Listeriosis during pregnancy: a disease of “refrigerators” and its risk to the fetus

Almost everyone knows that germs and viruses dangerous to the health of pregnant women and can endanger the fetus development defects or anomalies in the period of gestation.

This is especially dangerous in the first and third trimester, which threatens extremely dangerous, fatal consequences. But few moms know about this infection as Listeria. Meanwhile, these microbes are widely distributed in the environment, very dangerous during pregnancy.

Externally to recognize this infection is difficult, it is in gestation is very similar to banal SARS or light intestinal disorders, while threatening to launch a premature birth, intrauterine fetal death with stillbirth or in early miscarriages.

If infection occurs almost before birth, the child survives, but has numerous problems with the internal organs and tissues, which will require a long observation and treatment by a specialist, as well as resuscitation.

General data on listeriosis

Listeriosis is among microbial infections, which are dangerous and very actual in period of gestation. Infection can occur through some food products, contamination with Listeria, pathogens infection. A woman in an interesting position, but also her developing fetus or newborn baby, young children and adults with dramatically weakened immune systems are especially susceptible to Lister. They are able to cause sepsis, meningitis and various infectious complications, including life-threatening fetus and then newborn.

For most women this infection is not as dangerous as for the fetus, the fetus or child at birth, but the disease occurs infrequently, about 2.5 thousand cases per year, and only a third of them expectant mothers.

Properties of pathogens

Listeriosis in medicine became known not so long ago, while in veterinary medicine it know not the first century. Initially, the bacterium was struck by animals, both wild and domestic representatives, and people were rarely sick, mostly those who were in close contact with animals on farms, in clinics and agriculture. Usually the people suffered, neglecting personal hygiene and having a reduced immunity due to various reasons.

Today, listeriosis occurs among residents of towns and villages that encounter pathogen – Listeria. The microbe belongs to the same group as the causative agent of diphtheria, but has some different properties.

Special features for Listeria is their survival in unfavourable for other microbes conditions. They can actively survive and even multiply in cold water and the soil, in contaminated food stored in the refrigerator.

Threat also against Listeria monocytogenes vacuum packaging of products, they do not kill the salt solution to 20%, which is used for salting fish and vegetables. Can kill Listeria boiling treatment or high temperatures, UV radiation and special disinfecting solutions.

How do you get listeriosis?

The main sources of infection for humans are animals – wild and domestic, which, in turn, become infected with listeriosis by eating infected water, eating infected food with microbes, ingest particles of earth and dust with Listeria. When infected they then isolated germs from any bodily fluid is urine, feces, saliva, blood, etc. due to this, the pathogens back into the environment and become a source of infection to others animals and humans. Can also get animals that eat nutritious food – meat and bone meal from slaughtered sick animals.

In humans, the infection occurs in various ways. The main of them is the food, with infected food and water, infected with Listeria water. It is also possible airborne infection, and the fetus of pregnant women become infected if the germs pass through the placenta.

Expectant mothers can become infected with Listeria when there is contact with animals and birds (wild and domestic), by drinking unpasteurized and unboiled milk to any animal. It is also possible to infection by eating fruits, vegetables or berries, which are gathered in areas where there are infected animals, and are also not passed heat treatment and thorough washing. Dangerous in terms of infection poorly processed meat and fish, as well as other products, if the house is inhabited by rats and mice, bred rabbits.

Dangerous products such as raw cabbage, if it is watered with contaminated water or stored in the cellar, as well as raw egg, ice cream, soft cheeses prepared from unpasteurized milk. Dangerous inhalation of the bacteria when handling birds or carcasses of animals in contact with people who are infected with listeriosis, after which the woman did not wash hands, eating the food.

For listeriosis typical sporadic disease, but can occur and outbreaks in the Department of gynecology and maternity wards. In women undergoing treatment or ongoing pregnancy can be a source of infection, themselves unaware of the danger that is possible. They isolated pathogens in the feces, saliva and urine a very long period. Infect other women can pregnant and new mother and also the newborn baby is infected, they release germs for up to two weeks. The main time of the disease is the warm season, from late spring to late summer.

Symptoms of listeriosis in pregnancy

The combination of infection pregnancy – the situation is extremely dangerous, as the woman reports of Listeria to the fetus, whose body is simply not able to cope with them because of the weakness of the immune system. It causes severe destruction of the body, up to fetal death. Often, it is possible that in medicine is called the principle of “ping-pong” infection of the fetus from the mother, and the revitalization of the immune system that gradually learns to cope with the pathogen. However, due to the mother’s body, he again gets new pathogens, which then reports back to the mother.

