to mortality rate.

0:48:16.480 --> 0:48:22.440
<v Speaker 3>Absolutely contributes to mortality rate. Yes, definitely. So any other

0:48:22.520 --> 0:48:25.160
<v Speaker 3>questions erin, I mean, I have a lot, but.

0:48:25.239 --> 0:48:28.480
<v Speaker 1>Like I'm sure I'll come up with something again at

0:48:28.480 --> 0:48:29.160
<v Speaker 1>some point.

0:48:29.360 --> 0:48:33.320
<v Speaker 3>Yeah, well, can you tell me, like where this bacterium

0:48:33.440 --> 0:48:36.240
<v Speaker 3>came from and how long it's been making us sick

0:48:36.360 --> 0:48:38.160
<v Speaker 3>and everything that we know about it and how we

0:48:38.200 --> 0:48:38.560
<v Speaker 3>got here.

0:48:38.680 --> 0:48:42.239
<v Speaker 1>Oh yeah, everything, I'll just everything, all of it, all

0:48:42.280 --> 0:49:09.200
<v Speaker 1>of it right after this break. In many ways, I

0:49:09.239 --> 0:49:14.400
<v Speaker 1>think that the story of Listeria monocytogenies will sound like

0:49:14.520 --> 0:49:19.480
<v Speaker 1>maybe fairly familiar to you, and especially you Aaron, but

0:49:19.680 --> 0:49:24.360
<v Speaker 1>also you listeners, if you have listened to the podcast before.

0:49:25.840 --> 0:49:29.600
<v Speaker 1>It involves the discovery of a new pathogenic microbe in

0:49:29.640 --> 0:49:32.960
<v Speaker 1>the early twentieth century, and then it's followed by the

0:49:33.000 --> 0:49:36.799
<v Speaker 1>realization that, hey, this pathogen is a lot more widespread

0:49:36.840 --> 0:49:41.840
<v Speaker 1>than we previously thought, and then people tracing its spread

0:49:41.880 --> 0:49:44.800
<v Speaker 1>not just in present day but also in the past.

0:49:45.400 --> 0:49:48.680
<v Speaker 1>And it's a fascinating story of discovery, and it follows

0:49:48.680 --> 0:49:52.440
<v Speaker 1>this common pattern. But what I think separates the story

0:49:52.480 --> 0:49:56.480
<v Speaker 1>of Listeria from these other ones comes down to a

0:49:56.520 --> 0:49:58.839
<v Speaker 1>few things. And by the way, when I say listeria,

0:49:58.920 --> 0:50:02.120
<v Speaker 1>I am specific referring for the most part, unless I

0:50:02.160 --> 0:50:08.000
<v Speaker 1>say otherwise to Listeria monocytogenies, I mean same. Yeah. But

0:50:08.120 --> 0:50:11.280
<v Speaker 1>one of these things that separates this story out from

0:50:11.480 --> 0:50:14.360
<v Speaker 1>some of the others is what I found to be

0:50:14.480 --> 0:50:19.400
<v Speaker 1>a surprising delay between discovery and when people realized how

0:50:19.440 --> 0:50:22.960
<v Speaker 1>it was commonly transmitted. And we'll get into that. And

0:50:23.000 --> 0:50:26.719
<v Speaker 1>the other is just how well we can see the

0:50:26.880 --> 0:50:32.440
<v Speaker 1>drivers of pathogen movement across time and space. Oh okay,

0:50:32.640 --> 0:50:36.440
<v Speaker 1>and that's not just in hypothetical terms, but by looking

0:50:36.520 --> 0:50:40.280
<v Speaker 1>at what this bacterium's biology can tell us about the past.

0:50:40.400 --> 0:50:44.080
<v Speaker 1>It's I love this ooh okay. We'll get into all

0:50:44.080 --> 0:50:47.360
<v Speaker 1>of it, but first let's start at the beginning. And

0:50:47.480 --> 0:50:50.320
<v Speaker 1>I'm skipping right to the discovery side of things, because

0:50:50.400 --> 0:50:52.480
<v Speaker 1>even though you asked where did this thing come from?

0:50:53.000 --> 0:50:56.239
<v Speaker 1>Listeria is widely distributed in the environment, and it can

0:50:56.320 --> 0:50:59.600
<v Speaker 1>infect a ton of different animals, and so I don't

0:50:59.680 --> 0:51:03.279
<v Speaker 1>really know when or where it first emerged. There are

0:51:03.320 --> 0:51:09.319
<v Speaker 1>some papers looking at the evolutionary relationships among some of

0:51:09.360 --> 0:51:12.880
<v Speaker 1>the species within the Lasteria genus and some of the

0:51:12.960 --> 0:51:15.960
<v Speaker 1>nonpathogenic ones compared to the pathogenic ones, and looking at

0:51:16.000 --> 0:51:19.800
<v Speaker 1>when did they evolve virulence and so on and so forth.

0:51:20.840 --> 0:51:26.440
<v Speaker 1>But I'm not going to get into it. Okay, okay,

0:51:27.080 --> 0:51:33.640
<v Speaker 1>but when did we as humans first recognize it as such? Well,

0:51:33.920 --> 0:51:37.920
<v Speaker 1>sometimes people look for a pathogen to match a known

0:51:38.120 --> 0:51:43.960
<v Speaker 1>or an infamous disease, think like plague or cholera or something.

0:51:44.719 --> 0:51:48.000
<v Speaker 1>Other times it's more of like a fishing expedition. You

0:51:48.080 --> 0:51:50.399
<v Speaker 1>cast your net and you see what you pull up.

0:51:50.800 --> 0:51:53.720
<v Speaker 1>There are some where people are just like, let's collect

0:51:53.800 --> 0:51:58.279
<v Speaker 1>swabs from infants' throats and see what we find, or

0:51:58.360 --> 0:52:03.120
<v Speaker 1>from pond water or this rabbit's foot or something.

0:52:03.440 --> 0:52:08.200
<v Speaker 4>Oh okay, yeah, And sometimes it happens, I think, a

0:52:08.239 --> 0:52:12.160
<v Speaker 4>bit more methodically, in a bit more of an expected fashion,

0:52:12.719 --> 0:52:15.840
<v Speaker 4>as much as scientific discovery can be expected in any case.

0:52:16.760 --> 0:52:22.080
<v Speaker 1>Listeria monocytogenies or Bacterium monocytogenies as it was first called,

0:52:22.600 --> 0:52:25.919
<v Speaker 1>falls into this last category. And I'll tell you how.

0:52:26.600 --> 0:52:30.600
<v Speaker 1>In nineteen twenty four, a researcher named Everett George Dunn

0:52:30.680 --> 0:52:34.120
<v Speaker 1>Murray happened to be looking in the blood of lab

0:52:34.239 --> 0:52:39.120
<v Speaker 1>rabbits when he found something new. And I say happened

0:52:39.120 --> 0:52:41.719
<v Speaker 1>to be but it was really quite intentional, as you'll

0:52:41.760 --> 0:52:44.680
<v Speaker 1>hear when I read a snippet of his paper, which

0:52:44.840 --> 0:52:49.040
<v Speaker 1>I felt was like written in a surprisingly poetic way,

0:52:49.960 --> 0:52:52.719
<v Speaker 1>and I love when that happens with older papers. Like

0:52:52.760 --> 0:52:55.640
<v Speaker 1>it was lovely. So I have a lot of quotations

0:52:55.680 --> 0:52:58.200
<v Speaker 1>here from it, hopefully not too many, but I think

0:52:58.239 --> 0:53:02.000
<v Speaker 1>you'll enjoy it. I love it already, all right, prepare yourself.

0:53:02.040 --> 0:53:07.640
<v Speaker 1>This is a long quote, okay quote. An important responsibility

0:53:07.719 --> 0:53:10.920
<v Speaker 1>attached to the breeding of normal laboratory animals for the

0:53:10.960 --> 0:53:15.640
<v Speaker 1>Department of Pathology was the routine autopsies on animals which died.

0:53:16.400 --> 0:53:19.879
<v Speaker 1>This practice was rewarded by the control it exercised over

0:53:19.920 --> 0:53:23.000
<v Speaker 1>the quality of the stock and by the interesting diseases

0:53:23.080 --> 0:53:27.560
<v Speaker 1>it discovered. Foremost amongst these is the disease described in

0:53:27.640 --> 0:53:31.880
<v Speaker 1>this paper. In May nineteen twenty four, six cases of

0:53:32.000 --> 0:53:35.880
<v Speaker 1>rather sudden death in rabbits were observed to present strikingly

0:53:35.960 --> 0:53:40.360
<v Speaker 1>similar lesions, though no direct cause of the evidently acute,

0:53:40.360 --> 0:53:44.160
<v Speaker 1>toxic or infectious condition could be discovered in any of them.

