Congenital listeriosis – the infectious disease arising at pre-natal infection of the child with listeriya. Clinically pathology is characterized by a hyperthermia, increase in lymph nodes, papular or rozeolezny rash on skin, specific granulomas on mucous membranes, a picture of meningitis, pneumonia. Diagnostics consists in identification of listeriya in biological liquids of the child by means of a bakterioskopichesky research, crops of materials on special nutrient mediums, carrying out RSK, RPGA, IFA, PTsR. The main treatment is carried out by means of a combination of antibacterial means. Choice medicines – ampicillin and gentamycin.
Congenital listeriosis – the serious infectious disease of newborns caused by korinebakteriya of L.monocytogenes at which in bodies and tissues of the child specific granulomas are formed. For the first time the activator was identified in 1911, however the detailed description is submitted by Murray only in 1926. In 1940 the name "listeriosis" in honor of the English surgeon J. Lister was accepted. It is rare pathology in pediatrics and a neonatology which arises approximately at 0,1% of newborns. As a source of infection of mother practically any mammals, most often – the agricultural cattle can act. The lethality of children with congenital listeriosis depends a pregnancy trimester in which there was an infection, however the total indicator makes about 30%. Dangerous feature of listeriosis is that quite often at mother it proceeds asymptomatically, and without purposeful diagnostics it is difficult to reveal this pathology.
Reasons of congenital listeriosis
The causative agent of listeriosis – Listeria monocytogenes korinebakteriya. This microorganism represents a grampolozhitelny, short stick of the correct form. Is a facultative anaerobe bacteria, does not form disputes. Listeriya are capable to grow and breed in a temperature interval from +1 to +45 °C, are steady against changes in the external environment. Most often they are in food of an animal origin (crude meat, forcemeat, sausages, milk, cottage cheese, cheese), is rare – in vegetables and fruit. Often a factor of transfer is "fast food". Also contact and aerogenic mechanisms of infection are possible during the work with skins, etc.
Infection with congenital listeriosis can take place transplatsentarno or intranatalno. At any of forms one of key factors is the latent batsillonositelstvo of listeriya mother. Total absence of symptoms or existence of indistinct clinical manifestations reduces probability of timely diagnostics and treatment of the pregnant woman, respectively increasing risk of congenital listeriosis at the child. The probability of pre-natal infection by overcoming with activators of a placentary barrier or penetration through an amniotic cover exists in all trimesters of pregnancy. At hit in an organism of a fruit of a listeriya extend on all bodies and systems, first of all, infecting with TsNS. In the struck fabrics there is a specific type of granulomas – listeroma. Their formation provokes hyperproduction of tsitokin and saturation of pathological new growths macrophages. Continuous stimulation of work of macrophages and the increased maintenance of tsitokin lead to violation of blood supply and dystrophy of the struck bodies and fabrics.
Listeriya can get into an organism of the child and at the time of delivery, at contact with the infected mucous membranes of patrimonial ways or at aspiration of the amniotic waters containing bacteria. In rare instances the infected hands of medical personnel can be a source of infection.
Classification of congenital listeriosis
According to the period in which there was an infection allocate the following forms of congenital listeriosis:
- Early. Clinical symptoms arise in the first 24-36 hours of life of the child. Infection passes vnutriutrobno. As a rule, such form proceeds in the form of a generalized infection. A lethality – over 50%.
- Late. The first symptoms of listeriosis arise for 10-14 days. Infection – intra-or postanatalny. The disease proceeds in the form of local defeat. The clinical picture often imitates meningitis or pneumonia. The lethal outcome is observed approximately at 25% of children.
Symptoms of congenital listeriosis
Infection with listeriya in the first half of a gestation often causes spontaneous termination of pregnancy. Infection in an interval of 20-22 weeks and later provokes a clinical picture of early congenital listeriosis. The demonstration takes place right after childbirth or in the first several hours, sometimes – 1,5 days. Primary symptoms include a serious general condition of the child, a hyperthermia over 38,5-39 °C, skin rashes in the form of papules with hemorrhagic contents, sometimes – . Characteristic listeriozny granulomas on mucous membranes of a mouth, a throat are formed, it is rare – conjunctivas. The increased cervical lymph nodes can be palpated. Several hours later after emergence of early symptoms the condition of the child begins to worsen progressively, there are sharp short wind and generalized cyanosis, clinic of respiratory insufficiency. Development of rhinitis, conjunctivitis, jaundice is possible. Spasms and other displays of an encephalomeningitis are in parallel observed.
The first clinical manifestations of a late form of a congenital listeroz arise at the age of the child of 10-12 days. Primary symptoms most often indicate defeat of TsNS. It is a muscular tremor, giperesteziya, a convulsive syndrome. Increase in a liver and spleen, jaundice, temperature increase of a body up to 38,5 °C is often observed. Less often the clinical picture reminds pneumonia, gastro-or enterokolit.
Diagnosis of congenital listeriosis
The diagnosis "congenital listeriosis" generally is based on the laboratory methods of a research directed to identification of listeriya in the child's organism. Anamnestichesky data can indicate to the pediatrician or a neonatolog probable infection of mother. Clinical symptoms of a malospetsifichna, can remind other diseases: meningitis, pneumonia etc. "The gold standard" is the bacteriological research of biological liquids of the child: blood, a likvor, amniotic waters, aspiration masses from a trachea and a bronchial tree and identification of listeriya in them. Express diagnostics – a biomaterial bacterioscopy with coloring on Gram and identification of the painted sticks. The final diagnosis is exposed when carrying out crops of material of the patient on special nutrient myasopeptonny mediums with glucose or blood. Serological methods of a research (RSK, RPGA) in dynamics define increase of a caption of specific antibodies to listeriya in 4 and more times. IFA for the purpose of definition of IgM and IgG is sometimes carried out. In need of urgent diagnostics appoint PTsR which allows to reveal molecules DNA of listeriya with high precision within 2-3 hours.
Differential diagnosis of congenital listeriosis is carried out with such diseases as congenital toxoplasmosis, syphilis, a hemolytic disease, a patrimonial trauma of newborns, a Cytomegaloviral infection, staphylococcal sepsis.
Treatment of congenital listeriosis
Treatment of congenital listeriosis is performed in the conditions of intensive care unit and intensive therapy of newborns. A choice method at the confirmed diagnosis is the combination of antibacterial means from groups of aminoglycosides and penicillin – gentamycin and ampicillin. Both antibiotics are applied at the same time, but with different duration, and the dosage is defined by age, body weight of the child and a form of a disease. Duration of reception of ampicillin depends on defeat of brain covers – when developing meningitis treatment is carried out 21 days, without it – 14 days. Gentamycin is appointed to term no more than 1 week. After receiving an antibiotikogramma medicines are selected according to sensitivity of the activator. If necessary the symptomatic therapy directed to knocking over of spasms, a hyperthermia, etc. is carried out.
Forecast and prevention of congenital listeriosis
Forecast of congenital listeriosis doubtful. Even against the background of adequate antibiotic treatment the lethality makes about 25-50%. Often there are complications in the form of hydrocephaly, encephalopathy, pneumonia. On early terms of pregnancy listeriosis leads to an abortion.
Specific prevention of congenital listeriosis it is not developed. The main preventive measures have to be directed to prevention of infection of mother during pregnancy. For this purpose the use of thermally raw products, first of all, of meat and milk is completely excluded. In the presence in the anamnesis of risk factors of infection with listeriya purposeful diagnostics is carried out. At confirmation of the diagnosis immediate antibacterial therapy is shown.