Ordinary people listeriosis develops, how active the immune system copes with the pathogen. But during pregnancy, the immune protection naturally weaken, to be able to carry the baby, and the immune system is not attacking its cells. Therefore, there is infection which affects the woman’s body and the fetus.

The incubation period varies widely, ranging from 3-5 days and up to six months, symptoms may be different, and therefore highlighted several clinical forms of infection.

Maternity typically several of them who have the features:

• Anginal-septic course of listeriosis in the initial stage is practically no different from the usual flow of purulent tonsillitis. Typically increasing the temperature to 39°C, pronounced pain when swallowing, headache and weakness, nausea and drowsiness, malaise. On examination of the pharynx typically the presence of grayish film or bright red pits in the area are swollen and inflamed tonsils. If you do not start the treatment of this form of sore throat, the germs can quickly enter the blood stream, leading to the formation of sepsis. This penetration of microbes in the blood and spread them to all the internal organs with the formation of inflammatory foci. The fever intensifies and becomes heavier, the typical sudden jump of temperature with redness of face, cough and runny nose, malaise, a sharp increase in lymph nodes throughout the body. On the skin surface is formed bright red rash with irregular shape when stretching and fading.
• The neurological form of listeriosis may develop in those pregnant women who prior to pregnancy had problems with immunity. In addition, it is typical for infected newborns. The microbes penetrate through the blood-brain barrier, a barrier, protecting the brain and spinal cord, which threatens to inflammation of the meninges – meningitis or the formation of abscesses, cavities in the brain filled with pus. Typically fever, severe headaches, tremor of extremities, pain in the joints and spine, nausea and vomiting, disturbance of motor function and sensation in the limbs, convulsions, disorientation in time and space, confusion, delirium.
• Atypical forms of listeriosis may be similar to SARS Il intestinal infection, therefore difficult to detect. Typical temperature increase and flu-like symptoms with joint pain, headaches and aching muscles, discomfort in the back and digestive disorders. They are often mistaken for poisoning or a cold.

It is important to immediately consult a doctor if you suspect listeriosis, if the symptoms of digestive disorders last about two days, and the rest of the symptoms may emerge later, for several weeks.

How dangerous is listeriosis during pregnancy?

Itself infection in pregnancy very rarely have severe symptoms, most often symptoms as colds last about 5 days, but particularly dangerous infection to the fetus and the placenta. The microbes penetrate into the space between the placental villi, which it attaches to the uterus, forming the inflammation of the placenta, which leads to the fact that vast areas of the body ceases to function fully, which threatens to hypoxia of the fetus – a violation of the delivery to him of oxygen. At the same time suffering and power delivery, it also exacerbates the situation.

Infection of 15-16-year-weeks of pregnancy leads to fetal death and miscarriage is bleeding, sometimes it is necessary scraping stilled in the womb of the embryo with the remains of the ovum.

Infection in the second half of pregnancy, the period of 20-22 weeks with a relative development of the placenta, can be formed in several scenarios of events that have a sufficiently poor prognosis:

• the death of the fetus, triggered by the infection that leads to preterm birth, and stillbirth. Normally, a woman ceases to feel the fetus moving in the womb, referring to the doctor or the ultrasound, found the death of a baby, what is the reason for the referral to the hospital and delivery.
• if a woman turns for help to the doctors for 2-3 days, the dying part of the deceased fetus begin to rezorbiruetsa in the blood, leading to fever, weakness and nausea. Can be mother or a woman without sensing perturbations, in the hospital, needed stimulation delivery. Then you need long-term treatment to eliminate the consequences of infection for the mother’s body.

Listeria actively infect the placenta, membranes and water and apply to the body of the fetus.

The consequences of Listeria to the fetus (child)

If the infection listeriosis children survive, usually starts the process of premature birth. The baby may be born very painful or the infection starts immediately after birth, there are problems associated with General blood poisoning – sepsis. Possible respiratory disorders, severe fever and skin lesions in the form of ulcers, various kinds of damage to all internal organs and the nervous system in the form of meningitis.

Some children who are born from infected in the last weeks of pregnancy, mothers may be born apparently healthy, and the first signs of the infection in the form of meningitis they occur about a week or a few weeks after birth. This late start of the infection, which is formed during infection of a child during childbirth, as Listeria can dwell among ill women in the vaginal area and cervix. It is also possible to transfer the infection from the mother, and from third parties. Often children with such injuries are dying or they are irreversible changes in organs and systems on the rest of your life.