0:53:44.840 --> 0:53:48.440
<v Speaker 1>The interesting characters presented by the disease and the increasing

0:53:48.520 --> 0:53:52.880
<v Speaker 1>mortality amongst our young rabbits caused us to watch carefully

0:53:53.000 --> 0:53:56.240
<v Speaker 1>for any signs of illness and to investigate all cases

0:53:56.280 --> 0:53:59.800
<v Speaker 1>which occurred. Although there seemed to be every reason to

0:53:59.800 --> 0:54:02.480
<v Speaker 1>say suppose that the disease was of a septocemic nature,

0:54:02.880 --> 0:54:07.240
<v Speaker 1>all cultures from the heart's blood remained sterile. During July

0:54:07.360 --> 0:54:11.279
<v Speaker 1>nineteen twenty four, small gram positive basilla were found in

0:54:11.400 --> 0:54:14.480
<v Speaker 1>films of the acidic fluid in a guinea pig and

0:54:14.520 --> 0:54:18.400
<v Speaker 1>in smears from the omentum of a rabbit. Side note,

0:54:18.440 --> 0:54:21.880
<v Speaker 1>I don't know what an omentum is, so I did

0:54:22.040 --> 0:54:23.840
<v Speaker 1>look it up. I forgot to do. You want me

0:54:23.880 --> 0:54:25.400
<v Speaker 1>to tell you? Yeah, yeah, I tell you.

0:54:26.800 --> 0:54:26.920
<v Speaker 2>So.

0:54:27.120 --> 0:54:31.560
<v Speaker 3>It's like this kind of like fatty layer that lays

0:54:31.680 --> 0:54:35.120
<v Speaker 3>over our guts. It's like attached to the top of

0:54:35.160 --> 0:54:37.319
<v Speaker 3>your guts, and it kind of lays over all of

0:54:37.320 --> 0:54:40.160
<v Speaker 3>your intestines and it's a little cushing.

0:54:39.880 --> 0:54:40.520
<v Speaker 1>There for you.

0:54:40.800 --> 0:54:42.800
<v Speaker 3>Yes, nice, it's really nice.

0:54:42.880 --> 0:54:46.680
<v Speaker 1>Omentum. Cool, all right, back to the quotes. I have

0:54:47.440 --> 0:54:51.360
<v Speaker 1>just a few more lines, but little heed was taken

0:54:51.400 --> 0:54:55.200
<v Speaker 1>of these, and the heart blood cultures remained sterile. In

0:54:55.239 --> 0:54:58.320
<v Speaker 1>August nineteen twenty four, a pure culture of a small

0:54:58.400 --> 0:55:01.560
<v Speaker 1>gram positive bacillis was a obtained from the heart's blood

0:55:01.640 --> 0:55:05.520
<v Speaker 1>of an obviously acute case in a pregnant rabbit. These

0:55:05.560 --> 0:55:09.200
<v Speaker 1>basilla closely resembled those seen in the two animals during July,

0:55:09.400 --> 0:55:12.919
<v Speaker 1>and with their isolation in pure culture, our experimental work

0:55:13.000 --> 0:55:20.640
<v Speaker 1>began and quote. So basically what happened here was that

0:55:20.960 --> 0:55:24.960
<v Speaker 1>they found this disease, they found some sort of condition

0:55:25.040 --> 0:55:27.879
<v Speaker 1>in these rabbits. They kept culturing and culturing, and then

0:55:27.920 --> 0:55:32.920
<v Speaker 1>eventually they found this gram positive basilla. And after that point,

0:55:33.000 --> 0:55:36.200
<v Speaker 1>once they were able to culture this, they conducted a

0:55:36.200 --> 0:55:39.840
<v Speaker 1>bunch of observational and experimental work which included a combination

0:55:40.000 --> 0:55:44.480
<v Speaker 1>of clinical observations of the young rabbits in the lab, autopsies,

0:55:44.560 --> 0:55:49.560
<v Speaker 1>tissue preparations, experimental infection, culturing the organism, things that are

0:55:49.600 --> 0:55:52.120
<v Speaker 1>not just the usual but like the usual, and then

0:55:52.200 --> 0:55:57.080
<v Speaker 1>some This was a packed paper full of information. It

0:55:57.160 --> 0:56:00.920
<v Speaker 1>was really quite impressive. What they found was that the

0:56:00.960 --> 0:56:05.720
<v Speaker 1>infection seemed to hit the young rabbits particularly badly, causing

0:56:05.760 --> 0:56:08.719
<v Speaker 1>some to die very suddenly and others to die over

0:56:08.760 --> 0:56:13.839
<v Speaker 1>the course of weeks. The researchers remarked on how striking

0:56:14.080 --> 0:56:17.960
<v Speaker 1>the disease was, like how distinguishable it was once you

0:56:18.040 --> 0:56:20.480
<v Speaker 1>saw it in an animal. There was very little else

0:56:20.480 --> 0:56:23.720
<v Speaker 1>that they felt it could be I thought was really

0:56:24.520 --> 0:56:28.680
<v Speaker 1>interesting because we've talked about in the biology section, Like

0:56:28.719 --> 0:56:31.680
<v Speaker 1>you talked about it's very difficult. You can't look at

0:56:31.719 --> 0:56:35.200
<v Speaker 1>someone and go, oh, that's listeria for sure, right, but

0:56:35.360 --> 0:56:38.160
<v Speaker 1>they evidently could do that, at least in the way

0:56:38.200 --> 0:56:43.600
<v Speaker 1>it manifested in rabbits. And it was this characteristic nature

0:56:43.760 --> 0:56:47.320
<v Speaker 1>of the disease that was part of the reason why Murray,

0:56:47.560 --> 0:56:50.760
<v Speaker 1>the lead author on the paper, thought that this must

0:56:50.800 --> 0:56:55.880
<v Speaker 1>be a new pathogen not yet described. Quote. Both the

0:56:55.960 --> 0:57:00.279
<v Speaker 1>natural and experimental disease have interesting and characteristic features, and

0:57:00.320 --> 0:57:03.680
<v Speaker 1>their consideration has forced us to the conclusion that the

0:57:03.760 --> 0:57:08.520
<v Speaker 1>causative organism either has not been described previously or has

0:57:08.560 --> 0:57:12.440
<v Speaker 1>been inadequately described, and so cannot be traced in the literature.

0:57:13.120 --> 0:57:16.560
<v Speaker 1>In either case, we feel justified in naming it. Its

0:57:16.600 --> 0:57:21.240
<v Speaker 1>salient character is the production of a large mononuclear leucocytosis.

0:57:21.880 --> 0:57:25.600
<v Speaker 1>This is by far the most important and most striking

0:57:25.720 --> 0:57:29.720
<v Speaker 1>character we have discovered, and we name the microorganism we

0:57:29.760 --> 0:57:35.720
<v Speaker 1>shall describe in this paper Bacterium monocytogenes. I love that.

0:57:35.760 --> 0:57:39.720
<v Speaker 1>I love it. We feel what was it? We feel

0:57:39.840 --> 0:57:42.959
<v Speaker 1>justified in naming it. I love it. I mean they

0:57:43.360 --> 0:57:45.960
<v Speaker 1>maybe they were justified in naming it, but they certainly

0:57:46.000 --> 0:57:50.640
<v Speaker 1>weren't the first people to culture it, especially given its

0:57:50.680 --> 0:57:52.320
<v Speaker 1>widespread prevalence in nature.

0:57:52.600 --> 0:57:56.680
<v Speaker 3>I wonder if the really high monocyte peripheral monocytes that

0:57:56.720 --> 0:57:58.959
<v Speaker 3>they were seeing were part of what they said. Once

0:57:59.000 --> 0:58:01.360
<v Speaker 3>you see this, you know it can't be anything else,

0:58:01.680 --> 0:58:03.880
<v Speaker 3>because that is true in rabbits, but it is not

0:58:03.960 --> 0:58:05.400
<v Speaker 3>true in humans.

0:58:05.920 --> 0:58:09.760
<v Speaker 1>Interesting. Yeah, yeah, that's interesting in and of itself. But yeah,

0:58:10.160 --> 0:58:14.840
<v Speaker 1>why do different species respond differently to this? But yeah,

0:58:14.880 --> 0:58:18.520
<v Speaker 1>so not only had other there's pretty strong evidence for

0:58:18.680 --> 0:58:22.360
<v Speaker 1>like other people, other researchers having identified or at least

0:58:22.400 --> 0:58:27.560
<v Speaker 1>isolated this bacterium before. But either they're being punished for

0:58:27.600 --> 0:58:31.120
<v Speaker 1>the crime of not writing their paper in English, or

0:58:31.960 --> 0:58:35.360
<v Speaker 1>they didn't describe it well enough, or it was classified

0:58:35.360 --> 0:58:39.439
<v Speaker 1>as something else. But then also, retrospective analysis of old

0:58:39.520 --> 0:58:44.000
<v Speaker 1>tissue sections seemed to indicate that people there were human

0:58:44.040 --> 0:58:47.680
<v Speaker 1>infections at least before World War One. Okay, I mean

0:58:47.720 --> 0:58:49.360
<v Speaker 1>all of this is just to say that, like, this

0:58:49.440 --> 0:58:54.040
<v Speaker 1>bacterium has been around. There was no sudden rise necessarily

0:58:54.160 --> 0:58:57.000
<v Speaker 1>or any sort of reason why Murray was in the

0:58:57.080 --> 0:58:59.440
<v Speaker 1>right time and place for it was just a really

0:58:59.520 --> 0:59:06.400
<v Speaker 1>well written paper, But unlike we've seen with other infectious

0:59:06.440 --> 0:59:09.320
<v Speaker 1>diseases in the past, it didn't necessarily lead to this

0:59:09.560 --> 0:59:12.960
<v Speaker 1>widespread recognition where everyone's like, oh my gosh, I see it.

