A Pregnant Woman with Fever

Posted by • May 27th, 2016

104Listeriosis is a rare but notorious cause of chorioamnionitis. Listeriosis is caused by Listeria monocytogenes, an environmentally ubiquitous, facultative, anaerobic gram-positive bacillus. In humans, listeriosis is almost exclusively a foodborne disease, and unheated processed meats and unpasteurized soft cheeses can be contaminated with listeria; pregnant women should avoid eating such foods. Listeriosis is a nationally notifiable disease in the United States.

A 31-year-old woman who was pregnant with dichorionic, diamniotic twins presented at 35 weeks of gestation with fever, rigor, malaise, myalgias, anorexia, and loose stools. A chest radiograph revealed patchy right basilar opacities. Diagnostic test results were received. A new Case Record of the Massachusetts General Hospital summarizes.

Clinical Pearl

• What are some of the risk factors for chorioamnionitis?

Chorioamnionitis complicates 1 to 4% of births in the United States. It is typically caused by ascending infection with endogenous vaginal or cervical bacteria. Associated risk factors before the onset of labor or membrane rupture include bacterial vaginosis, maternal alcohol or tobacco use during the pregnancy, and colonization of the mother’s vagina, rectum, or urinary tract with group B streptococcus.

Clinical Pearl

• How does the rate of listeriosis in pregnant women compare to that in the general population?

In 2010 in the United States, the overall reported rate of listeriosis was only 2.7 cases per 1 million people. Pregnant women, however, are particularly susceptible to listeria and contract the disease at a rate that is 10 to 20 times the rate in the general population; up to 1 in every 4 reported cases of listeriosis in the United States occurs in a pregnant woman. The overwhelming majority of affected women are otherwise healthy. Most diagnoses are made in women who are in the third trimester of pregnancy. Women with multiple gestations are at an increased risk.

Morning Report Questions

Q: What are some of the clinical features and potential complications of listeriosis in pregnant women? 

A: The onset of listeriosis can occur anytime from 3 to 70 days after exposure; the typical incubation period for invasive disease is longer in pregnant women (2 to 4 weeks) than in nonpregnant persons (1 to 14 days). Pregnant women with listeriosis may be asymptomatic or present with an influenza-like or nonspecific febrile illness, sometimes accompanied by gastrointestinal symptoms. Malaise, nausea, loose stools, rigors, arthralgias, and myalgias are typical of the disease. Most pregnant women with listeriosis have leukocytosis. Pregnancy-associated L. monocytogenes infections can have catastrophic results, such as fetal loss, preterm delivery, serious neonatal illness, or neonatal death. As a consequence of maternal bacteremia and transplacental transmission of infection, infants may have an early-onset sepsis syndrome that occurs at birth or shortly thereafter.

Figure 2. Blood Specimens.

Q: What is the usual treatment of severe infections with listeria? 

A: Ampicillin and gentamicin are active against L. monocytogenes. These antibiotics are typically used in combination for the treatment of severe infections with listeria, although no controlled trials have established a standard antibiotic choice or duration of treatment for this infection.

One Response to “A Pregnant Woman with Fever”

  1. Kim says:

    When did you deliver the babies?