Maternal Infection with Listeria monocytogenes in Twin Pregnancy

Abstract

Listeria monocytogenes is the conditional pathogenic bacteria, and pregnant women are at higher risk of infection due to depressed immunity. Infection with Listeria monocytogenes in twin pregnancy is rare but devastating, which puts forwards a great challenge for clinical management. Here, a 24-year-old woman was diagnosed with twin pregnancy, intrauterine death of one fetus and fever at 29⁺⁴ week of gestation. Two days later, she developed into pericardial effusion, pneumonedema and potential septic shock. The emergent cesarean delivery was performed after anti-shock treatment. One alive and another dead fetus were delivered. Then, she developed postpartum hemorrhage after the surgery. Urgent exploratory laparotomy was conducted at the sites of cesarean section and B-Lynch suture to stop bleeding. The culture of blood and maternal side of both placentas indicated Listeria monocytogenes. Following anti-infection therapy with ampicillin-sulbactam, she recovered well and discharged with negative result of blood bacterial culture and normal inflammatory indicators. The patient was hospitalized for a total of 18 days including 2 days in the intensive care unit (ICU), and the anti-infection treatment was conducted throughout the course. Symptoms of the Listeria monocytogenes infection in pregnancy are non-specific, which should be paid more attention in case of unexplained fever and fetal distress. The blood culture is effective for accurate diagnosis. Listeria monocytogenes infection is associated with poor pregnancy outcomes. Close monitoring of fetal condition, early intervention with antibiotics, timely termination of pregnancy and comprehensive management of complications are essential for better prognosis.

Keywords: Listeria monocytogenes; outcomes; twin pregnancy.

Figure 1

Chest CT images of the patient on the 3rd day of admission showed enlarged heart shadow, pericardial effusion, ground-glass opacity and patchy consolidation as well as thickened bronchovascular bundle in bilateral lung.

Figure 2

Chest CT images of the patient 4 weeks after discharge. Compared with the findings on the 3rd day of admission, there was decreased ground-glass opacity and patchy consolidation as well as thinner bronchovascular bundle in the both lungs. The heart shadow and pericardial effusion as well as pleural effusion were also reduced.

Figure 3

Brain MRI images of the patient 4 weeks after discharge. There were no abnormalities in the morphology of bilateral cerebral hemispheres, cerebellum and brain stem. The cerebral ventricle did not dilate and cerebral sulci or fissure did not widen. However, shadow of the mucosa of bilateral ethmoid sinus and maxillary sinus was thickened.

Figure 4

Timeline of clinical presentations, examination and treatment of the patient since the admission to our hospital. Key results were: (1) The twin-pregnant women was admitted with fever for 3 days and one dead fetus; (2) On the 3th day of admission, the patient still had fever and presented with chest distress, breathlessness and potential septic shock; the cesarean section was performed after anti-shock therapy and one alive newborn was delivered; ampicillin-sulbactam was used since then for the potential Listeria monocytogenes infection; (3) On the 4th day, severe postpartum hemorrhage occurred and blood transfusion as well as exploratory laparotomy were conducted to stop bleeding; (4) On the 4th and 6th day of admission, Listeria monocytogenes infection was identified through culture of blood and placenta tissue, respectively; (5) On the 16th day, the placenta tissue culture found no colony formation; (6) On the 18th day, the patient was discharged; (7) On the 47th day (4 weeks after discharge), the patient was readmitted with fever. The blood culture result was negative.