Neonatal Listeriosis Guide

Neonatal
Listeriosis
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Prof. of Pediatrics
Saad’s Kids Clinic
Baghdad ,Iraq
anahbaghdad@gmail.com

Listeria monocytogenes
Listeria monocytogenes is the species
of pathogenic bacteria that causes the
infection listeriosis.
4/24/2020 Neonatal Listeriosis
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Listeria monocytogenes (Cont.)
Listeria monocytogenes is a facultative
anaerobic bacterium, capable of surviving
in the presence or absence of oxygen
3

Listeria monocytogenes(Cont.)
Listeria monocytogenes can grow and
reproduce inside the host's cells and is
one of the most virulent foodborne
pathogens
4

Listeria monocytogenes is a Gram-positive
bacterium
5
Ramaswamy V, Cresence VM, Rejitha JS, Lekshmi MU, Dharsana KS, Prasad SP, Vijila HM
(February 2007). "Listeria--review of epidemiology and pathogenesis“ Journal of Microbiology,
Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi. 40 (1): 4–13.
Pizarro-Cerda J, Cossart, P (2019). "Microbe Profile: Listeria monocytogenes: a
paradigm among intracellular bacterial pathogens". Microbiology. 165: 719–721.

Twenty to 30% of foodborne listeriosis
infections in high-risk individuals may
be fatal
6
Ramaswamy V, Cresence VM, Rejitha JS, Lekshmi MU, Dharsana KS, Prasad SP, Vijila HM
(February 2007). "Listeria--review of epidemiology and pathogenesis“ Journal of Microbiology,
Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi. 40 (1): 4–13.
Pizarro-Cerda J, Cossart, P (2019). "Microbe Profile: Listeria monocytogenes: a
paradigm among intracellular bacterial pathogens". Microbiology. 165: 719–721.

Listeria monocytogenes is the third-most
common cause of meningitis in newborns.
7
"Listeriosis (Listeria infection)"www.health.ny.gov. Retrieved 2015-11-16.

Pathophysiology
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Inutero
infection
Fetal
dissemination
with granuloma
formation
Granulomatosis
infantisepticum

Pathophysiology(Cont.)
9
Aspiration or
swallowing of
amniotic fluid
or vaginal
secretions
Inutero or
perinatal
infection of the
lungs
Respiratory
distress, shock,
and a fulminant
course

Epidemiology
Pregnant women typically acquire listeria
infection from ingestion of contaminated
food
10

Epidemiology(Cont.)
 Many foods can harbor and transmit L.
monocytogenes,
• Infection usually occurs via ingestion of: .
11
Contaminated
dairy products
Meats
Raw
vegetables
Refrigerated foods that require
no cooking before they are
eaten

The infection by L. monocytogenes in vivo: bacteria, via
contaminated food product, reach the intestinal barrier,
cross it, and then disseminate to the brain and placenta
12
https://www.pnas.org/content/108/49/19484

Symptoms and Signs
• Infections in pregnant women:
 May be asymptomatic
 Or characterized by a primary
bacteremia manifesting first as a
nonspecific flu-like illness.
13

Symptoms and Signs(Cont.)
• In the fetus and neonate
 Clinical presentation depends on
the timing and route of infection.
 Abortion, premature delivery with
amnionitis, stillbirth, or neonatal
sepsis is common.
14

Neonatal listeriosis
 Two clinical presentations are
recognized :
1. Early-onset neonatal disease (<5
days)
2. Late-onset neonatal disease (≥5
days)
15

Early – onset neonatal listeriosis
 (<5 days, usually within 1-2 days
of birth) low birth weight
 Predominantly septicemic form
 Occurs with milder transplacental or
ascending infections from the female
genital tract
 Mortality rate is ~ 20-30%
16

Early – onset neonatal listeriosis
(Cont.)
A strong association with:
 recovery of listeria monocytogenes from the
maternal genital tract
 obstetric complications
 prematurity
 neonatal sepsis with multiorgan involvement,
including rash BUT without CNS localization
17

Late-onset neonatal listeriosis
 ( >5 days, mean14 days of life but before 30
days of age)
 Predominantly meningitis form (purulent with
parenchymal brain involvement
 Affected infant frequently are full-term
 The mothers are culture-negative and
asymptomatic
 If adequately treated ,the mortality rate <20%
18