A possible form of generalized infection at birth, it manifests itself in the human heart and respiratory disorders, which leads to the need of the crumbs in the intensive care unit. Children usually are light weight and abundant redness in extremities, back and buttocks, mucous membranes of mouth and conjunctiva of the eye. They often die from multiple organ failure in first days of life, especially on the background of the development of purulent meningitis and cerebral edema.

If a woman who has been infected with listeriosis after childbirth sharply notes a decrease in temperature below 36°C, and then the fever no longer occurs, listeriosis can pass into the chronic form. Without treatment this infection will periodically give symptoms similar to colds and affections of the eye in the form of conjunctivitis, and then it has formed a miscarriage, fetal death in utero and congenital abnormalities that lead to infertility.

Analysis of Listeria in pregnant women: normal and decoding

To confirm the diagnosis, only symptoms is not enough, they are similar to many other infections, so you need the most Listeria in the urine, blood or saliva, feces. In the blood test for listeriosis typically increase the level of monocytes, but the exact results are obtained only blood tests for the detection of Listeria monocytogenes – antibodies using reactions Phragmites or RSK. Normal antibodies to Lister should not be, and if determined by a high titer of antibodies to Listeria, the diagnosis is confirmed. It is also possible to identify the pathogen through the use of PCR determination of its DNA material taken from the vaginal mucosa, nasopharynx, sputum. Usually spend the whole course of investigations to accurately determine the nature of infection, severity and prognosis.

Treatment of listeriosis in pregnancy

When infected with listeriosis require urgent admission and treatment only in a hospital.

Apply antibiotics with regard to their effects on pregnancy and fetal development. This is usually penicillins or group that is defined by the results of sensitivity to antibiotics. Therapy may last up to three weeks.

In the early stages of pregnancy when infected with listeriosis necessary abortion on medical indications, in the presence of infection in the second half of gestation with early treatment there are chances that the baby will not become infected in utero infection.

In addition to the antibiotics used adjuvants – hyperimmune globulins, immunofan and others safe during gestation. Parallel to prescribe a course of prevention of fungal infection and dysbiosis, used drugs lactic flora and antifungal drugs.

The detection of listeriosis of the newborn, he was transferred to box ward intensive care where the use of IV antibiotics and antifungals, as well as means for normal blood clotting. Shown drugs that normalize cerebral blood flow and relieve swelling of the brain tissue, medications to support the work of the internal organs, oxygen is given through a mask or the child is connected to the ventilator.

Methods of prevention of listeriosis during pregnancy

There are a number of recommendations that can significantly reduce the risk of Contracting listeriosis during pregnancy.

These include fairly simple but effective methods:

• need careful cooking fish, poultry or meat, it is important to fry or boil them until fully cooked, the juice and blood in the middle. The fish need to prepare very carefully, not allowed to eat undercooked and raw foods. It is forbidden to try nedoguleny dishes during their cooking, including raw meat.
• it is important to thoroughly warm up all the food from the fridge. Listeria can contaminate already prepared foods, carefully crafted, and survive and multiply in the refrigerator. It is important to fully warm up all the dishes that were stored in the evening, it is important that food is fully warmed. When using microwave ovens for heating food covered with a special lid, after heating you need to give the food to stand for a few minutes to warm up was completed.
• you should avoid foods, store food and dishes from cooking. Is to limit the use of sausages and different meat delicacies, pâté or boiled cold meat it is important to limit the consumption of salted and smoked meat, poultry, fish or vegetables, if they are not processed thermally. Canned goods and products with a long shelf life that do not need to be refrigerated after opening are used for two hours.
• you should avoid salads and various dishes production of shops and restaurants, especially if they have chicken, egg or seafood. You should give up during pregnancy from the barbecue.
• it is important to avoid taking unboiled and unpasteurized milk – cow and goat, as well as products that are prepared from it. Do not eat soft cheeses, as well as those with a mould. It is important to study labels to them was an indication that the product is made from pasteurized milk.
• all fruits and vegetables should be washed thoroughly under hot water, you should clear them from the peel before eating.
• all rags, sponges for washing dishes and kitchen towels are treated with disinfectant or boil, often replaced with new ones. In damp rags to actively multiply germs, so they should be regularly washed and processed. You can also use a disposable paper products.
• do not store cooked food for a long time, ideally you want to cook one meal, to avoid the risk of development of microbes in food and contamination of their body. All meals with a short shelf life need to eat immediately, without storing them in the refrigerator.
• need a strict temperature control in the refrigerator and the freezer, it is important to regularly washing, drying and airing the fridge, treating it with disinfectant solution.

It is important to remember that Listeria is very resilient to the negative effects of the external environment, they survive at low temperatures. Therefore it is necessary to warm up all the dishes that allow it, after storage in the refrigerator.