Parkash V, Morotti R A, Joshi V, Cartun R, Rauch C A, West A B
Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA.
Int J Gynecol Pathol. 1998 Oct;17(4):343-50. doi: 10.1097/00004347-199810000-00008.
Listeria monocytogenes, a worldwide pathogen, causes significant perinatal mortality and morbidity and has been implicated in spontaneous abortions, still-births, premature delivery, and neonatal sepsis, often with meningitis. Maternal symptoms are frequently minimal, and diagnosis is made only if the suspicion is high and diagnostic maternal blood or amniotic fluid cultures are performed. Because cultures are not routinely performed on spontaneously aborted fetuses, many authors feel that the true incidence of the disease may be underestimated. To date, the absence of a test to retrospectively diagnose Listeria infection has contributed to the lack of accurate estimates of the incidence of the disease. Seven cases in which immunohistochemical stains were used to confirm the diagnosis of placental listeriosis are described. All placentas showed the characteristic lesions with severe chorioamnionitis, numerous microabscesses, and focal necrotizing villitis. Immunohistochemical localization of Listeria antigen was made to the amnion (focally in areas with no inflammatory infiltrate), the abscesses, and the areas with villitis. In general, the antigen was extracellular and intracellular, predominantly within macrophages or the amnion epithelium. Listeria antigen was often found where definite identification of the organism was not possible on Brown-Hopps or Warthin-Starry stains. The immunohistochemical technique may therefore show an increase in sensitivity of detection of L monocytogenes compared with routine bacterial stains. Moreover, the ability to retrospectively evaluate placental specimens for evidence of this organism should permit the true incidence of perinatal listeriosis to be determined.
单核细胞增生李斯特菌是一种全球性病原菌，可导致严重的围产期死亡率和发病率，与自然流产、死产、早产及新生儿败血症有关，常伴有脑膜炎。孕妇症状通常很轻微，只有在高度怀疑且进行了孕妇血液或羊水培养诊断时才能确诊。由于对自然流产胎儿通常不进行培养，许多作者认为该病的实际发病率可能被低估。迄今为止，缺乏回顾性诊断李斯特菌感染的检测方法导致无法准确估计该病的发病率。本文描述了7例通过免疫组化染色确诊胎盘李斯特菌病的病例。所有胎盘均显示出特征性病变，包括严重的绒毛膜羊膜炎、大量微脓肿和局灶性坏死性绒毛炎。李斯特菌抗原在羊膜（在无炎性浸润的局部区域）、脓肿及有绒毛炎的区域进行免疫组化定位。一般来说，抗原存在于细胞外和细胞内，主要在巨噬细胞或羊膜上皮细胞内。在布朗-霍普斯或沃辛-斯塔里染色无法明确鉴定该病原体的地方，常常能发现李斯特菌抗原。因此，与常规细菌染色相比，免疫组化技术可能显示出检测单核细胞增生李斯特菌的敏感性有所提高。此外，回顾性评估胎盘标本以寻找该病原体证据的能力应有助于确定围产期李斯特菌病的实际发病率。
