Successful treatment of listeriosis by using high dose ampicillin in third trimester of pregnancy: a case report.

BACKGROUND

Listeriosis is a rare infection that causes mild maternal disease, but can be devastating to the fetus, in some cases leading to severe disease or even fetal death. Here, we report a case of successful treatment of listeria bacteremia with ampicillin in a pregnant woman.

CASE DESCRIPTION: A 33-year-old woman (gravida 3, para 1, with a first-trimester pregnancy loss at 25 years of age) at 31st gestational week was referred for further diagnosis and treatment. She had been receiving routine prenatal care and none of which showed abnormalities. Four days before this admission, she presented with fever (38.8 ℃) and decreased fetal movement to a local clinic. She was given cefixime (100 mg, bid) and she returned home. Two days later, she come to the clinic again because her symptoms did not abate and treatment of piperacillin/tazobactam was started (cefixime discontinued) and her blood was obtained for culture. Her symptoms did not improve, and even worse, she developed hypothermia (34.2 to 35 ℃). She was transitioned to West China Second University Hospital. Samples of blood culture were obtained again, and all the blood cultures yielded Listeria monocytogenes (L. monocytogenes). Intravenous ampicillin (2 g/q6h for 14 days) was administered promptly after L. monocytogenes was confirmed. Her temperature and non-stress test returned to normal within 72 hours after the initiation of ampicillin. The patient gave birth by spontaneous vaginal delivery to a healthy girl (Apgar score of 10 at 1, 5, 10 minutes) at term. During the 2 years outpatient follow-up, both the patient and her child survived without sequelae.

CONCLUSIONS

Due to the unspecific symptoms of maternal listeriosis in the third trimester, early diagnosis is difficult, but if high-does penicillin was commenced timely, favorable outcomes of maternal-fetal can be anticipated.