Wu Li, Zhang Xian-hua, Chen Hao, Yin Xue-lei
Department of Neonatology, Shanghai First Maternity and Infant Health Hospital & Nursing Center for Preterm Infants, Shanghai 200040, China.
Zhonghua Er Ke Za Zhi. 2008 Jan;46(1):22-5.
Neonatal listeriosis is a relatively rare but serious disease with a high mortality rate. This study was conducted to analyze the clinical features, treatment, and outcome of 6 cases with Listeria monocytogenes septicemia confirmed by positive blood cultures.
Totally 12,538 live births delivered in the hospital from January 1, 2004 to June 30, 2006 were investigated. Differences in the time of onset of the disease, clinical presentation, illness severity, laboratory data, management, and prognosis were compared between preterm and full-term infants.
The incidence of neonatal listeriosis was 4.8% in this study. All the cases with listeriosis were found to have early onset and the disease was transmitted from the mother to the fetus, 4 of the cases were delivered via cesarean section, 2 were born via normal spontaneous vaginal delivery. Maternal infection before parturition presented with fever in 4, diarrhea in 1; 5 had abnormal white blood cell counts and total neutrophil counts; 1 had positive result of Listeria monocytogenes in intrauterine contents culture. Three premature infants showed signs and symptoms of severe bacterial septicemia at birth, such as reduced activity, respiratory distress, poor skin color and poor peripheral perfusion; the enlarged liver was palpable 2 - 3 cm below the right costal margin and 5 cm below the xiphoid in one; congestive rashes over the body and muscular hypotonia. Abnormal results of laboratory tests included peripheral blood white cell count (21.6 - 33.8 x 10(9))/L, total neutrophil count 0.77 - 0.83; platelet count (102 - 59 x 10(9))/L; C-reactive protein (CRP) > (160 - 118) mg/L(24 - 72 h after birth). Three preterm infants who received intensive care, accompanied by pathological changes of lungs indicated by chest X ray required assisted mechanical ventilation and 2 of them survived without sequelae but the other one died at 51 h of life. The initial clinical signs of septicemia in 3 full-term infants appeared later than preterm newborn within 62 h, 63 h and 165 h, respectively after birth. They only had fever, T 38 - 39 degrees C, with lower activity in contrast to normal newborn and without other signs and symptoms of septicemia. Accurate diagnosis of listeriosis was established by positive bacterial blood cultures. Intravenous treatment of neonatal listeriosis with ampicillin or penicillins for 1 - 2 weeks was more effective, but cephalosporins were not effective.
There are sporadic cases with Listeria monocytogenes infection among pregnant women in this country, resulting in severe illness of their newborn infants. Early differential diagnosis, early detection of causative organisms, especially in newborn infants infected with Listeria monocytogenes, early treatment with sensitive antibiotics can decrease the mortality rate and improve neonatal outcome. It is necessary to enhance nationwide surveillance for listeriosis.
新生儿李斯特菌病是一种相对罕见但严重的疾病，死亡率很高。本研究旨在分析6例血培养阳性确诊为单核细胞增生李斯特菌败血症患儿的临床特征、治疗方法及预后。
对2004年1月1日至2006年6月30日在我院出生的12538例活产儿进行调查。比较早产儿和足月儿在疾病发病时间、临床表现、病情严重程度、实验室检查数据、治疗及预后方面的差异。
本研究中新生儿李斯特菌病的发病率为4.8%。所有李斯特菌病病例均为早发型，且疾病由母亲传播给胎儿，其中4例经剖宫产分娩，2例经自然阴道分娩。产前母亲感染中，4例有发热，1例有腹泻；5例白细胞计数及中性粒细胞总数异常；1例羊膜腔内容物培养单核细胞增生李斯特菌阳性。3例早产儿出生时即表现出严重细菌败血症的体征和症状，如活动减少、呼吸窘迫、肤色不佳及外周灌注不良；其中1例肝脏肿大，在右肋缘下2 - 3 cm、剑突下5 cm可触及；全身有充血性皮疹及肌张力低下。实验室检查异常结果包括外周血白细胞计数（21.6 - 33.8×10⁹）/L，中性粒细胞总数0.77 - 0.83；血小板计数（102 - 59×10⁹）/L；C反应蛋白（CRP）>（160 - 118）mg/L（出生后24 - 72小时）。3例接受重症监护的早产儿伴有胸部X线提示的肺部病理改变，需要辅助机械通气，其中2例存活且无后遗症，但另1例在出生后51小时死亡。3例足月儿败血症的初始临床体征分别在出生后62小时、63小时和165小时出现，晚于早产儿。他们仅有发热，体温38 - 39℃，与正常新生儿相比活动较少，无其他败血症的体征和症状。通过细菌血培养阳性确诊为李斯特菌病。新生儿李斯特菌病静脉应用氨苄西林或青霉素治疗1 - 2周效果更佳，但头孢菌素无效。
该国孕妇中存在散发性单核细胞增生李斯特菌感染病例，导致其新生儿病情严重。早期鉴别诊断、早期发现病原体，尤其是对于感染单核细胞增生李斯特菌的新生儿，早期使用敏感抗生素治疗可降低死亡率并改善新生儿预后。有必要加强全国范围内对李斯特菌病的监测。
