139 Neonatallisteriosis – a case report

Neonatal listeriosis is a rare but severe infectious disease caused by the gram-positive bacterium Listeria monocytogenes with a mortality rate of almost 30%. Pregnant women are mostly infected with Listeria by consuming contaminated food but cases of listeriosis after direct contact with an infected animal have been reported. Neonatal listeriosis has two clinical presentations, early and late-onset. Early onset listeriosis is caused by transplacental transmission or ascending infection with consequent chorioamnionitis, premature rupture of membranes, meconium amniotic fluid and neonatal sepsis, often with the presence of numerous granulomas mostly in spleen and liver of the infant. Late onset listeriosis is caused by an infection transmitted to the newborn when it passes through the birth canal or is, less likely, a nasocomial infection. Late onset listeriosis is manifested as meningoencephalitis between the 1st and 2nd week of life and is associated with a better prognosis. We report a case of a male newborn born in the 38th week of gestation from a febrile mother, born in meconium amniotic fluid, which was admitted to the neonate intensive care unit in the first hours of life due to development of respiratory distress syndrome and signs of early neonatal sepsis. After obtaining microbiological samples, empirical therapy with ampicillin and gentamicin was introduced. Listeria monocytogenes was isolated from skin swabs and gastric aspirate of the newborn, blood culture as well as urine and cerebrospinal fluid culture came sterile; cerebrospinal fluid PCR was also negative for Listeria DNA. We did not radiologically verify presence of granulomas in any organ. Following this result, cervical and vaginal swabs were obtained from the mother and also revealed presence of L. monocytogenes. In the further course, the doses of antibiotics were adjusted and the newborn was afebrile, control microbiological samples were sterile and he was discharged after 16 days. Reviewing medical records, it was noticed that the 1st child of this mother also had a perinatal infection where the causative agent was not isolated, and given the anamnestic data that the family is engaged in sheep breeding, it is possible that the background was also unrecognized L. monocytogenes infection. In conclusion, a blood culture sample and cervical swab should be done to any pregnant woman with an unclear febrile condition, as Listeria monocytogenes is a common unrecognized cause of miscarriages and stillbirths, and early treatment is necessary to prevent vertical transmission and thus severe complications and fatalities in newborns.