15.06.2014

Pregnant women exposed to flu

The following recommendations provide guidance for the management of pregnant women with presumptive exposure to listeria in three clinical scenarios: women who are 1) asymptomatic, 2) mildly symptomatic but afebrile, and 3) febrile with or without other symptoms of listeriosis (see Fig.
No testing, including blood and stool cultures, or treatment is indicated for an asymptomatic pregnant woman who reports consumption of a product that was recalled or implicated during an outbreak of listeria contamination. There are no data to guide the management of an exposed, afebrile pregnant woman with mild symptoms that do not strongly suggest listeriosis.
Initiating a program of fetal surveillance seems prudent for women in whom listeriosis is diagnosed or strongly suspected because of exposure and fever with or without other symptoms, although studies and data do not exist to point to one best plan for such testing. However, the incidence of listeriosis associated with pregnancy is approximately 13 times higher than in the general population (8). When it is symptomatic, infection generally presents as a nonspecific, flu-like illness with fever, myalgia, backache, and headache, often preceded by diarrhea or other gastrointestinal symptoms (9, 11). A pregnant woman who ate a product that was recalled because of listeria contamination and who is afebrile but has signs and symptoms consistent with a minor gastrointestinal or flu-like illness (such as mild myalgia, mild nausea, vomiting, or diarrhea) can be managed expectantly (ie, the same as for an exposed, asymptomatic pregnant woman). Pregnant women are about 13 times more likely than the general population to get listeriosis (8). The incidence of listeriosis associated with pregnancy is approximately 13 times higher than in the general population.


Invasive listeriosis, defined as isolation of listeria from a normally sterile site (typically blood or cerebrospinal fluid), is uncommon. Although recommendations exist for treating pregnant women with listeriosis (10, 13, 14), few guidelines exist for management of cases of possible exposure in pregnancy.
There is no reason to alter or begin fetal surveillance in asymptomatic women with known or presumptive exposure to listeria.
Maternal infection may manifest as a nonspecific, flu-like illness with fever but can result in severe fetal and neonatal infection, leading to fetal loss, preterm labor, neonatal sepsis, meningitis, and death. Maternal infection may present as a nonspecific, flu-like illness with fever, myalgia, backache, and headache, often preceded by diarrhea or other gastrointestinal symptoms. Although there are no prospective data to guide recommendations for the care of pregnant women with known or presumptive exposure to listeria, outbreak-related cases of listeriosis have highlighted the need for such guidance.
Nearly all pregnancy-associated cases of listeriosis occur in otherwise healthy women with no additional predisposing risk factors (9). A case series of 11 pregnant women with listeriosis and an accompanying review of 222 cases in the literature found that approximately one in five pregnancies complicated by listeriosis resulted in spontaneous abortion or stillbirth; approximately two thirds of surviving infants developed clinical neonatal listeriosis (9). Women who are allergic to penicillin, ampicillin, or both present a clinical conundrum; trimethoprim with sulfamethoxazole is the generally recommended alternative to ampicillin (14).


Pregnant women should be advised to avoid foods with a high risk of contamination with listeria (see Box 1).
This Committee Opinion provides background information on listeriosis in pregnancy as well as management recommendations, largely based on expert opinion, for known or suspected cases of listeriosis in pregnancy that are associated with outbreaks and product recalls. Management recommendations for cases of known or suspected listeria exposure during pregnancy, such as those associated with an outbreak or product recall, are summarized in Figure 1. Pregnant women have been advised to avoid foods with a high risk of contamination with listeria.
A pregnant woman who ate a product that was recalled because of listeria contamination and who is afebrile but has signs and symptoms consistent with a minor gastrointestinal or flu-like illness can be managed expectantly.



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