Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (04): 396 -402. doi: 10.3877/cma.j.issn.1673-5250.2019.04.007

Special Issue:

Original Article

Clinical analysis of listeriosis during pregnancy

Hui Li1,(), Chengbin Xie1, Qingyuan Jiang1, Zhi Yu1, Li Qiu1   

  1. 1. Department of Obstetrics and Gynecology, Sichuan Provincial Hospital for Women and Children, Chengdu 610041, Sichuan Province, China
  • Received:2019-02-02 Revised:2019-06-28 Published:2019-08-01
  • Corresponding author: Hui Li
  • About author:
    Corresponding author: Li Hui, Email:
  • Supported by:
    Research Project of Sichuan Provincial Health and Family Planning Commission(151018)
Objective

To study the clinical characteristics and pregnancy outcomes of listeriosis during pregnancy in order to improve the obstetricians′ understanding of the disease and the prognosis of patients and their newborns.

Methods

A total of 14 patients of listeriosis during pregnancy from April 2011 to August 2018 in Sichuan Provincial Hospital for Women and Children, were chosen as research subjects. Their clinical case data were analyzed retrospectively, including general conditions, clinical symptoms, laboratory results, antibiotics treatment and pregnancy outcomes of patients, and general conditions of fetus or newborns, also clinical symptoms, treatments and outcomes of alive newborns. Spearman rank correlation analysis method was used to analyze the correlation between rash and death of alive newborns infected by Listeria monocytogenes (LM). Mann-Whitney U test was used to compare the time of first use of antibacterials between cured and dead newborns who were live birth and infected by LM. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①The average age of 14 patients of listeriosis during pregnancy was 29.3 years old, ranging from 21 to 40 years old, and the average gestational age at onset was 31+ 2 weeks. Three cases of them occurred in the second trimester and the other 11 cases occurred in the third trimester of pregnancy. Fever of patients and fetal movement abnormalities were the most common clinical symptoms of patients of listeriosis during pregnancy, the ratio of these two clinical symptoms were 85.7% (12/14) and 64.3% (9/14), respectively. Other clinical symptoms including abdominal pain (57.1%, 8/14), uterine tenderness (35.7%, 5/14) of patients, etc.. Among the 11 patients of listeriosis during pregnancy in the third trimester, there were 9 cases (81.8%, 9/11) of abnormal of fetal monitoring and 9 cases (81.8%, 9/11) of amniotic fluid. ② The samples of LM detected in our study were blood, amniotic fluid and cervical secretions of patients of listeriosis during pregnancy, and blood and cerebrospinal fluid of their newborns. Among 8 cases of 14 patients of listeriosis during pregnancy who took placenta pathological examinations, all of them were acute chorioamnionitis. ③ All the 14 patients of listeriosis during pregnancy were treated by anti-infection and their prognosis was favorable. However, among 15 cases of fetuses or newborns (including twins) of 14 patients of listeriosis during pregnancy, 11 cases (73.3%) were live births, and among them, 5 cases were cured and 6 cases died. The mortality of 15 fetuses or newborns was 66.7% (10/15). ④The correlation analysis showed that there was a correlation between rash and death of alive newborns infected by LM (r=0.633, P=0.036). There was no significant differences between cured and dead newborns who were live birth and infected by LM in the time of first use of antibacterials (Z=—0.471, P=0.638).

Conclusions

Patients of listeriosis during pregnancy has no specific clinical manifestation. The empirical antibiotic therapy before final diagnosis has poor therapeutic effect. The prognosis of patient of listeriosis during pregnancy after treatment by anti-infection is favorable, but the prognosis of its newborn is poor.

