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妊娠期李斯特菌病18例临床分析

Clinical analysis of 18 cases of listeriosis during pregnancy
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摘要 目的探讨妊娠期李斯特菌病患者的临床及实验室特征,以提高对该疾病的认识。方法回顾性分析2012—2023年山西某两所医院收治的18例妊娠期李斯特菌病孕妇的临床特征及实验室检测结果。结果18例妊娠期李斯特菌病孕妇发病时间为孕早期1例,孕中期3例,孕晚期14例(其中2例为双胎,均为双绒毛膜双羊膜囊);临床表现主要为发热(17例,94.44%),同时伴阴道流血(5例,27.78%)、腹痛(4例,22.22%)、头痛(2例,11.11%)等;孕妇外周血白细胞计数、中性粒细胞百分比及降钙素原均升高;1例孕早期胎儿自然流产,3例孕中期胎儿全部死亡,16例孕晚期胎儿存活10例;所有孕妇均康复出院。单核细胞增生李斯特菌(LM)分离率较高的标本为孕妇宫腔分泌物(11例,61.11%)、全血(10例,55.55%),18例孕妇生产的17例新生儿中,4例(23.53%)咽部气管分泌物标本和3例(17.65%)全血标本分离出LM。13例胎盘经病理检查发现绒毛膜羊膜炎者10例。15株LM药敏试验结果显示,对氨苄西林、复方磺胺甲口恶唑和美罗培南的敏感率均为100%,对青霉素和红霉素的敏感率均为93.33%。结论妊娠期李斯特菌病临床特征缺乏特异性,易漏诊,不良妊娠结局发生率较高,妊娠晚期胎儿存活率高,妊娠早期经验性抗感染治疗应覆盖LM感染。 Objective To evaluate the clinical and laboratory characteristics of listeriosis in patients during pregnancy,and improve the understanding on the disease.Methods Clinical characteristics and laboratory detection results of 18 pregnant women with gestational listeriosis admitted to two hospitals in Shanxi from 2012 to 2023 were analyzed retrospectively.Results Among the 18 pregnant women,1,3 and 14 cases developed listeriosis in the early,middle and late pregnancy,respectively(including 2 cases of dichorionic diamniotic twin pregnancy).The main clinical manifestations were fever(n=17,94.44%),accompanied by vaginal bleeding(n=5,27.78%),abdominal pain(n=4,22.22%),and headache(n=2,11.11%).White blood cell count,neutrophil percentage,and procalcitonin level in peripheral blood of pregnant women all increased.There were 1 spontaneous abortion during early pregnancy,3 deaths during middle pregnancy,and 10 survival during late pregnancy.All pregnant women reco-vered and were discharged from hospital.Specimens with high isolation rate of Listeria monocytogenes(LM)were uterine secretion(n=11,61.11%)and whole blood(n=10,55.55%)of pregnancy women.Among the 17 newborns of 18 pregnant women,LM was isolated from 4(23.53%)pharyngeal tracheal secretion specimens and 3(17.65%)whole blood specimens.10 cases out of 13 revealed chorioamnionitis via pathology examination of placenta.Antimicrobial susceptibility testing results of 15 LM strains showed that the susceptibility rates to ampicillin,compound sulfamethoxazole,and meropenem were all 100%,and the susceptibility rates to penicillin and erythromycin were both 93.33%.Conclusion Listeriosis during pregnancy lacks specific clinical characteristics and is prone to be misdiagnosed.The incidence of adverse pregnancy outcomes is high.The survival rate of fetus in late pregnancy is high.Empirical anti-infection treatment during early pregnancy should cover LM infection.
作者 胡敏 王芳 张怡舜 韩方 张晓慧 周双艳 李浩 HU Min;WANG Fang;ZHANG Yi-shun;HAN Fang;ZHANG Xiao-hui;ZHOU Shuang-yan;LI Hao(Department of Laboratory Medicine,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Obstetrics,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Obstetrics and Gyneco-logy,The Second Affiliated Hospital of Xiamen Medical College,Xiamen 361021,China;Department of Laboratory Medicine,Shanxi Bethune Hospital,Tongji Shanxi Hospital,Taiyuan 030032,China)
出处 《中国感染控制杂志》 CAS CSCD 北大核心 2024年第6期706-711,共6页 Chinese Journal of Infection Control
基金 山西省卫生计生委科研课题(2018GW33)。
关键词 单核细胞增生李斯特菌 妊娠期李斯特菌病 临床症状 妊娠结局 Listeria monocytogenes listeriosis during pregnancy clinical symptom pregnancy outcome
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