Listeriosis in Pregnancy

Max Brinsmead MB BS PhD

May 2015
 Listeriosis
 Caused by Listeria monocytogenes
 A motile Gram-positive bacterium
 Relatively ubiquitous in the environment
 Found in 1 – 15% of human faeces
 Infection in animals is common
 Human infection is rare except:
 When immunocompromised
 Pregnant
 Elderly
 Newborn
 In 2004 - 05 there were 3 cases per million
population in the US
 But 30% of these were in pregnant women
The Listeria Bacterium
 Listeriosis Infection
 Begins with ingestion of contaminated food
 Will be phagocytosed by GI tract cells
 And thereafter continues a “hidden” life within cells
 Spread by direct cell-to-cell transfer
 Not exposed to humoral antibodies
 Controlled only by cell-mediated immunity
 Which is reduced in pregnancy
 So pregnant women have a 20-fold increased
susceptibility to this infection
 Risk is further enhanced by...
 Splenectomy
 HIV infection
 Steroids or immunosupressant drugs
 Diabetes
Listeria Proliferation
 Listeriosis in Pregnancy
 Fewer than 10 per 100,000 women
 Infection may be asymptomatic
 But the following symptoms also occur:
 Fever (38.2 to 41.20 C and mean of 38.9)
 Malaise
 Flu-like symptoms such as headache and myalgia
 Rarely CNS infection with meningitis or abscess
 Transmission risk to the fetus about 50%
 Untreated the risk of fetal death is 20 – 30%
 Pathognemonic finding is widespread abscesses
& granulomas in the fetus (rare)
 Diagnosis
 Clinical diagnosis requires a high index of
suspicion
 Culture from blood, amniotic fluid or CSF is
required
 Gram stain useful in only 33% of cases because
the organism is intracellular and can resemble
pneumococci, diptheroids and Haemophilus
 WCC may be raised but often within the normal
range for pregnancy
 Treatment
 Use Ampicillin 2G every 6 – 8 hrs
 This high dose is recommended in order to cross
to the amniotic fluid and membranes in
sufficiently high concentrations
 Gentamicin is said to be synergistic but not
recommended in pregnancy (nephro oto toxic)
 For penicillin allergy use Bactrim/Septrim
 Sometimes Vancomycin
 Maybe Erythromycin but placental passage is
poor
 Prevention
 Aims to reduce a pregnant woman’s exposure to
possible contaminated food sources
 Authorities recommend dietary advice to ALL
pregnant women
 But this has never been tested by RCT
 Most cases are sporadic and the source is rarely
identified
 Food sources have been identified either by
outbreaks or microbiological examination
 Typical Pregnancy Advice
“Listeria is a very rare infection that is mild in a mother
but can be fatal to the baby in utero. You should
NOT eat the following:
 Unpasteurised milk products esp. Soft cheeses,
included feta, Brie, Camembert and ethnic-style
cheeses.
(Hard cheeses, pasteurised, cottage & cheese spreads
are okay)
 Raw seafood
 Uncooked meats and vegetables
 Cold-stored cooked meats and pates,
 Milk products stored at >40 C
 Beware of cross contamination from these sources
 Wash all fruit and vegetables
 Cook foods at recommended temperatures”
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