Listeriosis in children

Listeriosis (leaf larynosis) - an acute infectious disease caused by Listeria monocytogenes, is accompanied by fever, symptoms of intoxication, frequent involvement of lymphoid formations of the pharyngeal ring, CNS, liver and spleen.

The disease often proceeds according to the type of prolonged, often chronic sepsis.

ICD-10 code

• A32.0 Cutaneous listeriosis.
• A32.1 Listeriogenic meningitis and meningoencephalitis.
• A32.7 Listeriosis septicemia.
• A32.8 Other forms of listeriosis (cerebral arthritis, endocarditis, oculoglandular listeriosis).
• A32.9 Listeriosis, unspecified.

Epidemiology of listeriosis in children

The main reservoir of infection in nature are rodents (field mouse, rats, jerboa, rabbits, rabbits, etc.). Pathogens are often found in raccoons, deer, wild boars, foxes, as well as in domestic animals: pigs, goats, cows, sheep, cats, chickens, ducks, etc. Given the source of infection, listeriosis can be attributed to typical zoonotic infections. Infection of a person often occurs through the digestive tract with the use of insufficiently thermally processed infected meat and dairy products. Often a person becomes infected through infected water. It is possible to transmit the infection with airborne dust, as well as contact in caring for sick animals. In children's practice, it is more often necessary to observe cases of intrauterine infection of the fetus from a mother, a patient with listeriosis or a carrier of listeria. Incidence is recorded year-round, but its maximum is in spring and summer. There are sporadic cases, but epidemiological outbreaks are possible among children, mainly in rural areas. All groups of the population are susceptible to listeriosis, but especially children of the first years of life, who often develop severe septic forms of the disease.

[1], [2], [3], [4], [5], [6],

The causes of listeriosis in children

The causative agent of Listeria monocytogenes belongs to the family of corynebacteria, it has the appearance of small polymorphic rods 0.5-2 μm long and 0.4-0.5 μm thick; Gram-positive, do not form a spore. There are 7 serovars and several subtypes. When the microbial cell disintegrates, endotoxin is released.

Pathogenesis of listeriosis

The entrance gates of the infection are the pharyngeal ring, the gastrointestinal tract, the conjunctiva of the eyes, the respiratory system, the damaged skin. From the sites of introduction of listeria by lymphogenous pathway enter the regional lymph nodes, and then hematogenously enter into the parenchymal organs, as well as in the central nervous system. The development of the pathological process essentially depends on the site of penetration of the pathogen.

• With the penetration of the pathogen through the pharyngeal ring, an anginous form occurs, in which the primary accumulation of the pathogen occurs in the lymphoid formations of the pharynx followed by the generalization of the infection and the possible formation of septic lesions.
• When the pathogen penetrates the digestive tract, the accumulation of listeria occurs in Peyer's patches and solitary follicles. Such patients usually develop a typhoid form of the disease.
• In the case of penetration of listeria through the conjunctiva of the eye, it is most likely the development of an eye-glandular shape.
• With transplacental infection, the process usually becomes generalized with the defeat of many organs, primarily the liver and the central nervous system.

Symptoms of listeriosis in children

Anginous form is manifested by catarrhal, ulcerative necrotic or pleural angina. Regional lymph nodes are enlarged and painful. Sometimes there is an increase in other groups of lymph nodes: cervical, axillary. The liver and spleen are enlarged. At the height of the disease, a polymorphic rash may appear. In the blood, leukocytosis is noted, monocytosis: ESR is increased. In severe cases, it is possible to develop sepsis, meningitis or meningoencephalitis. Listeriosis endocarditis, osteomyelitis, etc. Are described. It is especially difficult to differentiate the angiogenic form of the disease with infectious mononucleosis.

The eye-glandular shape occurs when the pathogen penetrates the conjunctiva of the eye. The eyelids of the affected eye are swollen, compacted, the eye gap narrowed. In the corners of the eye purulent discharge. On the hyperemia edema conjunctiva, especially in the region of the infiltrated transitional fold, bright follicles are seen-nodules-granulomas. The process does not spread to the cornea. Parotid, often submandibular, cervical, sometimes occipital lymph nodes are enlarged and painful.

