THE PATIENT HAS LISTERIOSIS MENINGITIS AT 33-34 WEEKS OF PREGNANCY. THEMULTIDISCIPLINARY SOLUTION

Abstract

In connection both with the continuing prevalence of the listeriosis disease, and polymorphism of clinical manifestations, as well as the high lethality rate, it is necessary to better understand this problem. Listeriosis infection often affects patients with the weakened immunity, the elderly persons, pregnant women, and newborns. In particular, in pregnant women, the risk of infection with listeriosis is 18 times higher than in the general population. This feature is due to cell-mediated immune suppression in pregnant women and placental tropism of the causative agent of listeriosis L. monocytogenes. The problem of listeriosis during pregnancy includes the maternal, fetal and neonatal disease. Listeriosis in a pregnant woman is usually characterized by a sharp onset, rapid development, and a high incidence, and often it does not take much trouble. Along with this, there are cases of asymptomatic, complicated and atypical variants of the disease, which requires a high degree of clinical awareness of various specialists and the implementation of adequate screening. Fetal listeriosis is characterized by the high mortality rate amounting to up 25-35%, depending on the gestational age at the time of the onset of infection. Clinical manifestations of listeriosis in newborn infants depend on the time and pathway of infection (antenatal or intranatal infection). Neonatal listeriosis can manifest as sepsis or meningitis with severe consequences and high mortality rate (up to 20%). The appropriate treatment of maternal listeriosis is aimed at preventing the fetal disease, it also has important therapeutic value for newborn babies. The empirical use of antibiotics may appear to be ineffective for listeria. Amoxicillin or ampicillin are at the first line of the treatment in pregnant women, alone or in the combination with gentamycin, followed by trimethoprim /sulfamethoxazole. The aim of the work is to summarize the available knowledge about the problem of listeriosis, including the features of the course of the disease during pregnancy, with presenting the example of a clinical case. The article reports a clinical case demonstrating the clinical problem of listeriogenic meningitis in a pregnant woman aged 35 years. Data showing different treatment strategies are also presented.