表1 本组14例妊娠期李斯特菌病患者的临床特点
编号 年龄(岁) 发病时孕龄(周) 孕次(次) 产次(次) 分娩方式 入院首次实验室检查结果
白细胞计数(×109/L) 中性粒细胞百分比(%) 血小板计数(×109/L) 单核细胞百分比(%) C反应蛋白含量(mg/L)
患者1 21 36+1 1 1 剖宫产术 20.49 83.2 155 8.7 101
患者2 30 32+3 5 2 剖宫产术 10.91 84.1 192 4.5 160
患者3 29 31+5 6 3 顺产 7.10 63.3 62 4.3 96
患者4 27 22+5 1 0 引产 6.98 73.3 127 6.7 10
患者5 27 29+3 1 1 顺产 16.77 70.6 148 6.3 113
患者6 26 33+4 1 1 剖宫产术 19.47 88.4 237 1.7 39
患者7 30 29+2 1 1 顺产 15.55 80.8 205 3.5 18
患者8 31 34+6 2 2 剖宫产术 15.80 78.1 141 4.2 23
患者9 31 37 4 2 剖宫产术 14.59 67.0 51 15.0 190
患者10 27 32+3 2 1 剖宫产术 29.92 80.8 267 4.5 104
患者11 40 26+5 3 1 自然流产 18.23 91.2 142 3.8 >200
患者12 31 25+2 3 1 自然流产 25.90 87.2 228 4.9 101
患者13 29 37+3 2 1 剖宫产术 22.38 85.5 148 2.7 39
患者14 31 30 3 0 剖宫产术 17.46 85.3 204 6.2 48
编号 病程(d) 产前症状
发热持续时间(d) 发热时最高体温(℃) 胎动异常 其他症状 胎儿胎心监护结果 胎膜早破 羊水粪染程度
患者1 8 2.0 39.4 腹痛、疲乏无力 NST无反应型 Ⅲ度
患者2 1 1.0 39.0 胎动减少 阴道流液 反复变异减速 Ⅲ度
患者3 1 0 无发热 胎动减少 腹痛、子宫压痛 频繁变异减速 Ⅲ度
患者4 4 3.0 40.0 胎动消失 头晕、恶心、咳嗽 未做 未记录
患者5 1 0.5 a 37.8 腹痛、子宫压痛 无异常(活胎)
患者6 2 0 无发热 胎动减少 子宫压痛 NST无反应型
患者7 2 2.0 不详b 见红、腹痛 无异常 Ⅰ度
患者8 1 0.5 a 39.5 胎动减少 腹痛、子宫压痛 CSTⅢ类,频繁晚期减速 Ⅲ度
患者9 6 6.0 40.0 腹痛、恶心、呕吐 CSTⅢ类,频繁晚期减速 Ⅲ度
患者10 2 0.5 a 39.3 胎动减少 腹痛、子宫压痛 CSTⅢ类,频繁晚期减速伴延长减速 Ⅲ度
患者11 1 1.0 38.9 腹痛、乏力、嗜睡 未做 未记录
患者12 2 2.0 38.8 胎动消失 未做 未记录
患者13 2 1.0 39.7 胎动减少 见红、鼻塞、流涕 CSTⅢ类,频繁晚期减速 Ⅲ度
患者14 1 0.5 a 39.2 胎动减少 CSTⅢ类,频繁晚期减速,胎心基线为180次/min Ⅲ度
表2 本组14例妊娠期李斯特菌病患者结局
编号 LM培养阳性标本 胎盘组织病理学检查 抗菌药物治疗及时间 妊娠结局 并发症 体温恢复正常时间
患者1 血液 头孢曲松×5 d+阿莫西林克拉维酸钾×3 d 早产 术后当天
患者2 宫颈分泌物 急性脐带炎,急性绒毛膜羊膜炎 (头孢美唑+阿奇霉素)×1 d+(头孢哌酮钠舒巴坦钠+甲硝唑)×2 d+左氧氟沙星×4 d 早产 术后当天
患者3 阿奇霉素×2 d 早产 产后当天
患者4 血液 (头孢哌酮钠舒巴坦钠+奥硝唑)×6 d+阿莫西林克拉维酸钾×3 d 死胎 产后当天
患者5 羊水 头孢曲松×7 d+(头孢曲松+青霉素)×4 d 双胎中,1胎为死胎,另1胎早产 产后当天
