Listeriosis complicating pregnancy.

CMAJ © 2009 Canadian Medical Association or its licensors 1 A28-year-old pregnant woman (gravida 2, para 1) presented at 33 weeks’ gestation with abdominal cramps and fever. While the cause of her fever was being investigated, continuous fetal heart rate monitoring showed persistent fetal tachycardia with late decelerations. A cesarean section was performed immediately. A male baby was delivered, weighing 2330 g, with Apgar scores of 4, 4 and 7 at 1, 5 and 10 minutes, respectively. The pH of the arterial blood in the umbilical cord was 7.04. The mother was given intravenous ampicillin intraoperatively after the delivery of the baby. The results of a blood culture, which came back on the second postoperative day, showed Listeria monocytogenes. The woman’s temperature returned to normal within 48 hours, and she was discharged home on the fourth day after surgery. The woman reported that she had occasionally eaten processed foods without reheating them during pregnancy, but she did not recall eating raw foods or the improper handling of foods. The infant had decreased tone and reflexes with no respiratory effort at birth, and he requried intubation and ventilatory support. A lumbar puncture was performed, which showed a leukocyte count of 22 cells/mL, with a differential of 24% polymorphs. the level of protein in the cerebrospinal fluid was 2.2 (normal 0.4–1.2) g/L, and the level of glucose was 4.1 (2.1–3.6) mmol/L. The corresponding blood glucose level was 4.2 mmol/L. Culture of the cerebrospinal fluid showed no growth. The infant was started empirically on broad spectrum antibiotics (intravenous ampicillin and gentamicin). In response to the result of the blood culture taken on day 1 after birth, which showed L. monocytogenes, ampicillin was increased to that used to treat meningitis. The infant had persistent hypotension, which required inotropic support. Between days 2 and 4 after birth, he had several episodes of possible mild seizures that resolved without the need for anticonvulsant therapy. An ultrasound of the infant’s head showed mild periventricular edema, which resolved after 4 days. The infant’s hemodynamic parameters began to improve. He was gradually weaned off the ventilator and was extubated on day 5 after birth. He was given a 14-day course of antibiotics and was discharged home when he was 30 days old. Characteristic features of listeriosis were evident on histological examination of the placenta, including severe acute chorioamnionitis, fetal vasculitis and funisitis, and acute villitis with microabscesses (Figure 1). Gram staining showed the presence of gram-positive bacilli (Figure 2). Cases