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A 20-year retrospective review at a tertiary hospital in Singapore identified 11 cases of perinatal listeriosis in maternal-fetal pairs (incidence, 4.8 cases per 100 000 live births). Fever, meconium-stained amniotic fluid, and fetal akinesia during the third trimester were associated with listeriosis. In this study early directed antibiotic therapy resulted in favorable outcomes., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aim Infection with toxoplasma, listeria and cytomegalovirus (CMV) infections can negatively affect pregnancy outcomes. Awareness of these infections, knowledge of preventive practices and pertinent behaviours was assessed. Methods A survey of patients at antenatal clinics in a Dublin maternity hospital was conducted over a six month period. Analysis was undertaken using SPSS. Results The response rate was 36% (287/800). One in two respondents were aware of toxoplasma, one in four of Listeria but only 1 in 10 of CMV. Overall, knowledge was highest among older, more educated pregnant women. Nativity had a significant effect on knowledge and behaviour, but increasing parity did not. However the majority practised key safe behaviours. Conclusion Information must be conveyed to pregnant women in a user friendly format and in a culturally sensitive way., Competing Interests: The authors declare no conflict of interest.

Clinical, laboratory, and placental manifestations of perinatal listeriosis are highly variable. Herein, we retrospectively analyzed all patients treated for neonatal listeriosis at the Charité University Medical Center in Berlin, Germany, 1999-2013. A total of 16 cases were identified. In 14 patients listeriosis was confirmed in neonatal specimens, while in two only the placenta tested positive. Elevated C-reactive protein and/or interleukin-6 levels were only inconsistently found, while a marked white blood cell left shift was present in all infants, if available. All but one infant manifested symptoms on the first day of life. Most patients required respiratory support, while none developed meningoencephalitis as evidenced by clinical or cerebrospinal fluid findings. Two patients died, all other patients survived without sequelae. In conclusion, perinatal listeriosis is still associated with significant morbidity and mortality. Clinical and laboratory findings are highly heterogeneous, but extreme leukocyte left shift seems to be a common feature.

Maternal listeriosis is often associated with mild symptoms for the patient, but fetal infection can lead to severe adverse perinatal outcome. The most described antenatal symptoms are reduced fetal movements and an abnormal fetal heart rate trace. We present a case of fetal listeriosis suspected by ultrasound findings of fetal gastrointestinal compromise, neonatal diagnosis and outcome., (Copyright © 2013 S. Karger AG, Basel.)

We present the case of a male with a neonatal Listeria monocytogenes infection. Its evolution was favorable with intravenous ampicillin and gentamicin. Listeriosis is an infrequent cause of neonatal pustulosis. The infection is acquired from the mother after bacteremia with few symptoms (early-onset forms) or while passing through an infected birth canal (late-onset forms). A cytological study and the quick stain technique make fast diagnosis of potentially serious neonatal pustuloses possible.

Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols.

The authors have described the issues surrounding Listeria monocytogenes infection with reference to cases diagnosed and managed during the 5-year period (1995-2000) in the Clinical Department of Neonatal Pathology and Intensive Care of the National Institute of Mother and Child in Warsaw. Four cases of congenital listeriosis have been diagnosed. Some mothers presented with "flu-like" symptoms. All mothers delivered prematurely (29 hbd - 32 hbd). Among the 4 infants the most common clinical features were: perinatal asphyxia, respiratory distress, pathological icterus, haematologic abnormalities. Septicemia occurred in 50% of cases; pneumonia in 100%. Three of them presented skin manifestations; one of the neonates had mucosal abnormalities of the laryngopharynx. Cerebral sonography showed intracranial hemorrhage. One of the infants died within 7 days of birth. The other two neonates developed posthemorrhagic hydrocephalus. Only one infant has normal development. Although listeriosis appears to be not a frequent cause of perinatal infection, clinicians must be aware of Listeria, particularly in gravid patients who present with fever and "flu-like" illness and go into premature labour. Initial therapy implemented in our Department, with ampicillin and aminoglycosides seem to be the most appropriate.