0:59:12.960 --> 0:59:18.680
<v Speaker 1>It's everywhere. Suddenly, here's Bacterium monocytogenies. It kind of laid

0:59:18.760 --> 0:59:22.160
<v Speaker 1>low for a while. It was mentioned in textbooks. It

0:59:22.840 --> 0:59:27.280
<v Speaker 1>got a genus name change along the way from Bacterium

0:59:27.360 --> 0:59:31.400
<v Speaker 1>or whatever it was called to Listeria. And also side

0:59:31.400 --> 0:59:35.520
<v Speaker 1>note Listeria, of course, is to honor Joseph Lister. Mister

0:59:36.160 --> 0:59:39.760
<v Speaker 1>features in our Percepsist episode, so go check that episode

0:59:39.760 --> 0:59:41.640
<v Speaker 1>out if you want to learn more about his story

0:59:41.720 --> 0:59:45.880
<v Speaker 1>if you haven't already. Anyway, in the twenty five years

0:59:46.000 --> 0:59:50.680
<v Speaker 1>or so since Murray first cultured this bacterium, it didn't

0:59:50.680 --> 0:59:54.720
<v Speaker 1>really make itself known as a pathogen of public health importance.

0:59:55.200 --> 0:59:59.240
<v Speaker 1>Took a while, which I find interesting. Mostly it was

0:59:59.320 --> 1:00:02.800
<v Speaker 1>found in small rodents or in domestic animals like sheep,

1:00:03.360 --> 1:00:09.120
<v Speaker 1>causing occasional outbreaks in those organisms. There were a handful

1:00:09.200 --> 1:00:12.560
<v Speaker 1>of human cases reported in Denmark in nineteen twenty nine,

1:00:13.240 --> 1:00:14.960
<v Speaker 1>and at the time it was thought to be related

1:00:14.960 --> 1:00:19.520
<v Speaker 1>to infectious mononucleosis, but in general it was thought to

1:00:19.560 --> 1:00:24.200
<v Speaker 1>be extremely rare in humans, so rare that it didn't

1:00:24.440 --> 1:00:29.320
<v Speaker 1>merit a mention in bacteriology textbooks relevant to human health

1:00:29.480 --> 1:00:34.920
<v Speaker 1>at the time. Wow, But it did merit a note

1:00:35.240 --> 1:00:39.919
<v Speaker 1>from a researcher named Burns in nineteen thirty five who

1:00:40.040 --> 1:00:45.000
<v Speaker 1>warned that Listeria monocytogenies could be a cause of granulomatis

1:00:45.000 --> 1:00:51.760
<v Speaker 1>septicemia in infants and fatal meningitis in adults. But this

1:00:51.920 --> 1:00:56.240
<v Speaker 1>warning by Burns was either forgotten about or never heard

1:00:56.280 --> 1:01:00.720
<v Speaker 1>in the first place until nineteen fifty one when HPR

1:01:00.920 --> 1:01:04.760
<v Speaker 1>Seliger at the University of Bonn, who wrote the textbook

1:01:04.800 --> 1:01:09.640
<v Speaker 1>on Listeria literally and I think there's a species named

1:01:09.800 --> 1:01:15.000
<v Speaker 1>after this researcher as well, when Seliger isolated the bacteria

1:01:15.040 --> 1:01:19.960
<v Speaker 1>from lesions in newborns who had infections that resembled some

1:01:20.120 --> 1:01:22.720
<v Speaker 1>that had just been written about from Germany had just

1:01:22.800 --> 1:01:26.960
<v Speaker 1>been published about, and so researchers there in Germany a

1:01:27.000 --> 1:01:30.720
<v Speaker 1>couple of years before had isolated the same bacteria from

1:01:30.840 --> 1:01:34.880
<v Speaker 1>various tissues of eighty three newborns and stillborn infants who

1:01:34.880 --> 1:01:40.280
<v Speaker 1>had been diagnosed with quote unquote Granulomatis in fantaseptica, which

1:01:40.400 --> 1:01:44.240
<v Speaker 1>was thought to be a never before described infection. Oh okay,

1:01:44.520 --> 1:01:47.920
<v Speaker 1>but these researchers thought that the bacteria they had found

1:01:48.160 --> 1:01:51.680
<v Speaker 1>was a kind of Krina bacterium, And it was only

1:01:51.720 --> 1:01:56.520
<v Speaker 1>realized that it was Listeria monocytogenies after Seliger recognized it

1:01:56.680 --> 1:01:59.720
<v Speaker 1>as such a couple of years later. So, like I said,

1:01:59.760 --> 1:02:02.280
<v Speaker 1>this was certainly not the first time that Listeria had

1:02:02.320 --> 1:02:07.120
<v Speaker 1>infected humans. And some researchers have looked back at case

1:02:07.160 --> 1:02:10.440
<v Speaker 1>reports from the late eighteen hundreds and early nineteen hundreds

1:02:11.040 --> 1:02:16.920
<v Speaker 1>and hypothesized that listeriosis may have previously been diagnosed or

1:02:16.960 --> 1:02:24.520
<v Speaker 1>described as quote unquote pseudo tuberculosis or quote unquote neonatal septicemia.

1:02:24.560 --> 1:02:27.240
<v Speaker 1>And I saw a reference to a paper that I

1:02:27.240 --> 1:02:31.520
<v Speaker 1>couldn't access where the author speculates that Queen Anne, who

1:02:31.560 --> 1:02:36.320
<v Speaker 1>lived from sixteen sixty five to seventeen fourteen, had repeated

1:02:36.400 --> 1:02:41.640
<v Speaker 1>pregnancy losses, still births, neonatal deaths, and post natal meningitis

1:02:41.720 --> 1:02:48.880
<v Speaker 1>seventeen pregnancies overall with no living offspring. Oh, and some

1:02:49.040 --> 1:02:52.840
<v Speaker 1>people have speculated that it was due to listeria. I

1:02:52.840 --> 1:02:55.360
<v Speaker 1>don't know. That's a lot of lasteria, it's a lot

1:02:55.360 --> 1:02:59.800
<v Speaker 1>of lysteria. So even though we know that listeria probably

1:03:00.080 --> 1:03:05.000
<v Speaker 1>infected people throughout history, there's no way to make precise

1:03:05.160 --> 1:03:11.640
<v Speaker 1>estimates of past prevalence for something like listeriosis. But infections

1:03:11.720 --> 1:03:14.600
<v Speaker 1>did seem to start rising in the second half of

1:03:14.640 --> 1:03:17.600
<v Speaker 1>the twentieth century. This could be due in part to

1:03:17.640 --> 1:03:21.920
<v Speaker 1>the increase in microbiology techniques and the fact that people

1:03:22.080 --> 1:03:31.000
<v Speaker 1>knew about listeriosis, but or I think it could be

1:03:32.080 --> 1:03:36.760
<v Speaker 1>the large scale changes in food production and the lag

1:03:37.320 --> 1:03:41.720
<v Speaker 1>in food safety policies that had been taking place and

1:03:41.920 --> 1:03:50.880
<v Speaker 1>continued to take place throughout the twentieth century. Yeah uh huh.

1:03:49.480 --> 1:03:51.880
<v Speaker 3>Okay, big chicken, Big chicken all over again.

1:03:51.920 --> 1:03:55.520
<v Speaker 1>Big chicken. Yeah, I mean, and this goes back even further.

1:03:56.640 --> 1:03:59.520
<v Speaker 1>I love talking about the Industrial Revolution and how it

1:03:59.640 --> 1:04:03.040
<v Speaker 1>changed so much in terms of health and disease. The

1:04:03.160 --> 1:04:06.920
<v Speaker 1>rise of cities, the growth of hospitals, the commercialization of medicine,

1:04:06.960 --> 1:04:10.480
<v Speaker 1>the poor air quality, the limited diets, the mass produced foods,

1:04:10.520 --> 1:04:15.680
<v Speaker 1>et cetera, et cetera. Many pathogens, as we know, as

1:04:15.720 --> 1:04:22.320
<v Speaker 1>we've talked about, absolutely flourished in these new settings, including listeria.

