李斯特菌败血症六例报告

目的 分析6例由血培养证实的新生儿李斯特菌病临床特征、治疗方法与转归,提高临床对本病的识别.方法 调查2004年1月1日至2006年6月30日我院分娩活产婴儿12 538例,其中6例检出李斯特菌.比较此6例中的早产儿与足月儿在发病时间、临床表现、病情严重程度、实验室指标变化、治疗措施、预后的差异.结果 李斯特菌病检出率为4.8%.6例均为早发型感染,由母亲孕期宫内感染所致.3例早产儿生后即有败血症多样临床表现,反应低下,肤色苍灰,呼吸窘迫,肝脏增大,皮疹,四肢肌张力低下;实验室指标明显异常,WBC(21.6～33.8×109)/L,N0.77～0.83;PLT(102～59×109)/L;CRP＞(160～118)mg/L.3例早产儿合并有肺部病变,需机械通气辅助呼吸,死亡1例,痊愈2例.3例足月儿发病时间较晚,分别在生后62、63、165h,仅表现为发热,精神反应欠活跃;实验室指标轻度异常,WBC(4.8～40.7×109)/L,N 0.72～0.80;PLT(202～192×109)/L;CRP(22～33)mg/L.治疗后痊愈.确诊必须依赖于细菌培养.氨苄青霉素或青霉素治疗有效.结论 我国存在成人李斯特菌病散发病例,并导致母婴传播的发生.早期发现和检测,针对性选择敏感抗生素治疗可有效降低死亡率.对孕妇进行食品安全性宣传教育,避免孕期感染,是防止新生儿李斯特菌病的重要措施.

Neonatal septicemia caused by Listeria monocytogenes: report of 6 cases

OBJECTIVE: Neonatal listeriosis is a relatively rare but serious disease with a high mortality rate. This study was conducted to analyze the clinical features, treatment, and outcome of 6 cases with Listeria monocytogenes septicemia confirmed by positive blood cultures. METHODS: Totally 12,538 live births delivered in the hospital from January 1, 2004 to June 30, 2006 were investigated. Differences in the time of onset of the disease, clinical presentation, illness severity, laboratory data, management, and prognosis were compared between preterm and full-term infants. RESULTS: The incidence of neonatal listeriosis was 4.8% in this study. All the cases with listeriosis were found to have early onset and the disease was transmitted from the mother to the fetus, 4 of the cases were delivered via cesarean section, 2 were born via normal spontaneous vaginal delivery. Maternal infection before parturition presented with fever in 4, diarrhea in 1; 5 had abnormal white blood cell counts and total neutrophil counts; 1 had positive result of Listeria monocytogenes in intrauterine contents culture. Three premature infants showed signs and symptoms of severe bacterial septicemia at birth, such as reduced activity, respiratory distress, poor skin color and poor peripheral perfusion; the enlarged liver was palpable 2 - 3 cm below the right costal margin and 5 cm below the xiphoid in one; congestive rashes over the body and muscular hypotonia. Abnormal results of laboratory tests included peripheral blood white cell count (21.6 - 33.8 x 10(9))/L, total neutrophil count 0.77 - 0.83; platelet count (102 - 59 x 10(9))/L; C-reactive protein (CRP) > (160 - 118) mg/L(24 - 72 h after birth). Three preterm infants who received intensive care, accompanied by pathological changes of lungs indicated by chest X ray required assisted mechanical ventilation and 2 of them survived without sequelae but the other one died at 51 h of life. The initial clinical signs of septicemia in 3 full-term infants appeared later than preterm newborn within 62 h, 63 h and 165 h, respectively after birth. They only had fever, T 38 - 39 degrees C, with lower activity in contrast to normal newborn and without other signs and symptoms of septicemia. Accurate diagnosis of listeriosis was established by positive bacterial blood cultures. Intravenous treatment of neonatal listeriosis with ampicillin or penicillins for 1 - 2 weeks was more effective, but cephalosporins were not effective. CONCLUSIONS: There are sporadic cases with Listeria monocytogenes infection among pregnant women in this country, resulting in severe illness of their newborn infants. Early differential diagnosis, early detection of causative organisms, especially in newborn infants infected with Listeria monocytogenes, early treatment with sensitive antibiotics can decrease the mortality rate and improve neonatal outcome. It is necessary to enhance nationwide surveillance for listeriosis.