目的 分析围生期孕妇感染产单核李斯特菌病的临床特征,治疗和愈后情况,以提高临床工作中对该病的认识和重视程度。方法 选取2017年4月—5月2例确诊产单核李斯特菌感染的产前发热患者,对其临床资料进行分析,包括发病情况、临床表现、实验室指标、病情严重程度、治疗情况及母婴结局等,并结合相关文献对围生期孕妇李斯特菌病的临床特点进行探讨。结果 2例孕妇均诊断为产单核李斯特菌感染合并菌血症,出现胎死宫内现象,娩出无生机儿。结论 李斯特菌很容易感染免疫力相对低下的孕产妇,并通过垂直传播引起宫内感染,易致不良妊娠结局。应提高对妊娠期妇女感染李斯特菌病的警惕性,以期做到早发现、早诊断、早治疗,改善围生儿生存结局。
Objective To enhance awareness and attention through demonstrating clinical characteristics of Listeria monocytogenes infection during pregnancy as well as its treatment and prognoses.Methods A retrospective study of two listeriosis cases who were treated in Tongji Hospital of Tongji University was conducted.Patients’ main complains,clinical features,laboratory examinations,severity of the disease,treatment,and maternal and infant outcomes were studied.The clinical characteristics of listeriosis in perinatal pregnant women were discussed based on relevant literature.Results These 2 mothers were diagnosed with Listeria monocytogenes infection combined with bacteremia.Both cases ended in bacteremia and intrauterine fetal death.Conclusion Listeriosis easily infects pregnant women with relatively low immunity and causes intrauterine infection through vertical transmission,resulting in adverse pregnancy outcomes.We should improve practioners’ vigilance for pregnant women infected with Listeria monocytogenes so as to achieve early detection,early diagnosis,and early treatment,and improve perinatal survival.
[1] Aureli P,Fiorucci GC,Caroli D,et al.An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes[J].N Engl J MED,2000,342(17):1236-1241.
[2] Ramaswamy V,Cresence V M,Rejitha J S,et al.Listeria—review of epidemiology and pathogenesis[J].J Microbiol,Immunol,Infection,2007,40(1):4-13.
[3] McLauchlin J.Human listeriosis in Britain,1967-85,a summary of 722 cases.1.Listeriosis during pregnancy and in the newborn[J].Epidemiol Infect,1990,104(2):191-201.
[4] Girard D,Leclercq A,Laurent E,et al.Pregnancy-related listeriosis in France,1984 to 2011,with a focus on 606 cases from 1999 to 2011[J].2014,19(38):11-18.
[5] Mylonakis E,Paliou M,Hohmann EL,et al.Listeriosis during pregnancy:a case series and review of 222 cases[J].Medicine (Baltimore),2002,81(4):260-269.
[6] Kourtis AP,Read JS,Jamieson DJ.Pregnancy and infection[J].N Engl J MED,2014,371(11):1077.
[7] Foodborne listeriosis.WHO Working Group[J].Bull World Health Organ,1988,66(4):421-428.
[8] 李翠云.单核细胞李斯特菌研究近况[J].中国热带医学,2010,10(1):120-122.
[9] 张秀丽,廖兴广,王秋菊,等.产单核细胞李斯特氏菌对理化因素抵抗力的研究[J].实用预防医学,2000,7(4):309-310.
[10] 余淑冰,梁景涛,周强忠,等.食品中单核细胞增生李斯特菌分离及药敏试验的研究[J].中国热带医学,2004,4(4):515-516.
[11] 曹泽毅.中华妇产科学[M].2 版.北京:人民卫生出版社,2004:195-362.
[12] 周颖,赵杨玉,魏瑗,等.妊娠合并李斯特菌感染母婴结局探讨[J].现代妇产科进展,2008,17(12):881-883.
[13] Lecuit M.Understanding how Listeria monocytogenes targets and crosses host barriers[J].Clin Microbiol Infect,2005,11(6):430-436.
[14] Hasbun J,Sepulveda-Martinez A,Haye MT,et al.Chorioamnionitis caused by Listeria monocytogenes:a case report of ultrasound features of fetal infection[J].Fetal Diagn Ther,2013,33(4):268-271.
[15] Hsieh WS,Tsai LY,Jeng SF,et al.Neonatal listeriosis in Taiwan,1990-2007[J].Int J Infect Dis,2009,13 (2):193-195.
[16] Cheung VY,Sirkin WL.Listeriosis complicating pregnancy[J].CMAJ,2009,181(11):821-822.
[17] 沈艳华,刘红,齐宇洁,等.新生儿李斯特菌败血症临床诊治分析[J].中国新生儿科杂志,2014,29(2):82-85.
[18] 徐丘卡.围产期李斯忒菌病1例报告并文献复习[J].浙江临床医学,2002,4(7):520-521.
[19] Janakiraman V.Listeriosis in pregnancy:diagnosis,treatment,and prevention[J].Rev Obstet Gynecol,2008,1(4):179-185.
[20] Committee on Obstetric Practice,American College of Obstetricians and Gynecologists.Committee opinion No.614:management of pregnant women with presumptive exposure toListeria monocytogenes[J].Obstet Gynecol,2014,124(6):1241-1244.
[21] 周文莉,朱敏丽,严超英,等.新生儿单核细胞增多性李斯特菌感染7例.中国当代儿科杂志,2010,12(2):154.