1:04:22.400 --> 1:04:24.840
<v Speaker 1>We now think of listeria as a pathogen that is

1:04:24.920 --> 1:04:29.120
<v Speaker 1>primarily associated with food. Many outbreaks have been traced to

1:04:29.440 --> 1:04:33.640
<v Speaker 1>food like milk, cheese made with raw milk, deli meats,

1:04:33.760 --> 1:04:38.000
<v Speaker 1>hot dogs, fruits and veggies contaminated with manure containing listeria,

1:04:38.840 --> 1:04:42.800
<v Speaker 1>but the link between listeria and contaminated foods was only

1:04:42.880 --> 1:04:47.520
<v Speaker 1>made in nineteen eighty three after an outbreak of listeriosis

1:04:47.560 --> 1:04:52.000
<v Speaker 1>among pregnant people and infants, with an extremely high mortality

1:04:52.080 --> 1:04:55.200
<v Speaker 1>rate of twenty seven percent of the infants born alive

1:04:55.720 --> 1:05:03.640
<v Speaker 1>despite aggressive supportive care and forty seven percent overall nineteen

1:05:03.800 --> 1:05:08.040
<v Speaker 1>eighty three nineteen eighty three. So this particular outbreak was

1:05:08.160 --> 1:05:12.160
<v Speaker 1>linked to coalslaw that had been contaminated by sheep manure

1:05:12.280 --> 1:05:19.840
<v Speaker 1>containing listeria. So before then, before this this outbreak, researchers

1:05:19.840 --> 1:05:23.720
<v Speaker 1>suspected that humans got infected with listeria from some kind

1:05:23.760 --> 1:05:28.400
<v Speaker 1>of indirect transmission from animal sources, especially given its widespread

1:05:28.400 --> 1:05:31.800
<v Speaker 1>prevalence in domestic and wild animals, but this was the

1:05:31.800 --> 1:05:35.960
<v Speaker 1>first time that it was actually demonstrated. Epidemiologists went to

1:05:36.280 --> 1:05:39.560
<v Speaker 1>the farms or went to the food production facilities where

1:05:39.600 --> 1:05:42.480
<v Speaker 1>this coal slaw had been processed, and they were like, oh,

1:05:43.280 --> 1:05:49.160
<v Speaker 1>it's in the everything, yeah, yeah, And later on I'm

1:05:49.160 --> 1:05:51.440
<v Speaker 1>going to pick back up on some of these food

1:05:51.440 --> 1:05:54.840
<v Speaker 1>born outbreaks of listeria and lessons learned and so on,

1:05:55.200 --> 1:05:57.360
<v Speaker 1>But first I want to head back into the Industrial

1:05:57.400 --> 1:06:01.800
<v Speaker 1>Revolution where I started this whole like topic. So, during

1:06:01.920 --> 1:06:04.360
<v Speaker 1>this time, as more and more people began to move

1:06:04.520 --> 1:06:08.400
<v Speaker 1>to live and work in cities, food production had to

1:06:08.560 --> 1:06:13.400
<v Speaker 1>change to accommodate these increasing population densities. There was more

1:06:13.440 --> 1:06:16.920
<v Speaker 1>of a demand for mass produced foods and process foods

1:06:17.080 --> 1:06:21.120
<v Speaker 1>as the time from harvest to table grew longer and longer.

1:06:21.960 --> 1:06:24.120
<v Speaker 1>And of course, as we've talked about on the podcast,

1:06:24.200 --> 1:06:29.400
<v Speaker 1>before food safeties or technology allowing for analysis of food

1:06:29.480 --> 1:06:34.000
<v Speaker 1>and food safety, it lagged tremendously far behind these new

1:06:34.040 --> 1:06:38.920
<v Speaker 1>food production practices, especially in the US, where the giants

1:06:38.920 --> 1:06:42.640
<v Speaker 1>and food industry, who were more concerned with profit than

1:06:42.680 --> 1:06:47.760
<v Speaker 1>the health of their consumers actively discouraged any safety legislation

1:06:47.840 --> 1:06:53.200
<v Speaker 1>from being passed in the US for years, years, decades.

1:06:54.760 --> 1:06:57.640
<v Speaker 1>Person surprised, Oh, oh, it's even though it's not surprising,

1:06:57.680 --> 1:07:04.600
<v Speaker 1>its shocking somehow, still just appalling. Maybe milk was diluted

1:07:04.680 --> 1:07:09.640
<v Speaker 1>with pond water, it was preserved with formaldehyde and adulterated

1:07:09.680 --> 1:07:12.760
<v Speaker 1>with plaster of Paris to get rid of the murky

1:07:12.800 --> 1:07:16.240
<v Speaker 1>blue tint because it had been diluted with like pond water,

1:07:16.720 --> 1:07:19.480
<v Speaker 1>and you could see horse hair worms swimming in and

1:07:19.520 --> 1:07:22.440
<v Speaker 1>of it and stop it. But the plaster of Paris

1:07:22.440 --> 1:07:24.800
<v Speaker 1>made it look farm fresh and straight from the utter.

1:07:25.200 --> 1:07:25.840
<v Speaker 1>Stop it.

1:07:26.040 --> 1:07:28.320
<v Speaker 3>Oh, this is worse than the Arsenic. I feel like

1:07:28.360 --> 1:07:31.480
<v Speaker 3>you talked about similar things.

1:07:32.240 --> 1:07:37.000
<v Speaker 1>Yeah, yep, I mean meat production, Like, don't even get

1:07:37.000 --> 1:07:39.640
<v Speaker 1>me started. It was. It was equally appalling, if not

1:07:39.760 --> 1:07:43.480
<v Speaker 1>more so. There's a reason that Upton Sinclair's The Jungle

1:07:43.640 --> 1:07:47.240
<v Speaker 1>caused such a stir. No food was safe to eat.

1:07:47.600 --> 1:07:51.800
<v Speaker 1>Spices were like cinnamon was mostly just brick dust, for instance.

1:07:52.560 --> 1:07:55.400
<v Speaker 1>If you want to learn more about this, stay tuned

1:07:56.000 --> 1:07:59.320
<v Speaker 1>to the podcast for a bonus episode later this season

1:08:00.040 --> 1:08:04.000
<v Speaker 1>where I interview Deborah Blum about her fantastic book The

1:08:04.040 --> 1:08:07.640
<v Speaker 1>Poison Squad, which goes into the fascinating history of food

1:08:07.680 --> 1:08:10.560
<v Speaker 1>safety in the US. Oh, will read the book now

1:08:10.560 --> 1:08:13.360
<v Speaker 1>if you don't feel like waiting for the upper Yeah,

1:08:13.680 --> 1:08:19.320
<v Speaker 1>it's such a jaw dropping book. Oh my gosh, that's yeah. Okay. Anyway,

1:08:20.240 --> 1:08:24.840
<v Speaker 1>it's easy to see how these practices with essentially no

1:08:25.080 --> 1:08:29.960
<v Speaker 1>oversight for food safety, mass processing of milk based products

1:08:29.960 --> 1:08:35.040
<v Speaker 1>and meats, longer times between production and purchase, no refrigeration.

1:08:36.000 --> 1:08:39.080
<v Speaker 1>How these things would have led to a massive increase

1:08:39.280 --> 1:08:43.520
<v Speaker 1>in listeria, both in terms of prevalence as well as geographically.

1:08:44.560 --> 1:08:47.400
<v Speaker 1>But this time we don't have to settle for speculation.

1:08:48.560 --> 1:08:52.519
<v Speaker 1>A paper from twenty twenty one by Maura at All

1:08:52.800 --> 1:08:57.920
<v Speaker 1>traced the global spread of listeria, particularly one clonal group

1:08:58.800 --> 1:09:03.759
<v Speaker 1>LMCC one, if anyone's interested, and this clonal group commonly

1:09:03.800 --> 1:09:07.280
<v Speaker 1>causes infection in humans and is often found in cattle

1:09:07.320 --> 1:09:11.920
<v Speaker 1>and dairy products, if you remember from our Anthrax episode.

1:09:12.160 --> 1:09:15.800
<v Speaker 1>The clonal aspect of this really helps with being able

1:09:15.840 --> 1:09:19.960
<v Speaker 1>to more closely trace diversification and rates of evolution and

1:09:20.000 --> 1:09:24.160
<v Speaker 1>so on. And when these researchers looked at the genetic

1:09:24.240 --> 1:09:27.719
<v Speaker 1>diversity of this group, what they found was that around

1:09:27.760 --> 1:09:32.840
<v Speaker 1>the mid nineteenth century Industrial Revolution time, this group, this

1:09:32.960 --> 1:09:37.760
<v Speaker 1>clonal group, underwent a big period of expansion both in

1:09:37.880 --> 1:09:43.679
<v Speaker 1>overall diversity as well as geographic expansion, particularly in Europe.

1:09:44.320 --> 1:09:47.040
<v Speaker 1>If you overlay this with what was going on in

1:09:47.040 --> 1:09:50.719
<v Speaker 1>the global food trade, you would find that in eighteen

1:09:50.840 --> 1:09:55.880
<v Speaker 1>seventy the North Atlantic Meat Trade Agreement was passed, which

1:09:55.920 --> 1:09:59.240
<v Speaker 1>allowed for excess cattle in North America to be shipped

1:09:59.280 --> 1:10:03.519
<v Speaker 1>to Europe, whose cattle population had dwindled due to things

1:10:03.600 --> 1:10:07.559
<v Speaker 1>like contagious bovine plural pneumonia and foot in mouth disease.

1:10:08.280 --> 1:10:11.519
<v Speaker 1>It's all about diseases, like I always everything.

1:10:11.800 --> 1:10:13.400
<v Speaker 3>It's just always about diseases.

1:10:13.560 --> 1:10:13.720
<v Speaker 2>Erin.

1:10:15.000 --> 1:10:19.160
<v Speaker 1>We're not biased or anything, uh huh, but this trade

1:10:19.160 --> 1:10:22.120
<v Speaker 1>agreement isn't just a matter of a few head of cattle.