We present a case of congenital listeriosis in a twin pregnancy. Presentation was prompted by decreased fetal movements and an ultrasound examination which demonstrated features similar to those observed in an adult with inflammatory conditions of the bowel, namely, small amounts of ascites, dilated loops of bowel and thickening of the bowel wall. Such ultrasound signs may be useful in consideration of the diagnosis of congenital infection and prompt diagnostic tests and appropriate interventions that assist in early therapy.

A case of congenital Listeria septicemia is reported. A 2256 g male infant suffering from respiratory and circulatory failure with shock-like symptoms and high levels of inflammatory cytokines (tumor necrosis factor-alpha, interleukin-1 beta, -6, and -8), was admitted to the Morioka Red Cross Hospital. Listeria monocytogenes was cultured from cord blood, contents from the external ear canal, rectum and stomach. The infant was treated with surfactant replacement as well as conventional therapy. The high levels of interleukin-1 beta decreased with the improvement of the circulatory function, which might have been the major cause of the poor clinical state.

Four babies with congenital listeriosis were diagnosed in the Prince of Wales Hospital in Hong Kong in 1990-1991. Two died in the early neonatal period. The remaining 2 survived and recovered with no sequelae. The clinical and pathological features of these babies, together with those reported in the recent literature are highlighted so as to raise a high index of suspicion toward this disease and hopefully prompt treatment can be offered.

Objective: The purpose of our study was to evaluate the usefulness of placental examination in the diagnosis of prenatal listeriosis., Study Design: Over a 7-year period, 4597 placentas with clinical indications for examination were retrospectively studied for morphologic evidence of listeriosis. The microbiology laboratory file records of positive Listeria monocytogenes cultures were used to confirm the diagnosis. The clinical records were studied for manifestations of the infection both in the neonates and in the mothers., Results: Seven placentas were identified as having listeriosis. The presence of macroabscesses, as opposed to microabscesses, was the most characteristic finding in this study, and the silver impregnation method was more reliable in identification of the bacilli in the tissue sections than the tissue Gram stains., Conclusions: Listeriosis could be diagnosed by placental examination alone, and this examination frequently strengthened the clinical diagnosis. When the infection was not suspected clinically, the examination helped us reach the correct diagnosis.

During the period november 1988-december 1989 eight cases of early onset neonatal Listeria monocytogenes infection were registered in the 'Neonatal Intensive Care Unit' of the University Hospital in Leuven (Belgium). Before bacteriological proof was available, diagnosis could be made in 7 cases, based on a characteristic clinical picture: a maternal flu-like syndrome leading to preterm labour with intact membranes, meconium stained amniotic fluid, perinatal asphyxia and respiratory distress of the neonate. In 5 infants a maculopapulovesicular skin eruption was present. Laboratory findings were non-specific. An interesting finding was the predominance of monocytes in the endotracheal aspirate of infected infants. In 5 out of 8 patients meningitis and intraventricular hemorrhage were present; two of them died, three developed severe neurological sequelae.

Perinatal listeriosis is a disease whose incidence has increased constantly in recent years. Like neonatal infection determined by B hemolyticus streptococcus, the disease appears in two forms: the first is the septicaemic form with early onset, the second form is meningoencephalitic with late onset. We describe a case of listeriosis with immediate onset in which, in spite of the prompt therapy and the normality of rachiocentesis, developed a purulent ventriculitis with outcome in hydrocephalus.

Pointed out has been a danger of listeria monocytogenes infections, which is most frequently transplacentally transmitted from the mother to the baby. In such cases, it results in early, septic forms with disseminated abscesses and granulomas in many organs. A case with a positive outcome has been described. Infection incited during delivery or soon after it results in late, meningitic form of listeriosis, which is characterized with a high mortality outcome. Such a case that resulted in death has also been described. Three children infected by listeria remained asymptomatic. Pointed out has been the inevitability of antibiotic treatment of such children, too, to prevent listeria from developing septic meningitic form. Imperative to prevent nosocomial listeria infections in obstetric wards, which is a reality, are strict measures of hygiene.

