( See also Listeriosis Listeriosis Listeriosis is bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis caused by Listeria species. Symptoms... read more in adults and Overview of Neonatal Infections Overview of Neonatal Infections Neonatal infection can be acquired In utero transplacentally or through ruptured membranes In the birth canal during delivery (intrapartum) From external sources after birth (postpartum) Common... read more .)
In utero infection with Listeria monocytogenes can result in fetal dissemination with granuloma formation (eg, in the skin, liver, adrenal glands, lymphatic tissue, lungs, and brain). If a rash is present, it is referred to as granulomatosis infantisepticum. Aspiration or swallowing of amniotic fluid or vaginal secretions can lead to in utero or perinatal infection of the lungs, manifesting in the first several days of life with respiratory distress, shock, and a fulminant course.
Pregnant women typically acquire listeria infection from ingestion of contaminated food. Many foods can harbor and transmit L. monocytogenes, but infection usually occurs via ingestion of contaminated dairy products, raw vegetables, meats, or, particularly, refrigerated foods that require no cooking before they are eaten. Contamination is favored by the ability of L. monocytogenes to survive and grow at refrigerator temperatures.
Symptoms and Signs of Neonatal Listeriosis
Infections in pregnant women may be asymptomatic or characterized by a primary bacteremia manifesting first as a nonspecific flu-like illness.
In the fetus and neonate, clinical presentation depends on the timing and route of infection. Abortion, premature delivery with amnionitis (with a characteristic brown, murky amniotic fluid), stillbirth, or neonatal sepsis Symptoms and Signs Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more is common. Infection may be apparent within hours or days of birth (early onset) or it may be delayed up to several weeks (delayed onset).
Neonates with early-onset disease frequently are of low birth weight, have associated obstetric complications, and show evidence of sepsis soon after birth with circulatory or respiratory insufficiency or both. Neonates with the delayed-onset form are usually full-term, previously healthy neonates presenting with meningitis Neonatal Bacterial Meningitis Neonatal bacterial meningitis is inflammation of the meninges due to bacterial invasion. Signs are those of sepsis, central nervous system irritation (eg, lethargy, seizures, vomiting, irritability... read more or sepsis Neonatal Sepsis Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more .
Diagnosis of Neonatal Listeriosis
Culture or polymerase chain reaction (PCR) testing of blood, cervix, and amniotic fluid (if available) of febrile pregnant woman
Culture or PCR of blood, cerebrospinal fluid (CSF), gastric aspirate, meconium, and infected tissues of sick neonate
Blood and cervix specimens should be obtained from any pregnant woman with an unexplained febrile disease and cultured or PCR tested for L. monocytogenes. A sick neonate whose mother has listeriosis should be evaluated for sepsis Diagnosis Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more , including cultures or PCR of either umbilical cord or peripheral blood, CSF, gastric aspirate, meconium, any potentially infected tissue, the mother’s lochia and exudates from cervix and vagina, grossly diseased parts of the placenta, and amniotic fluid (if available).
CSF examination may show a predominance of mononuclear cells, but usually polymorphonuclear cells predominate. Gram-stained smears frequently are negative but may show pleomorphic, gram-variable coccobacillary forms, which should not be disregarded as diphtheroid contaminants.
Laboratory confirmation of the organism involves biochemical testing and observation of motility using a slide test or showing motility in semisolid media. To do the slide test, colonies of the organism that have grown on solid media are mixed with saline and examined under a microscope. L. monocytogenes exhibits a distinctive end-over-end “tumbling” motility due to the presence of flagella at both ends. Serologic tests are not useful.
Prognosis for Neonatal Listeriosis
Mortality, ranging from 10 to 50%, is higher in neonates with early-onset disease.
Treatment of Neonatal Listeriosis
Ampicillin plus an aminoglycoside
Treatment of the newborn is with ampicillin plus an aminoglycoside ( see Table: Recommended Dosages of Selected Parenteral Antibiotics for Neonates Recommended Dosages of Selected Parenteral Antibiotics for Neonates and see table Recommended Dosages of Select Aminoglycosides for Neonates Recommended Dosages of Select Aminoglycosides for Neonates ). A 14-day course is usually satisfactory (21 days for meningitis), but the optimal duration is unknown. Other possible drugs include ampicillin or penicillin with rifampin or trimethoprim/sulfamethoxazole, trimethoprim/sulfamethoxazole alone, and meropenem, but they have not been well evaluated.
Neonates with sepsis require other measures Other treatment Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more . In heavy infection, drainage/secretion precautions may be considered.
Prevention of Neonatal Listeriosis
Pregnant women should avoid food products that have a higher risk of contamination by L. monocytogenes (eg, unpasteurized dairy products, soft cheeses, raw vegetables, prepared deli meats and salads, refrigerated meat spreads or smoked seafood). Proper food handling, in particular separating uncooked meats from other items during preparation and washing hands, utensils, and cutting boards after handling uncooked foods, is critical.
If infection during pregnancy is recognized, treatment may then be given before delivery or intrapartum to prevent vertical transmission, but the usefulness of such treatment is unproved.
Infection may be acquired in utero or during delivery, and clinical manifestations may appear within hours or days of birth (early onset) or may be delayed up to several weeks (delayed onset).
Early-onset listeriosis manifests soon after birth as sepsis with circulatory insufficiency, respiratory insufficiency, or both.
In delayed-onset listeriosis, full-term, previously healthy neonates present with meningitis or sepsis.
Do cultures or polymerase chain reaction testing for L. monocytogenes on pregnant women with unexplained febrile illness and on sick neonates.
Treat with ampicillin plus an aminoglycoside.
Pregnant women should avoid food products that may be contaminated by L. monocytogenes.