Listeriosis during pregnancy

Purpose

Listeriosis is a rare foodborne illness caused by Listeria monocytogenes. It can be transmitted by consuming contaminated ready-to-eat food, long shelf-life products, deli meats, and soft cheeses. Listeria has a predilection to affect immunocompromised patients, elderly people, pregnant women and neonates. In particular, pregnant women are at ~18 times greater risk of infection than general population due to specific pregnancy-related suppressed cell-mediated immunity and placental tropism of L. monocytogenes. The purpose of this review is to summarize the current knowledge regarding listeriosis during pregnancy.

Methods

A literature search on Medline and Embase was done for articles about listeriosis during pregnancy. A detailed review of published data on epidemiology, pathogenesis, diagnosis, treatment and prevention of listeriosis during pregnancy was performed.

Results

Listeriosis during pregnancy encompasses maternal, fetal and neonatal disease. Maternal listeriosis during pregnancy usually presents as a mild febrile illness. Fetal listeriosis has a high mortality rate of 25–35%, depending on the gestational age at the time of infection. Neonatal listeriosis may present as sepsis or meningitis with severe sequels and high case fatality rate of 20%. Adequate treatment of maternal listeriosis prevents and treats fetal disease and it is of imminence importance in the treatment of the neonates. Amoxicillin or ampicillin are the first line of treatment alone or in combination with gentamicin, followed by trimethoprim/sulfamethoxazole.

Conclusions

Pregnancy-associated listeriosis should be considered as a cause of fever during pregnancy and appropriate treatment should be initiated preemptively. Prevention remains the best way to control listeriosis and should be reinforced among patients, health care professionals, and regulatory agencies.

     

Listeriosis in human pregnancy: a systematic review

Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. Preventative measures are well prescribed and monitoring and voluntary recall of contaminated products has resulted in a 44% reduction in the prevalence of perinatal listeriosis in the USA. Pregnant women are at high risk for listeriosis, but symptoms are non-specific and diagnosis is difficult. The intracellular life-cycle of Listeria protects the bacterium from host innate and adaptive immune responses. Antibiotic treatment requires agents able to penetrate, distribute, and remain stable within host cells. Prolonged use of high-dose ampicillin can significantly improve neonatal outcome.     

Listeriosis in pregnancy: a case report.

Listeria monocytogenes is an alimentary infection which can be extremely dangerous for pregnant women. A 34-year-old pregnant woman was hospitalized with fetal cardiac rate alterations and influenza-like symptoms. A caesarean section due to fetal distress was performed. A maternal-fetal listeriosis diagnosis was possible only after the birth through bacteriological and histological examination on both the placenta and the newborn.     

妊娠合并李斯特杆菌感染母婴结局探讨

目的:探讨李斯特杆菌感染发病的特点及母婴结局,为早期诊治,减少母婴并发症积累临床经验。方法:回顾分析2007年在我院住院分娩并确定为李斯特杆菌感染孕妇的临床资料,主要探讨其临床症状、发病孕周及围产儿结局。结果:确诊李斯特杆菌感染的孕妇7例,2例妊娠晚期(分别为33+5周和28周)感染者临床症状明显,均发生早产,围产儿预后不良。其中1例新生儿败血症,另1例新生儿死亡。其余5例在妊娠中期诊断,孕妇无感染临床症状,经青霉素抗炎治疗,除1例因胎儿畸形引产外,其余4例均顺利分娩,母儿结局良好。结论:孕妇李斯特杆菌感染可导致母胎传播,妊娠晚期感染者围产儿预后不良。     

Listeriosis in pregnancy: case report and retrospective study

Background: Listeria monocytogenes usually causes mild maternal illness, but can be devastating to the fetus. Case: Listeriosis in a pregnant patient successfully treated with empiric antibiotic therapy is described. After induced delivery, despite severe placental infection, a healthy infant was born. Additionally, archived placental specimens with similar pathological manifestation were evaluated for evidence of L. monocytogenes. Conclusion: It is important to emphasize the value of associating maternal data and clinical and laboratory findings of the newborn with the pathologic placental findings to get better results in the etiologic diagnosis of the listeriosis.     

