Perinatal listeriosis

Outcomes of neonates with listeriosis supported with extracorporeal membrane oxygenation from 1991 to 2017

BACKGROUND

Listeriosis may cause severe disease in fetuses and neonates. The outcomes of critically ill neonates with early-onset listeriosis requiring extracorporeal membrane oxygenation (ECMO) from 1975 to 1991 have been reported.

OBJECTIVE

To update the characteristics and outcomes of neonates with listeriosis supported by ECMO.

STUDY DESIGN

Retrospective study of neonates with culture-proven listeriosis reported to the Extracorporeal Life Support Organization Registry between 1991 and 2017. Comparisons were made between this cohort and the case series from 1975-1991.

RESULTS

Twenty-two neonates had culture-proven Listeria monocytogenes infection and required ECMO support. Eight-six percent survived to discharge, compared with 67% in the previous cohort (p = 0.2). The median ECMO duration was 131 h, compared with 209 h in the previous cohort (p = 0.1). Nonsurvivors had a significantly lower pre-ECMO pH (6.91 vs 7.31, p = 0.0006).

CONCLUSION

The survival of neonates with listeriosis supported with ECMO is high, supporting the use of ECMO as rescue therapy for this condition.

Animal models of listeriosis: a comparative review of the current state of the art and lessons learned

Listeriosis is a leading cause of hospitalization and death due to foodborne illness in the industrialized world. Animal models have played fundamental roles in elucidating the pathophysiology and immunology of listeriosis, and will almost certainly continue to be integral components of the research on listeriosis. Data derived from animal studies helped for example characterize the importance of cell-mediated immunity in controlling infection, allowed evaluation of chemotherapeutic treatments for listeriosis, and contributed to quantitative assessments of the public health risk associated with L. monocytogenes contaminated food commodities. Nonetheless, a number of pivotal questions remain unresolved, including dose-response relationships, which represent essential components of risk assessments. Newly emerging data about species-specific differences have recently raised concern about the validity of most traditional animal models of listeriosis. However, considerable uncertainty about the best choice of animal model remains. Here we review the available data on traditional and potential new animal models to summarize currently recognized strengths and limitations of each model. This knowledge is instrumental for devising future studies and for interpreting current data. We deliberately chose a historical, comparative and cross-disciplinary approach, striving to reveal clues that may help predict the ultimate value of each animal model in spite of incomplete data.

Listeria monocytogenes infection in pregnant guinea pigs is associated with maternal liver necrosis, a decrease in maternal serum TNF-alpha concentrations, and an increase in placental apoptosis

Stillbirths and spontaneous abortions can result when pregnant women are exposed to the food borne pathogen, Listeria monocytogenes. Fetuses and neonates account for one-third of the 2500 cases annually. The objectives were to determine the dose dependent trends of immunological and pathological effects in pregnant guinea pigs after infection with L. monocytogenes. Timed pregnant guinea pigs were treated on gestation day (gd) 35 with doses of 10(4) to 10(8) colony forming units (CFUs) and sacrificed on gd 56. Hepatic lesions were found in dams treated with >or=10(5)CFUs. Apoptosis was detected in significantly more placentas from dams treated with >or=10(6)CFUs compared to controls. Maternal serum TNF-alpha concentrations were significantly decreased in all dose groups compared to controls. In conclusion, increases in premature delivery, maternal hepatic effects and placental apoptosis along with a decrease in TNF-alpha concentrations were associated with L. monocytogenes infection in pregnant guinea pigs.

The onset of rapidly progressive neurologic deterioration after a brief gastrointestinal illness in a renal allograft recipient

Renal transplant recipients are at increased risk for life-threatening complications, most commonly infections. Because of their impaired cell-mediated immunity, these patients are particularly susceptible to organisms that rely on intracellular survival and spread, such as Listeria monocytogenes. Despite being a food-borne pathogen, L. monocytogenes is associated with significant morbidity and mortality. Here we report the case of a renal transplant recipient who developed rapidly progressive neurological symptoms after a brief gastrointestinal illness. Magnetic resonance imaging scan of the brain showed a large mass that was identified as an abscess due to L. monocytogenes. Timely aspiration and antibiotic treatment resulted in complete recovery, as opposed to worse outcomes in the available case reports. We further review the epidemiology, microbiology, clinical presentation, and therapeutic options for listerial brain abscess.

Division of Listeria monocytogenes serovar 1/2a strains into two groups by PCR and restriction enzyme analysis

Altogether, 100 strains of Listeria monocytogenes serovar 1/2a isolated from humans, animals, food, and the environment were typed by a combination of PCR and restriction enzyme analysis (REA). A PCR product of 2,916 bp, containing the downstream end of the gene inlA (955 bp), the space between inlA and inlB (85 bp), and 1,876 bp of the gene inlB, was cleaved with the enzyme AluI, and the fragments generated were separated by gel electrophoresis. By this method two different cleavage patterns were obtained. Seventy of the 100 strains shared one restriction profile, and the remaining 30 strains shared the second one. No relation was found between the types differentiated by PCR-REA and the origins of the strains.

Prepregnancy and early pregnancy care

There is ample evidence to support the familiar message offered to women early in pregnancy that they should stop smoking, limit their alcohol intake to less than two units daily, avoid all unnecessary drugs and eat a normal well-balanced diet. They may continue to take exercise and work (in almost all occupations) without any risk to the fetus. For doctors the challenge is to balance their wish to pass on the scientific evidence with the obligation to address the concerns and needs of their individual patients. Routine screening in early pregnancy should be continued for syphilis and rubella, but the benefits do not justify it for other infectious illness, including urinary tract infection. The arguments for screening for toxoplasmosis in pregnancy are finely balanced; if more effective treatment were available then screening might become worthwhile. Provided a full screening programme for cervical cancer is achieving reasonable coverage for the adult female population, there is no need for additional screening in pregnancy. Unplanned and unwanted pregnancy is a substantial problem in the United Kingdom and will continue to be so. For those that request it, termination is a safe procedure with low morbidity, especially when carried out early on. Women with unplanned pregnancies are entitled to advice from their doctors in order to help them decide whether they want a termination or not.