Listeriosis of the newborn P37.2

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 03.10.2024

Synonym(s)

Granulomatosis infantiseptica; Newborn listeriosis; perinatal listeriosis

Definition
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Fetopathy caused by diaplacental infection with Listeria monocytogenes (gram-positive rod that is apathogenic for adults) with disseminated granulomas on the skin and in internal organs.

Occurrence/Epidemiology
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Neonatal listeriosis occurs as a result of maternal chorioamnionitis or passage through a birth canal colonized with Listeria from the gastrointestinal tract, which can be extremely serious. Due to the latent severe courses and high mortality rate, even with treatment, it is crucial for neonatologists to familiarize themselves with the related information on neonatal listeriosis.

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Etiopathogenesis
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Due to the insufficient immune protection of the unborn child, there is a severe course of the disease with sepsis and multiple granulomatous organ manifestations, which can result in intrauterine fetal death.

Clinical features
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Skin symptoms: Disseminated, pinhead-sized, yellowish-white nodules on the entire integument surrounded by a red courtyard, see also listeriomas. Multiple organ symptoms due to granulomas in liver, lung, spleen, intestine, pharyngeal mucosa. Meningitis/Meningoencephalitis.

Diagnosis
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Pathogen detection from blood, liquor, throat swab, meconium, amniotic fluid. Serological diagnostics.

Therapy
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Pediatric intensive care. High-dose parenteral antibiotic therapy with combination of ampicillin and aminoglycosides. Dosage: Ampicillin (e.g. Binotal) 100-200 mg/kg bw/day i.v. in 2-4 ED, gentamicin (e.g. Refobacin) 5 mg/kg bw/day.

Progression/forecast
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Risk of mortality (approx. 30-50%) due to multi-organ failure and/or lack of lung maturity (respiratory distress syndrome of the newborn) in the first few days of life. Surviving children may have lifelong psychomotor deficits due to CNS involvement. Characteristic signs of the skin in approx. 50% of cases are pinhead-sized, whitish-yellowish nodules with a red halo.

Literature
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Benshushan A et al. (2002) Listeria infection during pregnancy: a 10 year experience. Isr Med Assoc J 4: 776-780
Charlier C et al (2020) Maternal-neonatal listeriosis. Virulence 11:391-397.
Charlier C et al. (2017) Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis 17:510-519.
Dunphy L et al. (2022) Maternal sepsis caused by Listeria monocytogenes with a fatal fetal outcome. BMJ Case Rep 15:e249989.
Eiss HJ et al. (1951) Granulomatosis infantiseptica a general infection in newborns and infants with miliary granulomas. Z Gesamte Inn Med 6:451-457.
Gilbert GL (2002) 1: Infections in pregnant women. Med J Aust 176: 229-236
Gomez G et al. (2022) Neonatal listeriosis: a rare but not-to-be forgotten infection. BMJ Case Rep 15:e243033.
Siegman-Igra Y et al. (2002) Listeria monocytogenes infection in Israel and review of cases worldwide. Emerg Infect Dis 8: 305-310
Zhang S et al. (2023) Clinical Features and Antibiotic Treatment of Neonatal Listeriosis: A Hospital-Based Study. Infect Drug Resist 16:6647-6659.