Simultaneous Listeria monocytogenes septicaemia in mother and pre-term infant.

Case report A 22-year-old Caucasian primigravida in a hitherto normal 28-week pregnancy developed intermittent fever with generalized headache, facial paraesthesia, photophobia and 2 episodes of vomiting. Her parents suffered from migraine and the patient ascribed her headaches to the same cause. Her general practitioner prescribed paracetamol. She attended routine ante-natal clinic at 30 weeks and was admitted as her symptoms were unchanged. Her temperature was 353°'C, BP 100/60 mmHg and uterus 30-32 weeks by size. The fetal heart sounds were normal and the urine showed no abnormality. Further examination was unremarkable. On the following day her temperature was 382°0C. Full blood count, throat swabs, urine analysis and culture, and blood culture were performed. Hb, 10.2 g/dl; PCV 34%; white cell count 11 x109/l with 70% neutrophils, 26% lymphocytes, 2% monocytes and 2% eosinophils. Later that day her temperature rose to 39.4°C and ampicillin was started. However, that evening she commenced premature labour at 31 weeks' gestation and was given a single i.m. dose of dexamethasone, 12 mg. A live female infant (2.31 kg) was delivered with meconium-stained liquor after a labour of 3 hr 40 min. The infant gasped at birth but became apnoeic at 2 min. She was intubated and ventilated with oxygen for 7 min. No meconium was seen in the pharynx. The Apgar score was 9 at 10 min. Because of the maternal pyrexia, swabs and blood were taken for culture from the infant and a lumbar puncture was performed. The spinal fluid was uniformly bloodstained and no organisms were seen or cultured. At 12 hr the infant was tachypnoeic and began to grunt intermittently. There was minimal costal recession and she remained pink in air. The heart rate was 160/min with no evidence of cardiac failure. The liver was palpable 2 cm below the costal margin and the spleen 1 cm. Chest X-ray showed inflammatory changes in the right lower zone. The baby was treated with intravenous fluids, penicillin and gentamicin. By 36 hr the grunting had ceased and at the age of 2 days the chest X-ray was clear. Three days after delivery Listeria monocytogenes was identified from maternal and infant blood cultures and also from the infant's axillary, throat and umbilical swabs. As the organism was demonstrated to be only moderately sensitive to penicillin, ampicillin was substituted and continued for 7 days. The infant's subsequent course was uneventful.