Neglected listeria infection in pregnancy in China: 93 cases

Abstract

Objective: Listeriosis is a foodborne disease that occurs in immunocompromised patients. Pregnant women are a high-risk group for the disease. Listeria infection during pregnancy is uncommon in China because of dietary habits, with little clinician attention and minimal therapeutic options due to its population-specific nature.This article studies the clinical characteristics of Listeria infection in pregnant women and the improvement of treatment methods. Subjects: This study collected clinical data from 16 cases of pregnant patients with laboratory-confirmed Listeria monocytogenes infections at the Women and Children's Hospital of Jiaxing University. These data were combined with 77 cases that were reported in the literature for a total of 93 cases of Listeria monocytogenes infection in pregnancy that occurred in China over a 15-year interval. Methods: We collected the clinical data of 16 pregnant patients with listeriosis diagnosed in the laboratory of the Women and Children's Hospital of Jiaxing University from May 2013 to December 2020, and combined it with 77 cases of Listeria monocytogenes during pregnancy in China obtained from a literature search. We summarized the clinical features of listeriosis in pregnancy infection and investigated its treatment methods and prevention. Results: Ninety-three cases of Listeria monocytogenes infection in pregnancy occurred in early, middle and late pregnancy in 31, 27, and 35 patients, respectively. The initial clinical presentation was fever in 90 patients, intermittent lower abdominal pain in 50 patients, and abnormal fetal movement and/or abnormal fetal heartbeat in 27 cases. Specimens with a positive bacterial culture included the following: 6 amniotic fluid cultures, 35 blood cultures, 37 maternal placenta and uterine secretion cultures, and 15 neonatal blood cultures. Fifty-seven cases of placental pathology, all showing of neutrophil infiltration, were 100% consistent with acute chorioamnionitis. Fifty-eight patients were initially treated with cephalosporin antibiotics, and only 24 cases were initially treated with broad-spectrum penicillins to cover the pathogenic bacteria. Drug sensitivity tests revealed resistant strains, 15 penicillin G-resistant, 14 oxacillin-resistant, and 13 ampicillin-resistant strains. After penicillin failure, vancomycin or meropenem was given. Maternal outcomes included the following: 20 cases of sepsis, 3 cases of pneumonia, 6 cases of acute pyelonephritis, 28 cases of intrauterine infection, 2 cases of multiple organ dysfunction syndromes, and 1 case of septic shock. The fetal and neonatal outcomes were as follows: 16 cases of abortion, 16 cases of intrauterine fetal death, 22 cases of death after birth, and 39 cases of cure. Conclusion: In our study and reported cases, Listeria monocytogenes in pregnancy is associated with fever as the primary manifestation, a high incidence of adverse pregnancy outcomes, and a significant increase in fetal and neonatal mortality. The low coverage of practical use of antimicrobial drugs and the emergence of drug-resistant strains in recent years have increased the difficulty of treatment, suggesting the need for clinicians to raise awareness of the disease and strengthen healthy diet promotion for women in pregnancy.