Neonatal listeriosis
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《美国医学杂志》
1 Department of Microbiology,Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
2 Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
Perinatal listerial infection is the most common clinical syndrome caused by Listeria monocytogenes and includes abortion, still birth, neonatal sepsis and meningitis. Early onset neonatal listeriosis develops within 7 days and classically within 1 or 2 days of life. Aspiration of infected amniotic fluid contributes to pathogenesis, although, transplacental transmission is favored by most authors.[1] We report a case of early onset neonatal listeriosis in a full term baby presenting at 58 hours of life.
A 58-hour-old male baby presented with grunting respiration and poor feeding. The baby was born at term gestation to an unbooked gravida 1 mother by emergency cesarean section for eclampsia and weighed 3.4 kg at birth. The amniotic fluid was meconium stained and the baby suffered from perinatal asphyxia. There was no history of fever, foul smelling liquor and prolonged rupture of membranes or drug intake in the mother. Examination revealed a sick baby with heart rate of 136/min, respiratory rate of 70/min expiratory grunts and subcostal and intercostals retractions.
Laboratory evaluation of the baby showed total leucocyte count of 14,000 cells/mm3 (neutrophils 65%, lymphocytes 30%, monocytes 5%) and band cells 4 per 100 neutrophils; micro ESR was 4 mm/1sthour; C Reactive Protein was 1mg/L and chest X ray revealed bilateral reticulonodular opacities. Cerebrospinal fluid examination was normal and culture was sterile. Two samples of peripheral venous blood collected from different sites at the same time were inoculated into Brain Heart Infusion (BHI) broth. After incubation at 37 °C for 18 hours, Gram's stain from both BHI broths showed gram positive bacilli. Subsequent subculture yielded Listeria monocytogenes . The isolate was identified by standard methods.[2] Antimicrobial susceptibility testing by Kirby Bauer method showed the isolate to be sensitive to ampicillin, penicillin, chloramphenicol, gentamicin and vancomycin. The child was treated with parenteral ampicillin and gentamicin for fourteen days and showed uneventful recovery.
Few reports of neonatal listeriosis are available from India, wherein the incidence of neonatal listeriosis was found to be 2.2% in meconium stained babies and 0.2% in total births.[3] Listeria monocytogenes has been isolated from the genital tract of 14% cases of bad obstetric history in Mumbai[4] and 1.34% in Delhi.[5]
Listeriosis is primarily a zoonotic disease. Most transmission in humans is indirect and the most important mode of transmission is food borne infection.[2]
Infection or colonization of the GIT of the mother may result in an acute febrile illness mimicking influenza. Although some symptoms in mothers are vague and non specific (malaise and myalgia), others are sufficiently distinctive (fever, chills) to alert physicians to the risk of prenatally acquired listeriosis. If infection occurs late in pregnancy, the infant maybe still-born or septic at birth. Aspiration of infected amniotic fluid contributes to the pathogenesis of early onset neonatal listeriosis although, transplacental transmission is favored by most authors.[1]
Most cases of early onset neonatal listeriosis are preterm and clinically apparent at delivery with meconium staining, cyanosis, apnea, respiratory distress and pneumonia. A coarse mottled or reticulonodular pattern on chest-X-ray has been described. This baby was full term, born through meconium stained amniotic fluid and presented with respiratory distress and pneumonia with bilateral reticulonodular opacities in chest X-ray.
The paucity of reported cases of neonatal listeriosis emphasizes the fact that Listeria monocytogenes has not emerged in the same proportion as other causes of neonatal sepsis. This may be due to low carriage rates by pregnant women.[4],[5] Although the incidence of neonatal listeriosis is low in India, sporadic cases occur with mortality related to coexistence of other additive risk factors such as low birth weight and prematurity. Ampicillin remains the drug of choice, with an aminoglycoside added for synergistic activity. However, Listeria monocytogenes is uniformly resistant to cephalosporins which are frequently used in the management of sepsis and meningitis. If third generation cephalosporins are used for empirical therapy of neonatal sepsis, it is essential to add ampicillin for possible Listeria monocytogenes infection. Ampicillin resistant isolates, although rare, can be treated with vancomycin and an aminoglycoside. The lab should quickly communicate smear or culture findings suggestive for listeria whenever this situation arises.
References
1. Klein OJ. Bacterial Sepsis and Meningitis. In Remington S. Jack, Klein O. Jerome, edn . Infectious Diseases of the Fetus and Newborn Infant . 5th ed, Philadelphia; W.B Saunders Company, 2001; 943-984.
2. McLauchlin J, Jones D. Erysipelothrix and Listeria. In Balows, A, Ducrden IB, eds. Joply and Wilson's Systematic Bacteriology, 9th edn. London; Arnold Publishers, 1998; 683-708.
3. Thomas S, Verma IC, Singh M, Bhujwala RA. Study of neonatal listeriosis in north India. Indian J Med Res 1981; 73: 28-32.
4. Krishna U, Desai MW, Daftary VG. Listeriosis-a clinical and bacteriological study . J Obst Gynec India 1966; 16: 304-306.