1:10:22.920 --> 1:10:27.040
<v Speaker 1>According to this paper, it led to a one thousandfold

1:10:27.160 --> 1:10:30.560
<v Speaker 1>increase in the amount of cattle moved from North America

1:10:30.600 --> 1:10:35.639
<v Speaker 1>to Europe. Wow. And right around this time, the researchers estimate,

1:10:35.840 --> 1:10:39.960
<v Speaker 1>is when this particular clonal group of listeria arrived in Europe,

1:10:40.400 --> 1:10:43.720
<v Speaker 1>after which it spread across the continent, helped along by

1:10:43.840 --> 1:10:47.200
<v Speaker 1>railroad expansion which was currently going on both in Europe

1:10:47.240 --> 1:10:51.920
<v Speaker 1>and North America, and it continued to diversify along the way.

1:10:52.760 --> 1:10:56.759
<v Speaker 1>A drought in Oceania from eighteen ninety five to nineteen

1:10:56.840 --> 1:11:01.479
<v Speaker 1>oh three led to cattle and their listeria being transported there,

1:11:03.120 --> 1:11:06.800
<v Speaker 1>and then subsequent decades saw the continued global spread of

1:11:06.840 --> 1:11:10.880
<v Speaker 1>this pathogen from North America to Asia to Oceania, from

1:11:10.920 --> 1:11:14.920
<v Speaker 1>Europe to Africa, basically all over the world, and the

1:11:14.960 --> 1:11:20.080
<v Speaker 1>pattern in genetic diversity of Listeria supports this increasing during

1:11:20.080 --> 1:11:24.240
<v Speaker 1>this time of widespread cattle movement. And then this is

1:11:24.280 --> 1:11:28.760
<v Speaker 1>the part I find so interesting, slowing down during the

1:11:28.760 --> 1:11:32.960
<v Speaker 1>Great Depression, when countries such as the US and many

1:11:33.000 --> 1:11:37.000
<v Speaker 1>other countries stopped exporting cattle and other foods for a while,

1:11:37.800 --> 1:11:40.040
<v Speaker 1>so we're like, we need to food our people in

1:11:40.080 --> 1:11:41.240
<v Speaker 1>this variety or whatever.

1:11:41.600 --> 1:11:44.639
<v Speaker 3>Oh my gosh, that's really really cool that they had

1:11:44.760 --> 1:11:47.040
<v Speaker 3>enough data to be able to see.

1:11:46.920 --> 1:11:53.920
<v Speaker 1>That, right, And then it keeps going when trade resumed

1:11:54.000 --> 1:11:59.240
<v Speaker 1>and cattle farming and food industrialization intensified around the mid

1:11:59.240 --> 1:12:04.160
<v Speaker 1>twentieth century. Boom. You can see that these changing practices

1:12:04.840 --> 1:12:08.479
<v Speaker 1>are reflected by what's happening also with this clonal group,

1:12:08.520 --> 1:12:12.840
<v Speaker 1>which is so amazing and has also been seen for

1:12:12.920 --> 1:12:17.040
<v Speaker 1>a few other food borne pathogens with a zonotic reservoir

1:12:17.080 --> 1:12:21.960
<v Speaker 1>like E. Cola one five, seven, seven. Sooo, it seems

1:12:22.000 --> 1:12:25.880
<v Speaker 1>pretty likely to me that the apparent rise in Listeriosis

1:12:25.960 --> 1:12:29.200
<v Speaker 1>around the mid twentieth century may not have been just

1:12:29.280 --> 1:12:32.880
<v Speaker 1>because people knew what to look for. Seems like it

1:12:32.960 --> 1:12:38.800
<v Speaker 1>could be tied to the widespread global expansion of this pathogen.

1:12:39.560 --> 1:12:44.160
<v Speaker 3>Yeah, and changes in food production that just like favor Yeah,

1:12:44.240 --> 1:12:45.880
<v Speaker 3>this pathogen's growth.

1:12:46.880 --> 1:12:53.960
<v Speaker 1>Just favor contamination, Like yeah, like actively promotes contamination. But

1:12:54.439 --> 1:12:57.920
<v Speaker 1>I mean it certainly did help once people knew what

1:12:58.000 --> 1:13:02.519
<v Speaker 1>they were looking for. It wasn't until the nineteen eighties

1:13:02.640 --> 1:13:06.320
<v Speaker 1>that another change was made that we can see in

1:13:06.400 --> 1:13:11.680
<v Speaker 1>these clonal groups, which is the stabilization of the clonal population.

1:13:12.720 --> 1:13:15.880
<v Speaker 1>And that happened around the mid nineteen eighties, which is

1:13:16.200 --> 1:13:20.080
<v Speaker 1>after people realized that it was tied to food production

1:13:20.320 --> 1:13:23.320
<v Speaker 1>and certain food practices, and so they started to institute

1:13:23.439 --> 1:13:27.479
<v Speaker 1>these safety measures. Oh my gosh, how interesting. It is

1:13:28.080 --> 1:13:31.760
<v Speaker 1>so cool And I really hope that I interpreted this

1:13:31.800 --> 1:13:37.439
<v Speaker 1>paper correctly. And granted, this study did look at just

1:13:37.560 --> 1:13:39.960
<v Speaker 1>one clonal group, and there are others that are known

1:13:40.000 --> 1:13:42.840
<v Speaker 1>to cause disease in humans. But I think it's just

1:13:43.240 --> 1:13:46.800
<v Speaker 1>so cool because usually on the podcast, I feel like

1:13:46.840 --> 1:13:49.560
<v Speaker 1>I'm talking about the spread of this or that pathogen

1:13:49.720 --> 1:13:53.960
<v Speaker 1>in purely hypothetical terms. It's likely that this period of

1:13:54.040 --> 1:13:57.120
<v Speaker 1>history led to the proliferation of this pathogen because more

1:13:57.160 --> 1:14:00.840
<v Speaker 1>people were going to hospitals or as we know, war

1:14:01.000 --> 1:14:04.320
<v Speaker 1>always leads to increased infectious disease because of crowded and

1:14:04.400 --> 1:14:08.400
<v Speaker 1>unsanitary conditions, Like it's not very often that we can

1:14:08.479 --> 1:14:14.320
<v Speaker 1>actually trace the impact that certain political practices I think

1:14:14.520 --> 1:14:18.760
<v Speaker 1>had on a disease that we know about so much

1:14:18.760 --> 1:14:20.840
<v Speaker 1>more recently than I don't know. I just think it's

1:14:20.840 --> 1:14:21.240
<v Speaker 1>so cool.

1:14:21.680 --> 1:14:24.760
<v Speaker 3>Yeah, And to be able to track like pathogen diversity

1:14:24.840 --> 1:14:27.080
<v Speaker 3>like that, I really that's very cool.

1:14:27.240 --> 1:14:33.920
<v Speaker 1>Yeah, it's beautiful. But not only is it interesting or beautiful,

1:14:34.600 --> 1:14:39.800
<v Speaker 1>it also helps us with control or prevention today, since

1:14:39.840 --> 1:14:43.639
<v Speaker 1>Listeria is not transmitted human to human and mostly comes

1:14:43.680 --> 1:14:47.839
<v Speaker 1>from contaminated food sources, even if we don't necessarily always

1:14:48.000 --> 1:14:52.160
<v Speaker 1>or even often know the source of the contamination, and

1:14:52.240 --> 1:14:55.559
<v Speaker 1>because of the biology of this pathogen it's clonal nature,

1:14:55.840 --> 1:14:59.439
<v Speaker 1>the fact that at the local level, certain genotypes dominate,

1:15:00.160 --> 1:15:04.200
<v Speaker 1>we can use all this information to trace persistent sources

1:15:04.240 --> 1:15:07.479
<v Speaker 1>of infection, like whether it be from a particular herd,

1:15:07.560 --> 1:15:10.120
<v Speaker 1>maybe there's a really high prevalence and a certain herd

1:15:10.240 --> 1:15:13.800
<v Speaker 1>on a farm or within a certain farm, or within

1:15:13.840 --> 1:15:18.000
<v Speaker 1>a certain processing facility, and that's where public health officials

1:15:18.040 --> 1:15:22.280
<v Speaker 1>can sort of target or put resources to eliminate the

1:15:22.320 --> 1:15:26.680
<v Speaker 1>bacterium there. And on that front, We've made a lot

1:15:26.760 --> 1:15:30.280
<v Speaker 1>of progress since the nineteen eighties, in large part thanks

1:15:30.320 --> 1:15:34.160
<v Speaker 1>to the outbreaks of listeriosis that highlighted just how deadly

1:15:34.320 --> 1:15:39.400
<v Speaker 1>it could be, sparking these public health and food safety responses.

1:15:40.240 --> 1:15:43.479
<v Speaker 1>So earlier I mentioned that nineteen eighty three listeria outbreak

1:15:43.520 --> 1:15:47.479
<v Speaker 1>in Canada tied to contaminated coalslaw and that was the

1:15:47.479 --> 1:15:50.600
<v Speaker 1>one that really solidified food as a source of the pathogen.