The typhoid form is manifested by prolonged fever, enlargement of the liver and spleen, skin rashes. Often there is a phenomenon of parenchymal hepatitis with jaundice, darkening of urine and discoloration of feces. Possible phenomena of polyserositis with pericarditis and pleurisy. The process may involve lungs, gastrointestinal tract, central nervous system. In the blood, anemia, thrombocytopenia, a decrease in coagulation are possible, which may result in bleeding. Usually such forms occur in weakened children, as well as in newborns and children of the first year of life. Changes in throat with typhoid form are not characteristic. The disease is severe and may end up lethal.

The nervous form is manifested by meningitis, encephalitis or meningoencephalitis. With spinal puncture in the early stages of the disease, the fluid is clear, flows under increased pressure, it exhibits an increased protein content, a small pleocytosis due to both lymphocytes and neutrophils. At the height of the disease, the cerebrospinal fluid becomes turbid, with high protein content and neutrophilic cytosis. Possible residual effects in the form of mental disorders, memory impairment, persistent paresis, paralysis of individual muscle groups up to a long-lasting polyradiculoneuritis.

Congenital Listeriosis

On the skin of the newborn, there are nodular eruptions or papular, rosaolous, less often hemorrhagic rash, similar to rashes in meningococcemia. Similar rashes are found in the throat, especially on the tonsils. Sometimes there are ulcers on the mucous membranes of the mouth. The general condition of children is severe, they note disorders of breathing and blood circulation. There are phenomena of enterocolitis. As a rule, the liver and spleen are enlarged. Often there is jaundice.

[7], [8], [9], [10], [11],

Classification of listeriosis

The incubation period for listeriosis is from 3 to 45 days. Isolate anginous, typhoid, glazo-glandular, nervous clinical forms and congenital listeriosis. There are also atypical forms: erased, subclinical, influenza-like, etc.

[12], [13]

Diagnosis of listeriosis in children

For the diagnosis of congenital listeriosis, the data of anamnesis (miscarriages, stillbirths, miscarriages) and the fact of the birth of a child with signs of intrauterine infection (hypotrophy, adynamia, hypotension, dyspnoea, cyanosis attacks, enlargement of the liver and spleen, skin and mucous membrane rash, convulsions, etc. .).

To suspect listeriosis in older children is possible by the defeat of pharynx (necrotic-ulcerative or membranous angina) with a prolonged course and a mononuclear shift in the blood, and also with the appearance of an eye-glandular shape. Of decisive importance are PCR and ELISA. In addition, RPHA is used. RSK, RA. Specific antibodies in the blood begin to appear for 2 weeks of the disease. Diagnostic value has an increase in the titer of antibodies in the dynamics of the disease.

[14], [15], [16], [17]

Differential diagnostics

It should be differentiated:

• congenital listeriosis - with congenital cytomegaly, toxoplasmosis, syphilis, staphylococcal sepsis, hemolytic disease of the newborn, intracranial trauma;
• anginal form - with glandular form of tularemia, diphtheria, agranulocyte angina, infectious mononucleosis:
• typhoid form - with typhoid fever, sepsis, pseudotuberculosis;
• nervous form - with meningitis and encephalitis of another etiology.

[18], [19], [20], [21], [22],

Treatment of listeriosis in children

As an etiotropic therapy, antibiotics are prescribed: levomycetin, erythromycin, ampicillin, cephalosporins in the age-appropriate dose throughout the febrile period and another 3-5 days at normal body temperature.

In severe forms with damage to the nervous system, liver and other visceral organs, the appointment of glucocorticoids is calculated from the calculation of 1-2 mg / kg per day for prednisolone for 7-10 days.

For the purpose of dehydration, intravenous infusions are made with a 1.5% solution of reamberin / rheopolyglucin, polyglucin, 10% glucose solution, etc. Prescribed are desensitizing and symptomatic agents, probiotics (acipol, bifidumbacterin, etc.).

Prevention of listeriosis in children

Specific prophylaxis is not developed. Of decisive importance are strict adherence to the rules of personal hygiene in the care of animals, control of food, milk consumption only after boiling, especially in places unfavorable for listeriosis. It is necessary to destroy stray dogs, cats, fight with brown rodents. For the prevention of congenital listeriosis, all pregnant women with an adverse obstetric anamnesis should be examined for listeriosis. If found in them, listeria is treated with an antibiotic in combination with sulfanilamides for 7 days.