SESSION TITLE: Pediatric Pulmonary Case Report Posters
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Neonatal listeriosis, although rare, as incidence, leads to high mortality or outcome with sequelae among survivors.
CASE PRESENTATION: TA, female, euthrophic, premature infant, born at 34 gestational weeks birth weight 2250g, from a febrile mother, with premature rupture of membranes for 92hours., needed intubation and ventilation with positive pressure at birth. Physical examination at birth revealed disseminated erythematous rash, severe respiratory distress, tachycardia, hepatosplenomegalia. Within 24 hours the infant presented fever and seizures. After stabilizing ventilation and oxygenation with SIMV ventilation, rebalancing the hydroelectrolytic and acido-base status, we performed complete blood count, culture of gastric aspiration, hemoculture, both positive for Listeria monocytogenes. Mother’s cervical smear was positive to Listeria, too. Along antibiotherapy therapy ventilatory support, inotropics, anticonvulsivants and repeated blood transfusions were needed. 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. 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 transfontanellar ultrasound screening was normal, but reexamination after 4 weeks showed massive hydrocephalus, with evolutive intracranial hypertension, which eventually needed ventriculo-peritoneal shunting. The baby was discharged at the age of 11 weeks, on total enteral feeds, with mild hypotonia. She is continuing physicotherapy and showed a neuropshychomotor delay of 2 months at 10 months corrected age.
DISCUSSION: The authors present a case of congenital listeriosis with early clinical onset, that led to multiorgan implications and eventually hydrocephalus in a preterm infant. Early targeted treatment was performed. Meningitis could not ruled out with lumbar puncture due to the presence of thrombocytopenia, but early transfontanellar ultrasonography showed no pathologic features. In spite of lack of a diagnosis of meningitis, the infant developed hydrocephalus, most probably secundary to central nervous system listeriosis.
CONCLUSIONS: Congenital listeriosis is an infection that may lead to severe injuries of almost all organs and may have a poor outcome despite early, proper treatment.
Reference #1: Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. Jun 1999;66(6):375-80
DISCLOSURE: The following authors have nothing to disclose: Marta Simon, Manuela Cucerea, Zsuzsanna Gall, Monika Rusneac, Laura Suciu, Raluca Marian, Carmen Movileanu
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