Pregnant Women: Beware of Soft Cheeses and Undercooked Meats

Dec. 2, 2009 - PRLog -- Pregnancy, due to suppression in the immune system, can make a woman more susceptible to certain bacterial infections. Among the more serious infections is listeriosis, caused by the bacteria Listeria monocytogenes. This organism is a common colonizer of the gastrointestinal tract. It originates in the environment commonly found in soil, dust, water, produce, processed foods, and the feces of domestic and wild animals and humans. Invasive disease is rare but pregnant women have a 17 fold increased incidence compared to non-pregnant women.

What is the importance of listeria infections in pregnancy?

Listeria can be the cause of spontaneous abortions, premature labor, stillbirths, and infants with sepsis or meningitis. The newborn mortality rate from this disease is between 30 and 63%. The fetus gets infected either through the placenta via the maternal bloodstream, or ascending from the vaginal canal after having been infected from the gastrointestinal tract.

What is the incidence of listeriosis?

The general population has an incidence of invasive disease of 0.7 per 100,000 but pregnancyincreases the incidence to 12 per 100,000. CDC has estimated approximately 2,500 cases per year in the U.S. resulting in approximately 500 deaths. About a third of the cases of listeria occur in pregnant women. The bacteria can be found as a colonizer in the feces of 70% of healthy people and 44% of pregnant women. It is rarely found in the vagina. Although colonization is common, invasive disease is unusual.

Pregnant women that are immunocompromised with HIV infections, diabetes, steroid use, and splenectomy are especially susceptible to this pathogen.

How do pregnant women get infected with Listeria?

Food contaminated with the bacteria is the main source of infection. Main reservoirs include soft cheeses (feta, brie, camembert), blue veined cheeses, Mexican-style cheese (queso blanco), coleslaw, pâté, pork tongue, unpasteurized milk, foods prepared from raw milk, turkey franks, and delicatessen foods. Listeria has the capacity to multiply at refrigerator temperatures (4–10 degree C) and therefore can contaminate undercooked meat and vegetables. All surfaces and utensils must be washed carefully when exposed to uncooked meats.

What are the symptoms of infection in the mother and the newborn?

Most pregnant women are asymptomatic or present with a flu like illness with low grade fever, myalgia, headache, abdominal cramping or diarrhea. Rarely are the symptoms serious. Miscarriage or premature labor can occur 50% of the time with fetal distress 35% and meconium stained amniotic fluid 75% of the time. Occasionally a macular/papular rash can be present on the trunk and extremities. The placenta can also have evidence of micro-abscesses.

Onset of the disease in newborns is generally within 1–2 days of birth and appears as sepsis or pneumonia. There is also a late onset version of the disease in newborns that can occur 7–14 days after delivery and presents as meningitis.

A rare finding in infants is called granulomatous infantiseptica which is characterized by multiple widespread abscesses and granulomas.

The later in gestation that the disease occurs, the worse the outcome for the mother and the fetus.

Diagnoses is generally made with positive blood cultures. Organisms can also be found in the placenta or amniotic fluid. It can be isolated from urine, cerebrospinal fluid, and the oropharynx in infants.

What is the treatment for Listeria in pregnancy?

Treatment of choice for listeriosis is ampicillin, amoxicillin, or penicillin. For patients allergic to penicillin, treatment with erythromycin or vancomycin is recommended. Trimethoprim/sulfamethoxazole is another alternative for penicillin allergic patients but it is not recommended in the first trimester due to the anti-folate activity which can possibly lead to a neural tube defect. In utero therapy has been successful in several case reports averting the need for prompt delivery which is recommended in most other cases of chorioamnionitis.

Ampicillin along with an aminoglycoside is the management for newborn listeriosis. Length of treatment is controversial and some reports feel 3 to 4 weeks of high dose therapy is essential.

In summary, the key to prevention of listeria in pregnancy is avoidance of food products that may be contaminated with this bacteria. The FDA and CDC regularly monitors any reports of contamination but it is always best to avoid high risk foods. In addition, food should be stored, handled, and cooked properly to reduce the risk of acquiring this infection.

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