Listeria monocytogenes is not an equal-opportunity pathogen. For most healthy adults, ingestion of the bacteria causes mild or no symptoms. But for certain groups, listeriosis is a serious and potentially fatal illness.
Pregnant women are roughly 10 times more likely to get listeriosis than the general population. Infection during pregnancy can cause miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn. In the 2020 enoki mushroom outbreak, six of the 36 cases were pregnancy-associated, and two ended in fetal loss.
Adults aged 65 and older are also at elevated risk. The immune system weakens with age, and listeriosis in older adults frequently requires hospitalization. In the 2020 outbreak, the median age of patients was 67.
People with weakened immune systems from conditions like cancer, diabetes, kidney disease, or immunosuppressive medications face similarly elevated risk. The same applies to transplant recipients and people living with HIV.
Symptoms of listeriosis typically develop within two weeks of consuming contaminated food but can appear as early as the same day or as late as 10 weeks afterward. They include fever, muscle aches, nausea, and diarrhea. If the infection spreads to the nervous system, symptoms can include headache, stiff neck, confusion, loss of balance, and convulsions.
The CDC and FDA now explicitly advise people who are pregnant, aged 65 or older, or have weakened immune systems to avoid eating enoki mushrooms raw entirely. The agencies also recommend that all consumers cook enoki mushrooms thoroughly, keep raw enoki mushrooms separate from foods that will not be cooked, and wash hands, utensils, and surfaces that have touched raw enoki mushrooms.