November 5th, 2011

A Mysteriosis about Listeriosis

For obvious reasons, listeriosis has been much in the news recently.  The latest information from CDC on the Colorado cantaloupe outbreak cites 139 cases and 29 deaths.

The recent outbreak aside, however, actual cases of listeriosis are pretty rare. We easily could go months in our hospital without seeing a single case, and we have the largest obstetrical service in New England.

Which brings me to the mystery part:  Why is medical student knowledge about listeria so high?

I meet with the medical students to review basics of antibiotics at the beginning of every rotation.  Depending on the time of year and the number of prior clinical rotations they’ve done, they have variable amounts of ID knowledge before they get here.

But all of them know about listeria. And they know a lot about it.

  • Causative organism? (Listeria monocytogenes — check)
  • Dietary risk factors?  (deli meats, soft cheeses, now cantaloupes — check)
  • Population at risk? (pregnant women, transplant patients, and the elderly — check)
  • Clinical manifestations? (meningitis, sepsis, gastroenteritis — check)
  • Antibiotic of choice?  (ampicillin — check)

They seem to know way more about listeria than they do about far more common infections, such as Strep pneumoniae or Epstein-Barr virus.

It’s the oddest thing. Any proposed explanations for this remarkable expertise would be most welcome.

6 Responses to “A Mysteriosis about Listeriosis”

  1. JC says:

    For starters, look back to the board exams of the last two decades. There has been a Listeria question on every board exam I’ve ever taken. It’s also been in every board review book I’ve seen (obviously with good reason). If nothing else, we’ve taught our med students to be good test takers.

    Perhaps we should also look at the knowledge of the average attending physician. Feel comfortable discussing Listeria on rounds? Well, its been part of pimping lore for a generation….so, Check. Feel comfortable discussing the epidemiology, manifestations, and interpretation of the test of choice for EBV……or the impact on S. pneumo sensitivity patterns on the treatment of meningitis?……Hmm, maybe not so much. That’s when I get a sidebar consult from said attending. Bottom line, we can’t teach what we don’t know. [And to be fair, there’s a wide swath of non-ID subjects I avoid during rounds….]

  2. Trent says:

    The same reason that everyone remembers scorpions cause pancreatitis but doesn’t remember drugs. Everyone loves a fascinoma.

  3. anonydoc says:

    I guess it’s because:
    – many medschool teachers fail to balance topics by their clinical relevance.
    – so do medical textbooks.
    – so do, of course, popular media/mass media.
    – and a combination of these: it might be more fascinating to go through 500 words of listeriosis – which has been on the news – than go through 50 pages of stroke.

  4. Unc ms3 says:

    Jc is exactly right. People dont ask us the easy or common questions often, but you get points for pulling zebras out of your hat. I just took step 1, and I can go on at length about Charcot Marie tooth disease. Please don’t ask me to handle hypertension; I haven’t had my family medicine rotation yet.

    • Paul Sax says:

      Dear UNC MS3 (and others),
      Thanks for the MS perspective. Makes sense.

      …pulling zebras out of your hat

      Love that image!


  5. Deena Chandran says:

    It is nice to know that pulling zebras out of hats is appreciated more than knowing how to treat hypertension & Strep pneumoniae by medical schools all over the world!

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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