Pregnancy Complicated by Listeriosis

Abstract

Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. Pregnant women are at high risk of listeriosis, but the symptoms are non-specific and diagnosis is difficult. Here, we report a case of listeriosis complicating pregnancy and causing severe neonatal infection that was successfully rescued by antibiotic therapy. A 21-year-old pregnant woman (gravida 4, para 2, abortion 1) presented at 35 weeks' gestation with abdominal pain and fever. She came to our hospital due to regular uterine contractions and fever. While the cause of her fever was being investigated, continuous fetal heart rate monitoring showed persistent fetal tachycardia. However, she delivered the baby vaginally two hours after admission. A female baby was delivered, weighing 2328 g, with Apgar scores of 1, 6 and 7 at 1, 5 and 10 minutes, respectively. After birth, the infant was flaccid and cyanotic without respiratory activity. She was intubated and received mechanical ventilation and empirical antibiotic treatment with Ampicillin and Cefotaxime. Persistent pulmonary hypertension developed and high frequency ventilation with inhalated nitric oxide was given. Listeria monocytogenes was isolated from the blood culture. After treatment, her condition gradually improved at the 15th day. However, the next day her respiratory condition deteriorated and she was intubated again. Antibiotics were shifted to Vancomycin and Meropenem. Caspofungin was also prescribed due to possible fungal infection. After a 14- day course of treatment, she was discharged on the 45th day after birth. Neonatal listeriosis often causes neonatal death. Ampicillin is the first treatment of choice for listeriosis and can significantly improve neonatal outcome. Pregnant women are advised to take additional precautions while consuming and handling foods. Obstetricians should be also familiar with this life-threatening disease.