1:15:50.960 --> 1:15:53.439
<v Speaker 1>But that was really only the beginning in terms of

1:15:53.479 --> 1:15:58.760
<v Speaker 1>food associated outbreaks of listeria. That same year, another outbreak

1:15:58.800 --> 1:16:04.759
<v Speaker 1>of listeriosis involving forty nine people, primarily infants and aminosuppressed adults,

1:16:05.240 --> 1:16:09.160
<v Speaker 1>and a fatality rate of twenty nine percent was detected

1:16:09.200 --> 1:16:13.400
<v Speaker 1>in Massachusetts, this time linked to milk, not raw milk,

1:16:13.479 --> 1:16:18.320
<v Speaker 1>but pasteurized milk, which pointed towards dairy products as a

1:16:18.360 --> 1:16:21.559
<v Speaker 1>source of listeria minus cytogenies, because remember the first one

1:16:21.600 --> 1:16:25.200
<v Speaker 1>was Coleslaw, and so this one really put dairy on

1:16:25.240 --> 1:16:28.439
<v Speaker 1>the map. And sure enough, a couple of years later,

1:16:28.800 --> 1:16:32.160
<v Speaker 1>soft cheese was the culprit, and a large outbreak of

1:16:32.280 --> 1:16:35.880
<v Speaker 1>listeriosis in California involving at least one hundred and one

1:16:36.080 --> 1:16:38.879
<v Speaker 1>human cases and fifty or more deaths.

1:16:39.160 --> 1:16:41.120
<v Speaker 3>Oh my, that's massive.

1:16:41.400 --> 1:16:45.240
<v Speaker 1>Massive. Ice Cream was next on the chopping block. When

1:16:45.240 --> 1:16:48.160
<v Speaker 1>the bacterium was found in large quantities of a well

1:16:48.200 --> 1:16:51.679
<v Speaker 1>known brand, they didn't name it in the paper, and

1:16:51.880 --> 1:16:56.559
<v Speaker 1>there have been subsequent ice cream associated outbreaks as well.

1:16:56.600 --> 1:17:01.640
<v Speaker 1>And one consequence of these outbreaks was that screening for listeria,

1:17:01.840 --> 1:17:06.120
<v Speaker 1>especially in cheeses and other dairy products, ramped up significantly

1:17:06.240 --> 1:17:09.760
<v Speaker 1>all over the world with the finding that listeria was

1:17:10.240 --> 1:17:14.360
<v Speaker 1>so so much more prevalent in certain types of cheeses

1:17:14.880 --> 1:17:18.240
<v Speaker 1>as well as in raw meat and meat products than

1:17:18.479 --> 1:17:23.439
<v Speaker 1>anyone had guessed before. And of course, with this alarming news,

1:17:23.439 --> 1:17:26.720
<v Speaker 1>at WHO and national public health authorities got involved and

1:17:26.760 --> 1:17:29.840
<v Speaker 1>began to investigate how to best stop this bacterium from

1:17:29.880 --> 1:17:33.160
<v Speaker 1>getting into the food supply, and how to raise awareness

1:17:33.280 --> 1:17:38.600
<v Speaker 1>among medical professionals about potential outbreaks, and how to estimate

1:17:38.800 --> 1:17:42.240
<v Speaker 1>or even begin to estimate the scope of this problem.

1:17:43.640 --> 1:17:48.160
<v Speaker 1>Research into the ecology of this pathogen revealed how widespread

1:17:48.160 --> 1:17:50.760
<v Speaker 1>it was, not just in livestock settings, but also in

1:17:50.800 --> 1:17:55.160
<v Speaker 1>the wild, found in soil or infecting wild animals like

1:17:55.200 --> 1:17:59.000
<v Speaker 1>I read one paper that found Listeria monocytogenies in nearly

1:17:59.280 --> 1:18:02.719
<v Speaker 1>half of the black bears that they sampled in parts

1:18:02.960 --> 1:18:06.479
<v Speaker 1>of the eastern US bears. Oh my god, I know.

1:18:08.000 --> 1:18:12.360
<v Speaker 1>And also how different conditions in farms, things like herd

1:18:12.439 --> 1:18:16.280
<v Speaker 1>size or livestock composition, like whether you have this many

1:18:16.280 --> 1:18:21.600
<v Speaker 1>sheep or this many cattle, or whatever, grazing or housing practices,

1:18:21.680 --> 1:18:24.880
<v Speaker 1>how all of these things could change the amplification or

1:18:24.880 --> 1:18:30.040
<v Speaker 1>dispersal of the pathogen or select for certain strains that

1:18:30.160 --> 1:18:35.839
<v Speaker 1>differ in their abilities to infect humans or livestock. Basically,

1:18:35.840 --> 1:18:39.400
<v Speaker 1>there's been a lot of information that we have uncovered

1:18:39.439 --> 1:18:44.400
<v Speaker 1>and are continuing to uncover. And while outbreaks did continue

1:18:44.400 --> 1:18:50.040
<v Speaker 1>to happen and continue to happen today, these improved safety measures,

1:18:50.320 --> 1:18:54.480
<v Speaker 1>along with this greater understanding of the ecology of this bacterium,

1:18:55.120 --> 1:18:58.920
<v Speaker 1>led to a pretty substantial decrease and reported the stereosis

1:18:58.960 --> 1:19:02.880
<v Speaker 1>cases in the nineteen nineties from eleven per million population

1:19:03.240 --> 1:19:07.000
<v Speaker 1>in nineteen eighty eight to four cases per million in

1:19:07.120 --> 1:19:11.480
<v Speaker 1>nineteen ninety eight. So it's like, that's a pretty substantial decline.

1:19:12.560 --> 1:19:16.439
<v Speaker 1>In nineteen ninety nine, a US wide outbreak involving one

1:19:16.520 --> 1:19:19.559
<v Speaker 1>hundred and one cases and twenty one deaths linked to

1:19:20.000 --> 1:19:24.080
<v Speaker 1>hot dogs stopped lysteria from dropping further down on the

1:19:24.120 --> 1:19:27.720
<v Speaker 1>food borne priority list as it kind of had been

1:19:27.760 --> 1:19:31.040
<v Speaker 1>doing since. Like, Hey, the measures we're implementing are working,

1:19:31.840 --> 1:19:35.960
<v Speaker 1>and this outbreak, in conjunction with other sporadic outbreaks as

1:19:36.040 --> 1:19:39.840
<v Speaker 1>well as individual cases, has kept people searching for ways

1:19:39.880 --> 1:19:43.280
<v Speaker 1>to stop this pathogen from invading the food supply chain.

1:19:43.680 --> 1:19:47.960
<v Speaker 1>And I have to admit that when reading about all

1:19:48.000 --> 1:19:52.080
<v Speaker 1>of these outbreaks and the subsequent response, like it's great

1:19:52.240 --> 1:19:55.280
<v Speaker 1>that there seems to be a response, but it's also

1:19:56.760 --> 1:20:00.599
<v Speaker 1>frustrating or I wish it could be different. That it

1:20:00.680 --> 1:20:03.520
<v Speaker 1>has to be a response, it has to be reactive,

1:20:04.800 --> 1:20:09.120
<v Speaker 1>and people have to experience these horrible things in order

1:20:09.160 --> 1:20:12.200
<v Speaker 1>for change to be made, in order for or in

1:20:12.320 --> 1:20:14.080
<v Speaker 1>order for people to go, hey, maybe we should re

1:20:14.160 --> 1:20:19.480
<v Speaker 1>examine how often we're testing this particular machine for listeria,

1:20:19.600 --> 1:20:24.800
<v Speaker 1>or what constitutes an acceptable level of listeria or so on.

1:20:25.200 --> 1:20:29.200
<v Speaker 3>I wish that we could be relactable a whole another

1:20:29.400 --> 1:20:31.920
<v Speaker 3>set of discussion, and that.

1:20:33.360 --> 1:20:36.559
<v Speaker 1>Well, that being said, I think it is important to

1:20:36.600 --> 1:20:39.800
<v Speaker 1>recognize that we have come a long way, not just

1:20:40.000 --> 1:20:44.120
<v Speaker 1>in food safety practices, but also in our understanding of

1:20:44.240 --> 1:20:49.040
<v Speaker 1>Listeria monocytogenies and as you mentioned, not just as a

1:20:49.080 --> 1:20:51.639
<v Speaker 1>pathogen of public health importance, but also what it can

1:20:51.680 --> 1:20:55.200
<v Speaker 1>tell us about things like cell signaling, surface proteins, and

1:20:55.240 --> 1:21:00.840
<v Speaker 1>ad immunity. And my favorite mention was patho epigenetics. Ooh,

1:21:00.880 --> 1:21:03.360
<v Speaker 1>but I don't want to step on your toes erin,

1:21:04.120 --> 1:21:06.120
<v Speaker 1>So why don't you bring us up to speed on

1:21:06.280 --> 1:21:10.559
<v Speaker 1>where we stand with listeriosis today and also why the

1:21:10.640 --> 1:21:14.440
<v Speaker 1>heck cellular biologists are so fascinated with this bacterium.