患者6 青霉素×5 d 早产 术后当天
患者7 急性绒毛膜羊膜炎 头孢西丁×6 d 早产 产后当天
患者8 羊水 急性绒毛膜羊膜炎 头孢哌酮钠舒巴坦钠×7 d+青霉素×9 d 早产 术后第3 d
患者9 羊水 急性绒毛膜羊膜炎 万古霉素×1 d+(头孢哌酮钠舒巴坦钠+利奈唑胺)×5 d 足月 多器官功能障碍综合征 术后当天
患者10 急性绒毛膜羊膜炎 头孢美唑×2 d+哌拉西林钠他唑巴坦钠×5 d 早产 术后第3 d
患者11 血液 急性绒毛膜羊膜炎 亚胺培南西司他丁钠×10 d 死胎 感染性休克 产后当天
患者12 血液 头孢美唑×4 d+青霉素×11 d 死胎 产后当天
患者13 血液 胎盘底板急性炎症,急性绒毛膜羊膜炎,急性脐带炎 头孢哌酮钠舒巴坦钠×1 d+莫西沙星×9 d 足月 术后第3 d
患者14 羊水 急性绒毛膜羊膜炎 头孢西丁×5 d+青霉素×8 d 早产 术后第4 d
表3 本组14例妊娠期李斯特菌病患者的胎儿/新生儿临床资料
编号 出生/胎死胎龄(周) 胎儿/新生儿体重(g) Apgar评分(分,1-5-10 min评分) 发热时最高体温(℃) LM培养阳性标本 皮疹 生后首次使用抗菌药物时间(h)
患儿1 36+4 2 850 9-10-10 39.0 血液 2
患儿2 32+4 1 760 1-0-0 无发热 未送检 未使用
患儿3 31+5 1 600 3-9-9 无发热 血液 15
患儿4 22+5 未测 死胎 未测体温 未送检 未记录 未使用
患儿5 a 29+4 1 400 1-7-8 无发热 血液、脑脊液 2
患儿6 33+6 2 050 9-10-10 无发热 血液、脑脊液 2
患儿7 29+3 1 150 7-9-9 38.3 血液 2
患儿8 34+6 2 450 4-9-9 39.0 血液、脑脊液 28
患儿9 37 2 900 6-10-10 无发热 血液 4
患儿10 32+3 1 700 9-10-10 无发热 血液 3
患儿11 26+5 1 100 死胎 未测体温 未送检 未记录 未使用
患儿12 25+2 730 死胎 未测体温 未送检 未记录 未使用
患儿13 37+3 2 600 6-9-9 39.0 血液 2
患儿14 30 1 750 10-10-10 38.2 血液、胃液 2
编号 治疗所用抗菌药物及时间 转归/结局
患儿1 头孢他啶×1 d+美罗培南×1 d+(美罗培南+万古霉素)×2 d+(美罗培南+青霉素)×20 d+美罗培南×4 d 住院28 d,治愈
患儿2 未使用抗菌药物 死亡
患儿3 头孢呋辛×2 d+美罗培南×2 d 住院4 d后放弃治疗,死亡
患儿4 未使用抗菌药物 死胎
患儿5 a 美罗培南×2 d+(美罗培南+青霉素)×2 d 住院4 d后放弃治疗,死亡
患儿6 哌拉西林钠他唑巴坦钠×1 d+亚胺培南西司他丁钠×1 d+(美罗培南+青霉素)×28 d 住院31 d,治愈
患儿7 哌拉西林钠他唑巴坦钠×1 d+亚胺培南西司他丁钠×2 d+(美罗培南+青霉素)×1 d 住院4 d后放弃治疗,死亡
患儿8 哌拉西林钠他唑巴坦钠×1 d+(美罗培南+青霉素)×2 d 住院3 d后放弃治疗,死亡
患儿9 美罗培南×17 d 住院17 d,治愈
患儿10 哌拉西林钠他唑巴坦钠×3 d+美罗培南×1 d+(美罗培南+青霉素)×10 d+青霉素×3 d 住院17 d,治愈
患儿11 未使用抗菌药物 死胎
患儿12 未使用抗菌药物 死胎
患儿13 哌拉西林钠他唑巴坦钠×27 d 住院28 d,治愈
患儿14 (美罗培南+万古霉素)×7 d + (美罗培南+青霉素)×3 d 住院10 d后放弃治疗,死亡
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