Listeria monocytogenes: generalised maculopapular rash may be the clue
- Department of Pediatrics, Division of Neonatology, Palma de Mallorca, Baleares, Spain, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, Spain
- Correspondence to Ignacio Benitez-Segura. Ctra. de Valldemossa, 79 07010 Palma de Mallorca, Baleares, Spain;
- Received 24 January 2012
- Accepted 17 February 2012
- Published Online First 23 March 2012
Early-onset sepsis is an important cause of morbidity and mortality among newborn infants and one of the causative organisms can be Listeria monocytogenes. Occasionally, it may be suspected from physical findings. This 1996 g female infant was born at 33 weeks gestation by caesarean section for premature labour with chorioamnionitis and fetal distress. She responded to resuscitation with Apgar scores of 6 and 7 at 1 and 5 min, respectively. She was admitted to the Neonatal Intensive Care Unit where she required ventilation. Physical examination revealed a generalised maculopapular rash, respiratory distress and abdominal distension with hepatomegaly. Owing to the suspicion of L monocytogenes infection, she was treated with high-dose intravenous ampicillin, gentamicin and cefotaxime. She needed fluid resuscitation, high-dose pressors, steroids, blood component transfusions and nitric oxide for septic shock. Maternal intrapartum antibiotics had been administered, so blood culture was sterile. Placental and peripheral cultures (ear, conjunctival, umbilical swab and gastric content) were positive for L monocytogenes. Cerebrospinal fluid was sterile but showed significant pleocytosis and she developed subtle seizure. Ampicillin and gentamicin were continued for 21 days. A CT scan showed small cerebellar abscess not needing specific treatment. As shown in figure 1, a generalised maculopapular rash may appear in neonatal L monocytogenes infection. When present, it is a signal to provide early and appropriate antibiotic treatment.1,–,4 The patient was discharged on day 32, and is normal at follow-up 3 years later.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.