Examples of typical embryopathy (rubella, cytomegaly) and fetopathy (toxoplasmosis, listeriosis) demonstrate the disastrous effects intrauterine infections may have on the fetus. Even if they play a relatively small role numerically, they deserve our particular attention because we feel and hope that, by extending maternity care to environmental hygiene and prophylactic vaccination, they can be partly prevented and, by improving prenatal serological diagnosis and intensifying the cooperation of specialists, introduced early to an effective prenatal therapy, thus preventing severe damage to the child.

Since its first isolation by Murray in 1926 Listeria monocytogenes has become recognized as a significant pathogen occurring worldwide and involving a wide range of wild and domestic animals including man. The first confirmed human listeriosis case in Canada was published by Stoot in 1951. A later survey based on records maintained at the Laboratory Centre for Disease Control, Ottawa showed 101 cases detected over a 21 year period in nine provinces. The overall mortality was 30%. The most frequently isolated serotype was 4b followed by 1 and 1b. Prior to the Nova Scotia epidemic (41 cases) of 1981, fewer than 15 cases per annum had been diagnosed based on hospital discharge records. The Nova Scotia epidemic was unique in that the source and mode of transmission of the organism were determined. Sixty-three strains isolated from this outbreak were typed, and with the exception of one 1a strain, were identified as 4b. These were subsequently classified mainly as phage type 00 042 0000 and 00 002 0000. Listeriosis appears to be a common infection in the animal population in Canada primarily in cattle, sheep, chinchillas, chickens and goats. Outbreaks have been described in rabbits, goats, and chinchillas. Chinchilla farms were affected in one outbreak (serotype 1) in Nova Scotia which was attributed to feeding a new batch of meal containing beet pulp. Many aspects of the epidemiology of listeriosis are obscure. A cycle involving contaminated soil and consumption of raw vegetables has been confirmed as the cause of the Nova Scotia epidemic and could explain a proportion of the sporadic cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The results of examinations of autopsy materials in Leningrad and the data from the literature indicate that infectious diseases occupy a significant place in perinatal mortality. It is emphasized that if the autopsy materials are not sufficiently examined using not only light but also immunofluorescent microscopy, a considerable portion of these infections is not diagnosed and the pathological proprocess in such cases in considered to be aspiration pneumonia, hyaline membrane disease, etc. The paper briefly characterizes intrauterine bacterial infections (listeriasis, syphilis, staphylococcal infections, etc.) with special reference to virus diseases (cytomegaly, herpes infection, lesions caused by respiratory viruses, etc) and mycoplasmosis. It is shown that a relatively high incidence of lesions is caused by respiratory viruses and particularly mycoplasma. The possibility of protozoan and mycotic lesions is also indicated. The frequent occurrence of combined intrauterine infections is emphasized.

An electroimmunodiffusion method on hydroxyethylcellulose-agarose by which IgA and IgM concentrations down to 0.3 mg/dl can be measured in amniotic fluid is presented. Elevated Ig levels were found in both fetal infection and in congenital malformations. The potential value of Ig determination in amniotic fluid is discussed.

