What is Listeriosis in Children?
Listeriosis in children is an acute infectious disease caused by pathogenic species of listeria, which are transmitted to humans from animals. It occurs in the form of fever, has symptoms of intoxication, affects the liver, central nervous system, spleen. Often has a long chronic course.
Causes of Listeriosis in Children
The causative agent of listeriosis in children is Listeria monocytogenes. The path of infection is hematogenous (hematopoietic) and ascending (infection from the genital tract into the uterus). The disease proceeds with damage to the central nervous system or in angina-septic form. During infection in the perinatal period (a period that begins a few weeks before the birth of the baby and includes the moment of his birth and ends a few weeks after birth), characteristic disseminated infantile listeriosis. In the case of intrauterine infection, as a rule, a miscarriage and stillbirth occurs. The fetus or newborn has multiple abscesses or granulomas (listeriomas). Located in the central nervous system, liver, lungs.
Pathogenesis during Listeriosis in Children
The infection penetrates the mucous membrane of the gastrointestinal tract, affects the lymph nodes. For the development of infection, the state of immunity is of great importance. Children get listeriosis most often in the first year of life. A suppressed immune system contributes to infection. Transmission through the placenta leads to a generalized form of listeriosis in the fetus. If the virus enters the bloodstream, a febrile illness occurs. Subsequently, the pathogen settles in the liver, spleen, lymph nodes, nervous system with the development of meningitis and meningoencephalitis. Listeria can persist for a long time in the kidneys, which increases the likelihood of intrauterine infection of the fetus. Infection of the fetus with listeriosis contributes to septic granulomatosis or sepsis of the newborn, meningitis, which develops within three weeks after birth, which leads to mortality in 60-90%.
Symptoms of Listeriosis in Children
Pregnant women may not show symptoms of infection. But a few weeks before the birth, a fever can be observed, accompanied by breaking pains in the muscles, chills, purulent conjunctivitis and tonsillitis. Some cases are characterized by a manifestation of the form of flu-like diseases.
Congenital listeriosis in children is severe and leads to the death of children. With infection in newborns, the formation of specific granulomas in different organs is observed. Often in case of infection of the fetus, a dead or premature baby is born, which will certainly die during the first 2 weeks. after birth. In a child who has contracted listeriosis during childbirth, signs of the disease appear 1-2 weeks after birth. Listeriosis in newborns occurs in severe form with a high probability of mortality. The main symptoms include: fever, cyanosis, shortness of breath, nasal congestion. The upper respiratory tract, lungs are affected, manifests itself in the form of bronchopneumonia, which occurs with severe violations of bronchial patency and atelectasis, sometimes purulent pleurisy develops. Most sick children have an enlarged liver, spleen, jaundice. In addition to jaundice and cyanosis, in some patients exanthema appears. Meningeal symptoms, cramps, paralysis, uneven tendon reflexes occur. Exanthema affects the trunk and limbs. In the initial period, dark red spots are noted, turning into papules, vesicles. The foci of the rash can merge, then small granulomas are found in many internal organs. This is a peculiar course of sepsis, which usually leads to a lethal result. In mild cases, the rash may not be present, then pharyngitis, conjunctivitis, rhinitis, and diarrhea are observed. After recovery in 15-20% residual effects from the central nervous system remain.
In the case of a chronic form of listeriosis, the pathogen is in the body, while it does not cause obvious clinical symptoms. But sometimes they worsen in the form of flu-like illnesses or chronic pyelitis. In the case of a chronic form of listeriosis in pregnant women, the risk of intrauterine infection of the fetus increases.
Diagnosis of Listeriosis in Children
Diagnosing listeriosis is very difficult. For this, a pregnant woman needs to do a laboratory analysis, which consists of a bacteriological examination of blood, pharyngeal mucus, cerebrospinal fluid, amniotic fluid, placenta, organs of stillborn or deceased children. Serological diagnosis is not sufficiently effective due to false positive results, which is due to the antigenic relationship of listeria and staphylococci.
Treatment of Listeriosis in Children
Antibiotics such as ampicillin and genpamycin are prescribed for treatment, or aminoglycosides are used as an alternative drug. The course of treatment includes antibacterial drugs – chloramphenicol, bactrim, rifampicin.
With the development of meningitis under the age of 1 week. with a body weight of less than 2 kg, ampicillin 50 mg / kg is prescribed every 8 hours, older than 1 week. – ampicillin 50 mg / kg every 8 hours and gentamicin 7.5 mg / kg per day intravenously for 2 weeks. Gentamicin is canceled in the absence of listeria in the cerebrospinal fluid. Children older than 1 month. Ampicillin is administered 300-400 mg / kg per day intravenously.
Alternative drugs – a combination of benzylpenicillin sodium salt of 100-200 thousand units / kg per day intravenously for 2-3 weeks. and gentamicin at 7.5 mg / kg per day intravenously for 2 weeks.
Drug therapy in pregnant women is carried out with an ampicillin preparation of 2 g intravenously every 4 hours for 2 weeks and gentamicin 120 mg intravenously every 8 hours. Tetracycline drugs are contraindicated.
Prevention of Listeriosis in Children
The main measures for the prevention of listeriosis in children are to conduct sanitary-hygienic and veterinary-sanitary measures in areas where people live, for example, at farms or enterprises that process animal products. In such cases, it is necessary to heat-treat all meat and dairy dishes, keep the raw and finished products separate, and inspect the workers.
Pregnant women are suspended from work with animals and raw materials of animal origin. During pregnancy, a woman needs to thoroughly heat-treat raw vegetables, dairy and meat products.
Pregnant women and newborns who have undergone listeriosis should follow preventive measures and, after treatment, re-take an analysis to identify the pathogen.