5. Bhujwala RA, Hingorani V. Perinatal Listeriosis-A Bacteriological and Serological Study. Indian J Med Res 1975; 63: 1503-1508.(Srivastava Sumati, Sen MR)
2 Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
Perinatal listerial infection is the most common clinical syndrome caused by Listeria monocytogenes and includes abortion, still birth, neonatal sepsis and meningitis. Early onset neonatal listeriosis develops within 7 days and classically within 1 or 2 days of life. Aspiration of infected amniotic fluid contributes to pathogenesis, although, transplacental transmission is favored by most authors.[1] We report a case of early onset neonatal listeriosis in a full term baby presenting at 58 hours of life.
A 58-hour-old male baby presented with grunting respiration and poor feeding. The baby was born at term gestation to an unbooked gravida 1 mother by emergency cesarean section for eclampsia and weighed 3.4 kg at birth. The amniotic fluid was meconium stained and the baby suffered from perinatal asphyxia. There was no history of fever, foul smelling liquor and prolonged rupture of membranes or drug intake in the mother. Examination revealed a sick baby with heart rate of 136/min, respiratory rate of 70/min expiratory grunts and subcostal and intercostals retractions.
Laboratory evaluation of the baby showed total leucocyte count of 14,000 cells/mm3 (neutrophils 65%, lymphocytes 30%, monocytes 5%) and band cells 4 per 100 neutrophils; micro ESR was 4 mm/1sthour; C Reactive Protein was 1mg/L and chest X ray revealed bilateral reticulonodular opacities. Cerebrospinal fluid examination was normal and culture was sterile. Two samples of peripheral venous blood collected from different sites at the same time were inoculated into Brain Heart Infusion (BHI) broth. After incubation at 37 °C for 18 hours, Gram's stain from both BHI broths showed gram positive bacilli. Subsequent subculture yielded Listeria monocytogenes . The isolate was identified by standard methods.[2] Antimicrobial susceptibility testing by Kirby Bauer method showed the isolate to be sensitive to ampicillin, penicillin, chloramphenicol, gentamicin and vancomycin. The child was treated with parenteral ampicillin and gentamicin for fourteen days and showed uneventful recovery.
Few reports of neonatal listeriosis are available from India, wherein the incidence of neonatal listeriosis was found to be 2.2% in meconium stained babies and 0.2% in total births.[3] Listeria monocytogenes has been isolated from the genital tract of 14% cases of bad obstetric history in Mumbai[4] and 1.34% in Delhi.[5]
Listeriosis is primarily a zoonotic disease. Most transmission in humans is indirect and the most important mode of transmission is food borne infection.[2]
Infection or colonization of the GIT of the mother may result in an acute febrile illness mimicking influenza. Although some symptoms in mothers are vague and non specific (malaise and myalgia), others are sufficiently distinctive (fever, chills) to alert physicians to the risk of prenatally acquired listeriosis. If infection occurs late in pregnancy, the infant maybe still-born or septic at birth. Aspiration of infected amniotic fluid contributes to the pathogenesis of early onset neonatal listeriosis although, transplacental transmission is favored by most authors.[1]
Most cases of early onset neonatal listeriosis are preterm and clinically apparent at delivery with meconium staining, cyanosis, apnea, respiratory distress and pneumonia. A coarse mottled or reticulonodular pattern on chest-X-ray has been described. This baby was full term, born through meconium stained amniotic fluid and presented with respiratory distress and pneumonia with bilateral reticulonodular opacities in chest X-ray.
The paucity of reported cases of neonatal listeriosis emphasizes the fact that Listeria monocytogenes has not emerged in the same proportion as other causes of neonatal sepsis. This may be due to low carriage rates by pregnant women.[4],[5] Although the incidence of neonatal listeriosis is low in India, sporadic cases occur with mortality related to coexistence of other additive risk factors such as low birth weight and prematurity. Ampicillin remains the drug of choice, with an aminoglycoside added for synergistic activity. However, Listeria monocytogenes is uniformly resistant to cephalosporins which are frequently used in the management of sepsis and meningitis. If third generation cephalosporins are used for empirical therapy of neonatal sepsis, it is essential to add ampicillin for possible Listeria monocytogenes infection. Ampicillin resistant isolates, although rare, can be treated with vancomycin and an aminoglycoside. The lab should quickly communicate smear or culture findings suggestive for listeria whenever this situation arises.
References
1. Klein OJ. Bacterial Sepsis and Meningitis. In Remington S. Jack, Klein O. Jerome, edn . Infectious Diseases of the Fetus and Newborn Infant . 5th ed, Philadelphia; W.B Saunders Company, 2001; 943-984.
2. McLauchlin J, Jones D. Erysipelothrix and Listeria. In Balows, A, Ducrden IB, eds. Joply and Wilson's Systematic Bacteriology, 9th edn. London; Arnold Publishers, 1998; 683-708.
3. Thomas S, Verma IC, Singh M, Bhujwala RA. Study of neonatal listeriosis in north India. Indian J Med Res 1981; 73: 28-32.
4. Krishna U, Desai MW, Daftary VG. Listeriosis-a clinical and bacteriological study . J Obst Gynec India 1966; 16: 304-306.
5. Bhujwala RA, Hingorani V. Perinatal Listeriosis-A Bacteriological and Serological Study. Indian J Med Res 1975; 63: 1503-1508.(Srivastava Sumati, Sen MR)