Listeriosis in pregnancy: under-diagnosis despite over-treatment

Fouks, Yuval; Amit, Sharon; Many, Ariel; Haham, Alon; Mandel, Dror; Shinar, Shiri

doi:10.1038/jp.2017.145

Cited by 25 publications

(20 citation statements)

References 12 publications

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“…Only 20% of mothers were treated with a penicillin based antibiotic regimen before delivery, indicating the difficulty in the clinical diagnosis of pregnancy associated listeriosis [27].…”

Section: Discussionmentioning

confidence: 99%

Listeria infection in young infants: results from a national surveillance study in the UK and Ireland

et al. 2021

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ObjectivesTo describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants.DesignProspective 2-year surveillance of Listeria monocytogenes infection in young infants detected through the British Paediatric Surveillance Unit ‘orange card’ system and triangulated with the public health laboratories.SettingNational population study (England, Wales, Scotland and the Ireland)PatientsAll infants under 90 days with proven or probable invasive listeriosisMain outcome measuresIncidence, mortality, age of infection, clinical characteristics and outcomeResultsDuring a 2-year period (2017–2019), 27 cases of listeriosis in infants <90 days of age were reported. The incidence of listeriosis in this study was 1.8 per 100 000 live births with 7% mortality (2/27). Nearly all cases presented within the first 24 hours of life (26/27). The majority (20/27, 74%) were born preterm and 16/24 (67%) were born to women from ethnic minority backgrounds.ConclusionsInvasive listeriosis in young infants in the UK and Ireland is rare and presents early in the neonatal period. National guidelines that recommend the use of amoxicillin as part of empiric regimes for sepsis and meningitis in infants over 1 month of age should be modified.

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“…Only 20% of mothers were treated with a penicillin based antibiotic regimen before delivery, indicating the difficulty in the clinical diagnosis of pregnancy associated listeriosis [27].…”

Section: Discussionmentioning

confidence: 99%

Listeria infection in young infants: results from a national surveillance study in the UK and Ireland

et al. 2021

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“…Diagnosing Lm infection prior to an adverse event such as stillbirth or preterm birth continues to be difficult and inconsistent based on patient presentation and laboratory results (Charlier et al, 2014). A retrospective study at a hospital in Israel found that listeriosis is simultaneously underdiagnosed and overtreated (Fouks et al, 2018): over the course of five years, more than one hundred pregnant women who received a diagnosis of suspected listeriosis did not subsequently have a Lm+ culture, while 7 patients who had culture-confirmed Lm had not initially received a diagnosis of suspected listeriosis. One of the advantages of our model is that we can assess infection outcomes given a known bacterial quantity and timing of exposure.…”

Section: Discussionmentioning

confidence: 99%

Sequelae of Fetal Infection in a Non-human Primate Model of Listeriosis

et al. 2019

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Listeria monocytogenes (Lm) is a common environmental bacterium that thrives on vegetation and soil matter, but can infect humans if contaminated food products are ingested, resulting in severe disease in immunosuppressed populations, including pregnant women and newborns. To better understand how the unique immunological milieu of pregnancy increases susceptibility to infection, we study listeriosis in cynomolgus macaques, a non-human primate that closely resembles humans in placentation and in the physiology, and immunology of pregnancy. Non-human primates are naturally susceptible to Lm infection, and spontaneous abortions due to listeriosis are known to occur in outdoor macaque colonies, making them ideal models to understand the disease pathogenesis and host-pathogen relationship of listeriosis. We have previously shown that Lm infection in the first trimester has a high rate of miscarriage. This study expands on our previous findings by assessing how the quantity of Lm as well as stage of pregnancy at the time of exposure may influence disease susceptibility. In the current study we inoculated a cohort of macaques with a lower dose of Lm than our previous study and although this did not result in fetal demise, there was evidence of in utero inflammation and fetal distress. Animals that were reinfected with an equivalent or higher dose of the same strain of Lm resulted in approximately half of cases continuing to term and half ending in fetal demise. These cases had inconsistent bacterial colonization of the fetal compartment, suggesting that Lm does not need to directly infect the placenta to cause adverse pregnancy outcomes. Timed surgical collection of tissues following inoculation demonstrated that transmission from mother to fetus can occur as soon as 5 days post-inoculation. Lastly, third trimester inoculation resulted in pregnancy loss in 3 out of 4 macaques, accompanied by characteristic pathology and Lm colonization. Collectively, our studies demonstrate that common laboratory culture tests may not always recover Lm despite known maternal ingestion. Notably, we also find it is possible for maternal infection to resolve in some cases with no discernible adverse outcome; however, such cases had evidence of a sterile intrauterine inflammatory response, with unknown consequences for fetal development.

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“…Second, non-speci c signs in infected pregnant women would in uence the antibiotic prophylaxis to prevent neonatal listeriosis [22]. Previous studies have showed that adequate maternal antimicrobial treatment before delivery was associated with a signi cant decrease of infants' severity [24,25]. Unfortunately, in our study and others performed in China[18], none of the maternal listeriosis cases received adequate rst-line antimicrobial treatment [9].…”

Section: Discussionmentioning

confidence: 63%

“…The diagnosis of maternal listeriosis would be challenging, apart from nonspeci c obstetrical signs, fever or u-like symptoms are the only clinical signs in infected mothers [24], but they were not always present. In our study, only one patient had u-like symptoms before delivery.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-Associated Listeriosis in a Tertiary Hospital in Ningbo, Zhejiang, China: A Retrospective Study

Zhu

et al. 2021

Preprint

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Background Pregnancy-associated listeriosis is a severe infectious disease and potentially leading to fetal/neonatal fatal. Limited information on pregnancy-associated listeriosis is available in China. Methods We performed a retrospective study on maternal and neonatal patients with pregnancy-associated listeriosis. The clinical characteristics of pregnancy-associated listeriosis were studied, and the outcome determinants of neonatal listeriosis were explored. Results 14 cases of pregnancy-associated listeriosis were identified. The incidence of pregnancy-associated listeriosis in our hospital was 16.69/100,000 births. All of the 14 maternal patients eventually recovered after delivery shortly with no sequelae. None of the 12 mothers who delivered in this hospital received antepartum first-line empirical treatment. Among the 14 neonatal cases, 1 was late onset listeriosis and 13 were early onset cases; 11 survived and 3 died. Fatality rates were significantly higher in outborn neonates (P=0.005). Besides, higher mortality rates were observed in neonates with lower birth weight (P=0.038), gestational age<28 weeks (P=0.056), and Apgar score (5th min) <5 (P=0.056), with marginally significant differences. Conclusions There is a neglected burden of pregnancy-associated listeriosis in our hospital. Timely and optimal resuscitative measures are considered to be important to reduce mortality of neonatal listeriosis. Listeriosis should be considered in the differential diagnosis of pregnancy-associated infections.

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Listeriosis in pregnancy: under-diagnosis despite over-treatment

Abstract: Although 'febrile gastroenteritis' is a poor predictor of listeriosis in pregnancy, fever, premature contractions and inflammatory markers are important risk indices prompting workup and adequate empiric treatment.

Cited by 25 publications

References 12 publications

Listeria infection in young infants: results from a national surveillance study in the UK and Ireland

Listeria infection in young infants: results from a national surveillance study in the UK and Ireland

Sequelae of Fetal Infection in a Non-human Primate Model of Listeriosis

Pregnancy-Associated Listeriosis in a Tertiary Hospital in Ningbo, Zhejiang, China: A Retrospective Study

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