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Perinatal listeriosis--a review of twelve patients
Insights
Early diagnosis and management of infant listeriosis are crucial. Early-onset disease has a high mortality and morbidity rate, while late-onset meningitis responds well to antibiotics.
Area of Science:
- Neonatal infections
- Pediatric infectious diseases
- Microbiology
Background:
- Listeriosis is a serious infection in infants, presenting in early-onset (congenital) and late-onset (meningitis) forms.
- This study reviews 12 infant cases managed between 1974 and 1978.
Observation:
- Early-onset listeriosis (9 patients) often occurred in premature infants with pneumonia, rash, and hepatosplenomegaly.
- Prenatal indicators included maternal fever, abdominal pain, and leukocytosis with meconium-stained amniotic fluid.
- Gram-positive coccobacilli were identified in gastric aspirates.
Findings:
- Early-onset disease resulted in death for 3 infants, permanent sequelae for 3, and normal outcomes for 3.
- Late-onset listeriosis presented as meningitis after the second week of life.
- All 3 infants with late-onset meningitis recovered fully with antibiotic treatment.
Implications:
- Early perinatal management may improve outcomes for early-onset listeriosis.
- Prenatal diagnosis and prompt antibiotic therapy (prenatally and for 3 weeks postnatally) are recommended.
- Late-onset listeriosis meningitis shows a favorable prognosis with appropriate antibiotic intervention.
Abstract:
From July, 1974 to February, 1978, we managed 12 infants with listeriosis. This infection presented in two distinct forms: an early-onset type (nine patients), often representing a congenital infection following maternal illness, and a late-onset type in which the patient presented with meningitis (three patients). Of our nine infants with early-onset disease, three died, three developed permanent sequelae, and only three were normal at follow-up. Appropriate early management in the perinatal period may improve the outlook in this condition. Affected infants were often premature and had pneumonia, rash, and hepatosplenomegaly at birth. Prenatal clues to the diagnosis included maternal fever, abdominal pains, and leukocytosis with meconium staining of the preterm amniotic fluid. Examination of gastric aspirate at birth showed gram-positive coccobacilli. Antibiotic therapy should be started prenatally and continue for three weeks after birth to prevent recurrences of the late-onset type. This late-onset disease presented as meningitis after the second week of life and responded well to antibiotics. Our three patients recovered without sequelae.