Listeriosis in pregnancy: case report and retrospective study

Post-infectious hydrocephalus complicating Listeria meningitis in a healthy newborn

Listeria monocytogenes is a relatively uncommon cause of foodborne infection in the general population. Most cases of Listeriosis occur among newborns, pregnant women, the elderly and those with impairment of cellular immunity. Neonatal Listeria meningitis is rare. We present a case of Listeria meningitis at the age of 15 days in a previously healthy neonate who presented with acute onset of fever, poor feeding and lethargy. Sepsis workup revealed L. monocytogenes identified in cerebrospinal fluid PCR and culture. The infant's course was complicated by transient syndrome of inappropriate antidiuretic hormone and subsequent hydrocephalus that required a ventriculoperitoneal shunt placement. Though rare, neonatal infections due to Listeria can present with meningitis leading to serious and devastating complications. Our case emphasises the importance of considering Listeria in cases of neonatal meningitis and the value of close follow-up of such cases through early detection and management of acute and long-term complications.

A comprehensive analysis of listeriosis in 13 pregnant women and 27 newborns in Xi'an from 2011 to 2020

BACKGROUND

Listeriosis is a severe foodborne infection associated with high mortality. Pregnant women and newborns are at a particularly high risk of infection. However, the data on epidemiology of maternal-neonatal listeriosis in Xi'an are little known. The aim of this study was to investigate the epidemiological and clinical features of maternal-neonatal listeriosis in Xi'an.

METHODS

A total of 40 cases of listeriosis confirmed by positive cultures [blood or cerebrospinal fluid (CSF)] and admitted to the Northwest Women's and Children's Hospital (NWCH) from 2011 to 2020 were enrolled. Data from all patients were collected from the hospital's electronic medical records. Data analysis and epidemiological investigation were carried out by demographic information, time of onset, clinical and laboratory characteristics. Descriptive statistical indicators were obtained using SPSS21.0 and were expressed as median, mean, standard deviation and interquartile range.

RESULTS

The incidence of maternal and neonatal listeriosis in NWCH over the last decade was 5/100,000 and 10.4/100,000 respectively and Listeriosis was more likely to occur in spring and summer. The most common symptom was as follows: (I) maternal: fever (85%), abdominal pain (77%), vaginal fluid or colporrhagia (46%); (II) neonatal: respiratory distress (52%), fever (33%). Laboratary results were as follows: (I) maternal: elevated C-reactive protein (CRP) (100%), white blood cells (WBC) or neutrophil (NEUT#) (85%), and monocyte counts (MONO#) (77%); (II) neonatal: increased WBC (81%), MONO# (81%), CRP (78%), NEUT# and lymphocytes (73%); and elevated protein (PRO) (95%) and WBC count (86%) in CSF while decreased in glucose (GLU) (73%). Compared to neonatal group, the ratio of neutrophils to lymphocytes in maternal group raise to a higher level (92% to 42%). The outcomes of maternal were favorable and 54% of them suffered acute chorioamnionitism. Yet neonatal deaths account for up to 33%.

CONCLUSIONS

Listeriosis is a rare disease with extremely variable clinical characteristics in Xi'an. Our data indicated that unexplained fever, abdominal pain, signs of premature and respiratory symptoms accompanied by a progressive increase in WBC, CRP, NEUT#, MONO# even include WBC and PRO in CSF while GLU decreased, the possibility of an LM infection should be considered.

An Update Review on Listeria Infection in Pregnancy

Listeria monocytogenes (LM) is an intracellular, aerobic and facultative anaerobic, Gram-positive bacterium, which is primarily transmitted to humans orally via food. LM could occur in asymptomatic pregnant women; however, fetal infection is a serious condition, entailing premature birth, abortion, sepsis, central nervous system (CNS) involvement, or even death. If a pregnant woman exhibits symptoms, the performance is almost like influenza, such as fever, headache, diarrhea, myalgia, or other digestive-related symptoms. This review collected clinical and empirical results regarding the mechanism, clinical manifestations, obstetrical outcome, diagnosis, treatment, vertical transmission, neonatal infection, and prevention of listeriosi according to articles published in PubMed from January 1, 1980, to March 20, 2021. The early detection and diagnosis of pregnancy-associated listeriosis are significant since sensitive antibiotics are effective at enhancing the prognosis of newborns. Listeriosis can be diagnosed using positive cultures from maternal or neonatal blood, neonatal cerebrospinal fluid (CSF), amniotic fluid, intrauterine mucosa, or the placenta. Two weeks of high-dose intravenous amoxicillin (more than 6 g/day) is recommended for LM pregnant women without allergy. Terminating the pregnancy to save the mother’s life should be considered if maternal and fetal conditions aggravate. Neonatal Listeria infection is primarily transmitted through the placenta, which is a critical illness associated with a high mortality rate. The necessary dietary guidance for pregnant women can reduce the incidence rate of pregnancy-related listeriosis.

Challenging management of chorioamnionitis with placental listeriosis: lessons from 2 cases

Listeriosis is a rare foodborne infection caused by Listeria monocytogenes. It is 12–20 times more prevalent in pregnant women compared to the general population, with a 20–40% mortality rate in neonates. Early treatment with appropriate antimicrobial agents is critical for pregnancy outcomes; however, the infection is difficult to control because the nonspecific clinical manifestations and rarity of the disease often preclude early diagnosis. We encountered 2 cases of pregnancy-associated listeriosis that occurred at 29 and 37 weeks of gestation. Both neonates were delivered by emergent cesarean section due to fetal condition, and one of the preterm infants died immediately after birth. Pregnancy-associated listeriosis should be considered in the management of unexplained fever or inflammatory conditions in pregnant women.

GNP-GAPDH1-22 nanovaccines prevent neonatal listeriosis by blocking microglial apoptosis and bacterial dissemination

Clinical cases of neonatal listeriosis are associated with brain disease and fetal loss due to complications in early or late pregnancy, which suggests that microglial function is altered. This is believed to be the first study to link microglial apoptosis with neonatal listeriosis and listeriosis-associated brain disease, and to propose a new nanovaccine formulation that reverses all effects of listeriosis and confers Listeria monocytogenes (LM)-specific immunity. We examined clinical cases of neonatal listeriosis in 2013–2015 and defined two useful prognostic immune biomarkers to design listeriosis vaccines: high anti-GAPDH_1-22 titres and tumor necrosis factor (TNF)/interleukin (IL)-6 ratios. Therefore, we developed a nanovaccine with gold glyco-nanoparticles conjugated to LM peptide 1-22 of GAPDH (Lmo2459), GNP-GAPDH_1-22 nanovaccinesformulated with a pro-inflammatory Toll-like receptor 2/4-targeted adjuvant. Neonates born to non-vaccinated pregnant mice with listeriosis, showed brain and vascular diseases and significant microglial dysfunction by induction of TNF-α-mediated apoptosis. This programmed TNF-mediated suicide explains LM dissemination in brains and livers and blocks production of early pro-inflammatory cytokines such as IL-1β and interferon-α/β. In contrast, neonates born to GNP-GAPDH_1–22-vaccinated mothers before LM infection, did not develop listeriosis or brain diseases and had functional microglia. In nanovaccinated mothers, immune responses shifted towards Th1/IL-12 pro-inflammatory cytokine profiles and high production of anti-GAPDH_1–22 antibodies, suggesting good induction of LM-specific memory.