Although fetal or neonatal infection with Listeria monocytogenes is known to have a high mortality, the longterm morbidity is unknown. Clinical sequelae of fetal or neonatal listeriosis were studied in eight survivors of such infections at a mean age of 16 months corrected for prematurity. A developmental and health history was taken and a Denver Developmental Screening Test and neurological exam performed on each subject. Two infants were seen again and the remainder had developmental and health histories obtained from their mothers and primary physicians at a mean age of 31 months. Six of the eight infants studied had no evidence of neurodevelopmental sequelae. Four of these six had mild or no clinical disease after birth. However, two of the six intact survivors, both born prematurely, were critically ill in the early postnatal period. The two remaining infants had neurodevelopmental handicap. In addition to being prematurely born with severe perinatal disease, these two had CNS complications in the newborn period, both with meningitis and one with intraventricular hemorrhage. Although intelligence in both appeared to be normal, one had mild and the other moderate spastic diplegia. Severe perinatal disease, including fetal or neonatal death, appeared to be related to delayed or no antepartum antibiotic therapy of mothers. Premature delivery appeared to be an important factor both in the severity of disease and in the development of longterm handicap. There were no deaths and no longterm sequelae in infants born at a gestational age greater than 37 weeks. However, in the absence of meningitis and other CNS complications, it would appear that the prognosis even for prematurely born survivors of perinatal listeriosis is very good.

A case of congenital listeriosis presenting with premature labor at 24 weeks' gestation is described. Listeria monocytogenes were isolated from the amniotic fluid, which also had an increased concentration of IgA. The significance of amniotic fluid Ig levels and their potential value in the diagnosis of intrauterine infections as an adjunct to the isolation of the infectious agent is discussed.

Clinical data were correlated with postmortem findings in 14 cases of fatal listeriosis in adults and 23 cases of listeriosis during pregnancy and the neonatal period. Most children born with congenital listeriosis showed the typical morphological picture of granulomatosis infantiseptica. Occasionally no pathological changes were demonstrable. In adult patients the morphological lesions were those of non-specific purulent meningoencephalitis or septicemia. Sometimes encephalitis with abscesses in the brain was found.

From July, 1974 to February, 1978, we managed 12 infants with listeriosis. This infection presented in two distinct forms: an early-onset type (nine patients), often representing a congenital infection following maternal illness, and a late-onset type in which the patient presented with meningitis (three patients). Of our nine infants with early-onset disease, three died, three developed permanent sequelae, and only three were normal at follow-up. Appropriate early management in the perinatal period may improve the outlook in this condition. Affected infants were often premature and had pneumonia, rash, and hepatosplenomegaly at birth. Prenatal clues to the diagnosis included maternal fever, abdominal pains, and leukocytosis with meconium staining of the preterm amniotic fluid. Examination of gastric aspirate at birth showed gram-positive coccobacilli. Antibiotic therapy should be started prenatally and continue for three weeks after birth to prevent recurrences of the late-onset type. This late-onset disease presented as meningitis after the second week of life and responded well to antibiotics. Our three patients recovered without sequelae.

A phage-typing system for Listeria monocytogenes is necessary to eludicate its transmission and spread. We describe the general characteristics of a phage-typing system for L. monocytogenes and its use in selected epidemiological studies. Previously 78.4% of 823 strains of Listeria isolated in France between 1958 and 1978 were typable with a set of twenty phages isolaged from lysogenic strains. We now use twenty-seven phages; six derived from serovars 1/2a and 1/2b, eight from 4b, and thirteen from 4ab, 3c, 5, 6a and 6b. We used this system to examine 186 strains isolated during and after an outbreak in the province of Anjou which occurred during 1975 and 1976. One hundred and eight of these strains were of one phage type (octal code 000 420 000). Using this system we confirmed two cases of cross-infection in hospital neonates in England. Our results show that the reproducibility of the technique and the discrimination of the system are satisfactory for routine use. However, further testing and development of this system are underway.

Neonatal listeriosis accounts for the largest recognizable group of infections due to Listeria monocytogenes. Fetal wastage with early gestational infection is a recognized complication of maternal infection. Late gestational maternal infection or asymptomatic colonization may be associated with neonatal infection. Early-and late-onset clinical forms are recognized and the epidemiology, and clinical features of neonatal listeriosis resemble neonatal infections due to group B streptococci. The source of L. monocytogenes in most cases of neonatal listeriosis, particularly the late-onset form, remains obscure.