1:21:14.720 --> 1:21:17.840
<v Speaker 3>M hmm, I can't wait to We'll take a quick

1:21:17.880 --> 1:21:48.520
<v Speaker 3>break and then get into it. In the US, annually,

1:21:49.360 --> 1:21:53.320
<v Speaker 3>the CDC estimates that there are one thousand, six hundred

1:21:53.439 --> 1:21:58.160
<v Speaker 3>cases of listeriosis, so again that means invasive infection, not

1:21:58.720 --> 1:22:03.040
<v Speaker 3>just diarrhea. Oney six hundred cases and two hundred and

1:22:03.120 --> 1:22:07.559
<v Speaker 3>sixty deaths annually, and as far as I can tell,

1:22:07.640 --> 1:22:12.519
<v Speaker 3>that statistic does not include necessarily things like early or

1:22:12.560 --> 1:22:16.920
<v Speaker 3>premature labor or other pregnancy complications that don't result in

1:22:17.200 --> 1:22:20.000
<v Speaker 3>death of a neonate that would be counted as deaths.

1:22:22.200 --> 1:22:26.960
<v Speaker 3>So that's not a massive number compared to most of

1:22:27.000 --> 1:22:30.200
<v Speaker 3>the pathogens that we talk about on this podcast. But

1:22:30.320 --> 1:22:34.960
<v Speaker 3>it's not an entirely small number either. When we try

1:22:34.960 --> 1:22:39.000
<v Speaker 3>and look globally, unsurprisingly we don't have Greade numbers what

1:22:39.640 --> 1:22:44.960
<v Speaker 3>but the World Health Organization estimates anywhere from point one

1:22:45.840 --> 1:22:51.320
<v Speaker 3>to ten cases per one million people per year globally.

1:22:52.080 --> 1:22:54.479
<v Speaker 3>So if we air in math that situation love it

1:22:54.760 --> 1:22:59.519
<v Speaker 3>trademark air and math, that is anywhere from eight hundred

1:22:59.600 --> 1:23:03.040
<v Speaker 3>to eight thousand cases globally every year, which is a

1:23:03.200 --> 1:23:09.960
<v Speaker 3>huge range, but all together numbers that are significantly smaller

1:23:10.400 --> 1:23:17.240
<v Speaker 3>than numbers that you mentioned, Aarin. And I think one

1:23:17.280 --> 1:23:23.639
<v Speaker 3>thing that's really interesting about this is that I talked

1:23:23.640 --> 1:23:27.360
<v Speaker 3>about the pathogenesis of this and how terrifying and how

1:23:27.439 --> 1:23:32.040
<v Speaker 3>severe the disease listeriosis is when it causes this invasive

1:23:32.280 --> 1:23:37.160
<v Speaker 3>infection in people who are susceptible, immuno compromised, or during pregnancy.

1:23:38.280 --> 1:23:42.680
<v Speaker 3>But this is still a very rare pathogen and despite that,

1:23:43.000 --> 1:23:46.760
<v Speaker 3>like you said, Aarin, it's still an incredibly important part

1:23:46.800 --> 1:23:51.360
<v Speaker 3>of how we make our food safety regulations, which I

1:23:51.360 --> 1:23:56.080
<v Speaker 3>think is fascinating and it really has sparked continued continues

1:23:56.120 --> 1:24:00.240
<v Speaker 3>to be a big point of debate. The US actually

1:24:00.280 --> 1:24:04.640
<v Speaker 3>has I learned, a zero tolerance policy for listeria monacytogenies

1:24:04.680 --> 1:24:07.439
<v Speaker 3>in industry sampling, which I was shocked by.

1:24:07.640 --> 1:24:08.360
<v Speaker 1>Yeah, me too.

1:24:11.800 --> 1:24:14.920
<v Speaker 3>How often are we testing, et cetera. I don't know,

1:24:15.040 --> 1:24:18.800
<v Speaker 3>but it does have a zero tolerance policy. Most other

1:24:18.840 --> 1:24:22.599
<v Speaker 3>countries don't necessarily have a zero tolerance policy because that's

1:24:22.760 --> 1:24:28.200
<v Speaker 3>really difficult to achieve. So deciding how do we balance

1:24:28.640 --> 1:24:32.360
<v Speaker 3>risk of infection versus being able to feed a growing

1:24:32.400 --> 1:24:37.040
<v Speaker 3>global population, it's really difficult. But I do think that

1:24:37.080 --> 1:24:39.960
<v Speaker 3>it's really interesting that a pathogen that is as rare

1:24:40.120 --> 1:24:43.679
<v Speaker 3>as listeria when you look at it compared to other

1:24:43.760 --> 1:24:48.400
<v Speaker 3>food borne illnesses causing hundreds of millions of infections, it

1:24:48.600 --> 1:24:52.559
<v Speaker 3>still has a really important role to play in making

1:24:52.600 --> 1:24:56.000
<v Speaker 3>this kind of policy because of how severe it is

1:24:56.000 --> 1:24:59.880
<v Speaker 3>when it does happen, right, and because like you mentioned it,

1:25:00.040 --> 1:25:03.439
<v Speaker 3>and we do still see a lot of outbreaks food

1:25:03.439 --> 1:25:08.800
<v Speaker 3>born outbreaks associated with specific types of foods, which means

1:25:08.800 --> 1:25:11.920
<v Speaker 3>that this is a pathogen that could potentially cause quite

1:25:11.920 --> 1:25:16.200
<v Speaker 3>a lot more morbidity and mortality if a large outbreak

1:25:16.200 --> 1:25:16.920
<v Speaker 3>were to occur.

1:25:18.439 --> 1:25:19.200
<v Speaker 1>In terms of the.

1:25:19.240 --> 1:25:22.360
<v Speaker 3>Types of foods that are highest risk, I think you

1:25:22.479 --> 1:25:28.000
<v Speaker 3>mentioned a lot of them already, but you can think

1:25:28.040 --> 1:25:32.919
<v Speaker 3>of them as things that are already prepared and then

1:25:33.320 --> 1:25:37.920
<v Speaker 3>refrigerated and then you eat them right because despite how

1:25:38.000 --> 1:25:43.880
<v Speaker 3>heardy of a bacteria, Listeria monocytogenes is, it can't survive

1:25:43.920 --> 1:25:47.799
<v Speaker 3>the cooking process. So foods that you take home and cook,

1:25:48.240 --> 1:25:51.639
<v Speaker 3>like most meats that you're cooking thoroughly, even if they

1:25:51.680 --> 1:25:55.040
<v Speaker 3>have listeria on them. If you're cooking them thoroughly, then

1:25:55.080 --> 1:25:59.160
<v Speaker 3>that listeria is going to die. But foods like a

1:25:59.200 --> 1:26:03.840
<v Speaker 3>deli turkey eat or deli ham, any deli meats that

1:26:03.920 --> 1:26:06.360
<v Speaker 3>you don't cook when you bring home that are cooked

1:26:06.400 --> 1:26:12.080
<v Speaker 3>and then processed and refrigerated and sold for immediate consumption, those,

1:26:12.280 --> 1:26:16.360
<v Speaker 3>if contaminated with listeria, can pose a significant risk because

1:26:16.360 --> 1:26:19.920
<v Speaker 3>that listeria can continue to replicate even if it's at

1:26:20.040 --> 1:26:23.800
<v Speaker 3>very low levels in that food to begin with, and

1:26:23.840 --> 1:26:28.080
<v Speaker 3>then can cause infection thereafter. The same thing is true

1:26:28.240 --> 1:26:34.160
<v Speaker 3>for milks that are raw or unpasteurized, or cheeses that

1:26:34.200 --> 1:26:37.599
<v Speaker 3>are not cured, so like soft cheeses that are made

1:26:37.640 --> 1:26:40.479
<v Speaker 3>from milks that are unpasteurized. Those are some of the

1:26:40.520 --> 1:26:45.639
<v Speaker 3>highest risk things that we've seen, but we see outbreaks

1:26:45.640 --> 1:26:50.880
<v Speaker 3>in other things too, like one that's ongoing currently, as

1:26:50.920 --> 1:26:55.639
<v Speaker 3>we record in Inenok mushrooms in the US often consumed

1:26:55.760 --> 1:26:59.800
<v Speaker 3>raw those mushrooms. In twenty twenty two, in the US,

1:27:00.040 --> 1:27:04.000
<v Speaker 3>we saw outbreaks in deli meats and cheeses like generically

1:27:04.200 --> 1:27:09.599
<v Speaker 3>just meats and cheeses of deli counters across the country.

1:27:10.439 --> 1:27:13.719
<v Speaker 3>We also saw outbreaks in some soft cheeses like Breeze

1:27:13.720 --> 1:27:18.080
<v Speaker 3>and Camembers, and in ice cream. Like you mentioned, there's

1:27:18.120 --> 1:27:22.439
<v Speaker 3>been outbreaks in various bad salads, things that again are

1:27:22.640 --> 1:27:27.400
<v Speaker 3>prepared and ready to eat. So those are the kinds

1:27:27.439 --> 1:27:29.639
<v Speaker 3>of things that tend to be highest risk, and that's

1:27:29.720 --> 1:27:33.080
<v Speaker 3>why the recommendations tend to be that people who are

1:27:33.120 --> 1:27:37.320
<v Speaker 3>at high risk, who are immunal compromised, or pregnant, try

1:27:37.320 --> 1:27:38.880
<v Speaker 3>to avoid those foods.