Perinatal Listeriosis

Listeriosis can have a devastating effect on the outcome of pregnancy. Three recent cases seen at the University of Toronto Regional Perinatal Complex are presented and are meant to serve as a reminder to the clinician to maintain a high index of suspicion for this infection. The clinical manifestations in fetal, maternal, and neonatal àsease are reviewed in this paper. The epidemiology of listeriosis in Canada is described, and recommendations for prevention and treatment are provided.     

Listeriosis and borreliosis in perinatal medicine

Authors review the available literature on listeriosis and boreliosis in perinatology. A growing clinical importance of listeriosis is noted. Boreliosis is a newly described disease. In the light of the literature data, listeriosis and boreliosis do not seem to play an important role in the perinatal medicine. However, in selected cases, these infections should be considered in diagnostic and therapeutic procedures.     

Listeriosis prevention knowledge among pregnant women in the USA

BACKGROUND: Listeriosis is a food-borne disease often associated with ready-to-eat foods. It usually causes mild febrile gastrointestinal illness in immunocompetent persons. In pregnant women, it may cause more severe infection and often crosses the placenta to infect the fetus, resulting in miscarriage, fetal death or neonatal morbidity. Simple precautions during pregnancy can prevent listeriosis. However, many women are unaware of these precautions and listeriosis education is often omitted from prenatal care. METHODS: Volunteer pregnant women were recruited to complete a questionnaire to assess their knowledge of listeriosis and its prevention, in two separate studies. One study was a national survey of 403 women from throughout the USA, and the other survey was limited to 286 Minnesota residents. RESULTS: In the multi-state survey, 74 of 403 respondents (18%) had some knowledge of listeriosis, compared with 43 of 286 (15%) respondents to the Minnesota survey. The majority of respondents reported hearing about listeriosis from a medical professional. In the multi-state survey, 33% of respondents knew listeriosis could be prevented by not eating delicatessen meats, compared with 17% in the Minnesota survey (p=0.01). Similarly, 31% of respondents to the multi-state survey compared with 19% of Minnesota survey respondents knew listeriosis could be prevented by avoiding unpasteurized dairy products (p=0.05). As for preventive behaviors, 18% of US and 23% of Minnesota respondents reported avoiding delicatessen meats and ready-to-eat foods during pregnancy, whereas 86% and 88%, respectively, avoided unpasteurized dairy products. CONCLUSIONS: Most pregnant women have limited knowledge of listeriosis prevention. Even though most respondents avoided eating unpasteurized dairy products, they were unaware of the risk associated with ready-to-eat foods. Improved education of pregnant women regarding the risk and sources of listeriosis in pregnancy is needed.     

Listeriosis revisited: the role of the obstetrician

The clinical course and outcome is described of three pregnancies complicated by listeriosis encountered during a 6-month period. All three ended in preterm labour characterized by the passage of meconium by the fetus. Two babies died in the early neonatal period and the third survived with neurological handicap. Although the diagnosis of listeriosis was made only after delivery, all the mothers had a pyrexial illness before delivery. A high index of suspicion is needed for the early detection and prompt treatment of this life-threatening perinatal infection. Effective advice concerning prevention of listeriosis by avoidance of high-risk foods must be given to women during pregnancy.     

Listeriosis and borreliosis as causes of antepartum fever

Fever of unknown origin in the pregnant woman presents special diagnostic, therapeutic, and obstetric problems. Two such clinically ill, febrile third-trimester patients, one presenting with maternal septicemia and transplacental fetal listeriosis and the other with borreliosis, are discussed. Although the neonatal outcome in such infections historically is poor, the infants of these mothers survived. It is suggested that special diagnostic procedures, timely administration of parenteral antibiotics, and vigilant antepartum testing be considered in all similar pregnant patients.