Xu Wen, Peng Mei-Juan, Lu Lin-Shan, Guo Zhen-Jun, Li A-Min, Li Jing, Cheng Yan, Li Jia-Yu, Li Yi-Jun, Lian Jian-Qi, Li Yu, Sun Yang, Zhang Wei-Lu, Zhang Ye
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China.
Department of Disease Prevention and Control, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, China.
Infect Dis Ther. 2024 Jun;13(6):1359-1378. doi: 10.1007/s40121-024-00986-3. Epub 2024 May 11.
Listeriosis is a severe food-borne disease caused by Listeria monocytogenes infection. The data of listeriosis in Xi'an population are limited. The aim of this study is to evaluate the clinical features and fatality risk factors for listeriosis in three tertiary-care hospitals in Xi'an, China METHODS: The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, cranial imaging examination, antibiotics therapeutic schemes, and clinical outcomes were collected between 2011 and 2023. Logistic regression analysis was performed.
Seventy-one etiologically confirmed listeriosis patients were enrolled, including 12 neonatal and 59 non-neonatal cases. The majority of neonatal listeriosis presented as preterm (50%) and fetal distress (75%). The main clinical manifestations of non-neonatal listeriosis included fever (88%), headache (32%), disorder of consciousness (25%), vomiting (17%), abdominal pain (12%), and convulsions (8%). The fatality rate in neonatal cases was higher than in non-neonatal listeriosis (42 vs. 17%). Although no deaths were reported in maternal listeriosis, only two of 23 patients had an uneventful obstetrical outcome. Five maternal listeriosis delivered culture-positive neonates, three of whom decreased within 1 week post-gestation due to severe complications. Twenty-eight cases were neurolisteriosis and 43 cases were bacteremia. Neurolisteriosis had a higher fatality rate compared with bacteremia listeriosis (36 vs. 12%). The main neuroradiological images were cerebral edema/hydrocephalus, intracranial infection, and cerebral hernia. Listeria monocytogenes showed extremely low resistance to ampicillin (two isolates) and penicillin (one isolate). The fatality risk factors were the involvement of the central nervous system, hyperbilirubinemia, and hyponatremia for all enrolled subjects. Hyperuricemia contributed to the elevation of fatality risk in non-neonatal listeriosis.
When the patients suffered with symptoms of fever and central nervous system infection, they should be alert to the possibility of listeriosis. Early administration of ampicillin- or penicillin-based therapy might be beneficial for recovery of listeriosis.
李斯特菌病是由单核细胞增生李斯特菌感染引起的一种严重食源性疾病。西安人群中李斯特菌病的数据有限。本研究旨在评估中国西安三家三级医疗机构中李斯特菌病的临床特征和死亡危险因素。方法：收集2011年至2023年期间的人口统计学数据、基础疾病、临床表现、实验室指标、头颅影像学检查、抗生素治疗方案及临床结局等特征。进行逻辑回归分析。
共纳入71例病因确诊的李斯特菌病患者，其中新生儿病例12例，非新生儿病例59例。大多数新生儿李斯特菌病表现为早产（50%）和胎儿窘迫（75%）。非新生儿李斯特菌病的主要临床表现包括发热（88%）、头痛（32%）、意识障碍（25%）、呕吐（17%）、腹痛（12%）和抽搐（8%）。新生儿病例的死亡率高于非新生儿李斯特菌病（42%对17%）。尽管孕产妇李斯特菌病未报告死亡病例，但23例患者中只有2例产科结局良好。5例孕产妇李斯特菌病分娩出培养阳性的新生儿，其中3例在出生后1周内因严重并发症病情恶化。28例为神经型李斯特菌病，43例为菌血症型李斯特菌病。神经型李斯特菌病的死亡率高于菌血症型李斯特菌病（36%对12%）。主要神经影像学表现为脑水肿/脑积水、颅内感染和脑疝。单核细胞增生李斯特菌对氨苄西林（2株分离菌）和青霉素（1株分离菌）的耐药性极低。所有纳入患者的死亡危险因素为中枢神经系统受累、高胆红素血症和低钠血症。高尿酸血症导致非新生儿李斯特菌病死亡风险升高。
当患者出现发热和中枢神经系统感染症状时，应警惕李斯特菌病的可能性。早期给予基于氨苄西林或青霉素的治疗可能有利于李斯特菌病的康复。
