Multiple Organ Implication in a Case of Congenital Listeriosis authors: Marta Simon1, Manuela C. Cucerea1, Zsuzsanna Gall1, Monika Rusneac2, Laura Suciu1, Raluca Marian1, Carmen Movileanu2 INSTITUTIONS: 1: University of Medicine and Pharmacy Targu-Mures, Targu-Mures, Romania. 2: Mures County Emergency Hospital, Targu-Mures, Romania Introduction Listeriosis is a severe disease caused by Listeria monocytogenes, a food-borne pathogen, is a Gram-positive rod-shaped bacterium, also a facultative intracellular parasite In human, the disease affects primarily pregnant women, newborns, and adults with weakened immune systems. The overt form of the disease has a mortality greater than 25 percent. The two main clinical manifestations are sepsis and meningitis, but literature also describes hepatocellular implications in rare cases Infection with Listeria monocytogenes in the perinatal period is challanging for it’s complexity, difficulty in treating and long term outcome. It could end with the exitus or it can lead to several neurological sequelae Case presentation T.A., female premature GA: 34wks infant, BW: 2250g, L: 47cm, HC: 30cm, Apgar score: 2/6/6 Maternal hystory: mom 21 years, IGIP, admitted in the 34th week of her first pregnancy for general malaise, weakness and fever - 38•C. Her past general and gynecologic history were unremarkable On admission, her general physical examination revealed no specific findings and her vital signs were normal except for the fever of 38•C At birth: meconium stained amniotic fluid, perinatal asphyxia (pH:6.98, Apgar score 6/10min), the limp baby needed neonatal resuscitation with tracheal suctioning, PPV via ET, External Chest Compressions Physical examination at birth revealed disseminated erythematous (blueberyy muffin like) rash, severe respiratory distress, tachycardia, hepatosplenomegaly The baby was transferred to the NICU for further investigations and treatment Dg. at this stage: congenital sepsis due to materno-fetal infection of unknowed etiology Within 24 hours the infant presented fever and seizures The clinical status rameined altered for the first 15 days, the infant developed acute renal failure, liver failure, with thrombocytopenia, ascites, jaundice, massive generalized edemas CBC showed severe hemolytic anaemia and thrombocyopenia, left shifted peripheral smear In all cultures (culture of gastric aspiration, blood culture, as well as mother’s cervical smear ) grew Listeria monocytogenes Treatment: assisted ventilation (SIMV), inotropic agents (Dopamine), anticonvulsivants, fluid management, correction of metabolic acidosis, wide spectrum antibiotherapy: meropenem+gentamicine, suplemented with ampicillin after the antibiogram, repeted blood and platelet transfusions After 15 days, renal and liver functions gradually had normalized, we managed extubation after 25 days of life. Feeding was initially with MCT formula, followed by lactose free formula after 6 weeks. Initial head US-normal appearance Abdominal US scan- ascites After 40 days of complex treatment, evolution was good, the infant underwent routine investigations before discharge: bulging fontanell, otherwise no neurological signs, head US: hypertensive hydrocephalus – v-p shunt was needed Discharge: at 11 wks, she’s continuing physicotherapy, showing neuropshychomotor delay of 2 months at 10 months corrected age Discussions In our case congenital listeriosis had an early clinical onset, that led to multiorgan implications and eventually hydrocephalus in a preterm infant. Early targeted multilevel treatment was performed with good outcome at discharge Meningitis could not be ruled out with lumbar puncture due to the persistent thrombocytopenia, and early transfontanellar ultrasonography showed no pathologic features. In spite of positive initial findings for meningitis, the infant developed hydrocephalus, most probably secundary to central nervous system listeriosis. Conclusions Congenital listeriosis is a are but challenging neonatal pathology In congenital infections initial normal head ultrasound findings do not exclude the posibility of further complications Serial US examinations and measurements are needed in the high risc population Serial US examinations of the abdominal organs help with valuable additional data in monitoring the hepatic or renal implications Further head ultrasound scans and Doppler measurements helped the practicioner to decide the best moment to make depletive lumbar puncture and v-p shunt placement References 1. H. Hof: History and epidemiology of listeriosis. FEMS Immunology and Medical Microbiology 35 (2003) 199-202 2. Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. Jun 1999;66(6):375-80 3. 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