Early-onset vs. Late-onset
No. Features Early-onset
(<5 days)
Late-onset
(≥5 days)
1 Maternal listeria culture Positive Negative
2 Obstetric complications Present Absent
3 newborn Premature
delivery
Term delivery
4 Birthweight Low Normal
5 Neonatal infection Neonatal sepsis Neonatal meningitis
6 Mean age at onset 1.5 days 14.5 days
7 Mortality rate > 30% < 10%
19
Benitez-Segura I , Fiol-Jaume M , Balliu PR ,Tejedor M. Listeria monocytogenes:
maculopapular rash may be the clue. Arch Dis Child Fetal Neonatal Ed.2013;98 (1):F64

• A sick neonate whose mother has
listeriosis should be evaluated
for sepsis, including cultures of either
umbilical cord or peripheral blood,
CSF, gastric aspirate, meconium and
any potentially infected tissue,
20

Diagnosis
 CSF examination may show a
• predominance of mononuclear cells
• usually polymorphonuclear cells
predominate.
• Gram-stained smears frequently are
negative but may show pleomorphic,
gram-variable coccobacillary forms
21

• Laboratory confirmation of the
organism involves biochemical testing
and observation of motility using a
slide test or showing motility in
semisolid media
• Molecular detection via PCR is
available in certain laboratories
22
Diagnosis ( cont.)

Listeria monocytogenes are gram-positive rods (three white
arrows) of variable size, shape, and length, which is somewhat
evident in this gram-stain of a blood culture.
23
https://www.pinterest.com/pin/4939892714863324
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Prognosis
• Mortality, ranging from 10 to 50%,
is higher in neonates with early-
onset disease
24

Treatment
• Treatment of the newborn is with
ampicillin plus an aminoglycoside
• A 14-day course is usually
satisfactory (21 days for meningitis),
25

Other possible drugs
• Ampicillin or penicillin with rifampin
or trimethoprim/sulfamethoxazole
• Trimethoprim/sulfamethoxazole alone
• Meropenem
they have not been well evaluated.
26

Other measurements
In heavy infection, drainage/secretion
precautions may be considered.
27

Prevention
Food products that may be contaminated by L.
monocytogenes
should be avoided by pregnant women
28
unpasteurized dairy
products
raw vegetables
soft cheeses prepared deli meats and
salads
refrigerated meat
spreads
Refrigerated smoked
seafood)

Prevention ( cont.)
• 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.
29

• infection during pregnancy is recognized,
treatment may then be given before
delivery or intrapartum to prevent vertical
transmission,
• ??the usefulness of such treatment
30

References
 Ramaswamy V, Cresence VM, Rejitha JS, Lekshmi MU, Dharsana KS, Prasad SP, Vijila HM (February 2007).
"Listeria--review of epidemiology and pathogenesis“ Journal of Microbiology, Immunology, and Infection = Wei
Mian Yu Gan Ran Za Zhi. 40 (1): 4–13.
 Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, et al. Clinical features and prognostic factors
of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017 May. 17 (5):510-519
 Mook P, Grant KA, Little CL, Kafatos G, Gillespie IA. Emergence of pregnancy-related listeriosis amongst ethnic
minorities in England and Wales. Euro Surveill. 2010 Jul 8. 15(27):17-23
• Pizarro-Cerda J, Cossart, P (2019). "Microbe Profile: Listeria monocytogenes: a paradigm among intracellular
bacterial paogens". Microbiology. 165: 719–721.
• Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, et al. Listeriosis in human pregnancy: a
systematic review. J Perinat Med. 2011 May. 39(3):227-36
 Jackson KA, Iwamoto M, Swerdlow D. Pregnancy-associated listeriosis. Epidemiol Infect. 2010 Oct. 138(10):1503-
9.
 [Guideline] Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee
Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet
Gynecol. 2014 Dec. 124 (6):1241-4.
 Imanishi M, Routh JA, Klaber M, Gu W, Vanselow MS, Jackson KA, et al. Estimating the attack rate of pregnancy-
associated listeriosis during a large outbreak. Infect Dis Obstet Gynecol. 2015. 2015:201479.
• Benitez-Segura I , Fiol-Jaume M , Balliu PR ,Tejedor M. Listeria monocytogenes: maculopapular rash may be the
clue. Arch Dis Child Fetal Neonatal Ed.2013;98 (1):F64
•
•
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Neonatal Listeriosis Guide

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