1:27:39.600 --> 1:27:44.320
<v Speaker 1>That's hard to do, Yeah, it's really hard. And it

1:27:44.920 --> 1:27:47.720
<v Speaker 1>seems like it could also be an issue of access

1:27:47.920 --> 1:27:54.400
<v Speaker 1>where where it's difficult to buy food to then prepare

1:27:54.600 --> 1:27:58.280
<v Speaker 1>rather than getting like who has the time, or it's

1:27:58.320 --> 1:28:01.960
<v Speaker 1>more expensive sometimes to buy food to then prepare, and

1:28:02.000 --> 1:28:05.439
<v Speaker 1>so it's that's an interesting, I think component of it.

1:28:05.920 --> 1:28:11.960
<v Speaker 3>Yeah, absolutely absolutely, But that's kind of where we stand

1:28:12.000 --> 1:28:18.839
<v Speaker 3>with infections with listeriosis today across the globe, a lot

1:28:19.240 --> 1:28:24.400
<v Speaker 3>left to be desired, I feel like, but I think

1:28:24.400 --> 1:28:27.200
<v Speaker 3>we're in a very interesting place where it's definitely still

1:28:27.320 --> 1:28:31.040
<v Speaker 3>a pathogen of big concern, especially for the food industry,

1:28:31.080 --> 1:28:34.639
<v Speaker 3>and it's something that still shapes how our food industry

1:28:34.680 --> 1:28:39.840
<v Speaker 3>operates and makes decisions globally. H Yeah, I do think

1:28:39.960 --> 1:28:44.600
<v Speaker 3>in terms of even bigger picture, you know, future directions

1:28:44.600 --> 1:28:48.479
<v Speaker 3>and research when it comes to listeria. The most exciting

1:28:48.520 --> 1:28:51.880
<v Speaker 3>thing is all of the ways in which listeria serves

1:28:51.960 --> 1:28:56.479
<v Speaker 3>as this model organism that I mentioned in the biology section,

1:28:56.479 --> 1:28:59.960
<v Speaker 3>which again I had no idea, but I will post

1:29:00.120 --> 1:29:07.040
<v Speaker 3>a few really great, incredibly detailed papers about the kinds

1:29:07.080 --> 1:29:12.680
<v Speaker 3>of research being done on the pathogenesis of listeria and

1:29:12.760 --> 1:29:17.200
<v Speaker 3>what the implications are for what we can learn about

1:29:17.200 --> 1:29:23.439
<v Speaker 3>intracellular infection in general, as well as our understandings of

1:29:23.880 --> 1:29:28.960
<v Speaker 3>cell to sell communication on a broad scale, because understanding

1:29:29.160 --> 1:29:36.000
<v Speaker 3>listeria infection has implications for understanding the process of infection

1:29:36.280 --> 1:29:41.080
<v Speaker 3>and dissemination and how pathogens not just evade our immune

1:29:41.160 --> 1:29:47.200
<v Speaker 3>responses but also penetrate these supposedly impenetrable barriers that are

1:29:47.240 --> 1:29:50.519
<v Speaker 3>meant to keep them out, but also the way that

1:29:50.640 --> 1:29:54.479
<v Speaker 3>our cells actually talk and communicate with each other because

1:29:54.560 --> 1:29:59.120
<v Speaker 3>Listeria hijacks a lot of these mechanisms in our own cells.

1:30:00.120 --> 1:30:03.679
<v Speaker 3>So the things that we are learning from listeria are

1:30:03.880 --> 1:30:07.000
<v Speaker 3>having and I think we'll continue to have implications that

1:30:07.080 --> 1:30:13.519
<v Speaker 3>go far beyond this one food borne pathogen, which is

1:30:13.760 --> 1:30:15.799
<v Speaker 3>just it fills me with thrill.

1:30:16.200 --> 1:30:20.120
<v Speaker 1>Yeah, so.

1:30:22.360 --> 1:30:26.040
<v Speaker 3>That's listeriosis, Listeria monocytogenies.

1:30:27.160 --> 1:30:29.400
<v Speaker 1>There's a lot to it, there, really is.

1:30:29.880 --> 1:30:31.240
<v Speaker 3>We probably missed a lot.

1:30:31.479 --> 1:30:35.040
<v Speaker 1>We probably did, and you can check for us by

1:30:35.800 --> 1:30:41.320
<v Speaker 1>taking a look through our references. Yes, so I have

1:30:41.600 --> 1:30:44.080
<v Speaker 1>several I have a bunch, but I will shout out

1:30:44.120 --> 1:30:47.040
<v Speaker 1>just a couple in particular, So the one that was

1:30:47.120 --> 1:30:51.599
<v Speaker 1>tracing the spread of that one clonal group of Listeria

1:30:51.640 --> 1:30:55.200
<v Speaker 1>monocytogenies by Mara at All from twenty twenty one. And

1:30:55.240 --> 1:30:57.680
<v Speaker 1>then of course I want to shout out the classic

1:30:57.840 --> 1:31:01.759
<v Speaker 1>discovery paper by Murray at All from nineteen twenty six

1:31:02.600 --> 1:31:06.960
<v Speaker 1>and where I saw the phrase patho epigenetics I just

1:31:07.000 --> 1:31:09.840
<v Speaker 1>want to shout out was in a paper looking at

1:31:09.840 --> 1:31:15.200
<v Speaker 1>sort of this like new microbiology and understanding the cellular

1:31:15.400 --> 1:31:20.839
<v Speaker 1>signaling aspects of Listeria monocytogenies by Cosart and le Breton

1:31:21.000 --> 1:31:22.439
<v Speaker 1>from twenty fourteen.

1:31:23.720 --> 1:31:25.680
<v Speaker 3>I have a paper by it sounds like one of

1:31:25.720 --> 1:31:30.720
<v Speaker 3>the same authors. The two papers that were very detailed

1:31:30.880 --> 1:31:35.000
<v Speaker 3>on where we stand with understanding this pathogen as more

1:31:35.040 --> 1:31:38.880
<v Speaker 3>than just a pathogen. One was from twenty eighteen in

1:31:38.960 --> 1:31:43.759
<v Speaker 3>Nature Reviews Microbiology called Listeria monocytogenies Toward a complete picture

1:31:43.840 --> 1:31:46.920
<v Speaker 3>of its physiology and pathogenesis, and the other was from

1:31:47.120 --> 1:31:52.639
<v Speaker 3>Cellular Microbiology in twenty twenty called Listeria monocytogenies a Model

1:31:52.680 --> 1:31:55.639
<v Speaker 3>in Infection biology. And then I had a few older

1:31:55.640 --> 1:31:59.280
<v Speaker 3>papers more specific to the symptoms and what we see

1:31:59.320 --> 1:32:03.320
<v Speaker 3>with disease ats self, as well as the citations for

1:32:03.479 --> 1:32:06.519
<v Speaker 3>the numbers of epidemiology and all of that. You can

1:32:06.600 --> 1:32:10.160
<v Speaker 3>find the list of our sources for this episode and

1:32:10.680 --> 1:32:13.599
<v Speaker 3>every one of our episodes on our website, This podcast

1:32:13.640 --> 1:32:16.960
<v Speaker 3>will Kill You dot com under the episode's tap.

1:32:17.880 --> 1:32:21.800
<v Speaker 1>A huge and heartfelt thank you again to Denise for

1:32:21.880 --> 1:32:25.200
<v Speaker 1>sharing your story with us. It's we really can't thank

1:32:25.240 --> 1:32:27.360
<v Speaker 1>you enough. Yeah really.

1:32:28.560 --> 1:32:31.280
<v Speaker 3>Thank you also to Bloodmobile for providing the music for

1:32:31.360 --> 1:32:34.400
<v Speaker 3>this episode and all of our episodes.

1:32:33.960 --> 1:32:38.080
<v Speaker 1>And thank you to Leana Squalacci for the excellent audio

1:32:38.120 --> 1:32:39.640
<v Speaker 1>mixing you're the greatest.

1:32:39.880 --> 1:32:42.120
<v Speaker 3>Thank you to the exactly Right Network.

1:32:41.840 --> 1:32:45.599
<v Speaker 1>And thanks to you listeners. We hope you liked this one.

1:32:45.800 --> 1:32:48.080
<v Speaker 1>Hope you found something new.

1:32:48.680 --> 1:32:51.599
<v Speaker 3>Yeah, and something I did, so did.

1:32:51.400 --> 1:32:53.759
<v Speaker 1>I lots of new, lots of new.

1:32:54.600 --> 1:32:57.480
<v Speaker 3>And as always, a special thank you to our patrons.

1:32:57.560 --> 1:33:00.400
<v Speaker 3>Thank you so much for your support. It really means

1:33:00.439 --> 1:33:01.080
<v Speaker 3>a lot.

1:33:01.400 --> 1:33:06.880
<v Speaker 1>It does so much. Okay, Well, until next time, wash

1:33:06.920 --> 1:33:07.519
<v Speaker 1>your hands

1:33:07.840 --> 1:33:08.920
<v Speaker 3>You feel the animals