Pathological characteristics of listeria monocytogenes infection in the placenta during mid-pregnancy
10.3760/cma.j.cn113903-20231110-00315
- VernacularTitle:妊娠中期胎盘单核细胞增生李斯特菌感染的胎盘病理特征
- Author:
Xia LI
1
;
Shudong YANG
;
Lu WANG
;
Rong GAO
;
Bingqing ZOU
Author Information
1. 南京医科大学附属无锡人民医院（南京医科大学无锡医学中心、无锡市人民医院）病理科，无锡 214023
- Publication Type:Journal Article
- Keywords:
Listeriosis;
Chorioamnionitis;
Sepsis;
Pregnancy Trimester, Second
- From:
Chinese Journal of Perinatal Medicine
2024;27(12):1059-1062
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the pathological characteristics of listeria monocytogenes infection in the placenta during mid-pregnancy. Methods:A retrospective review was conducted on the clinical and placental pathological examination data of a patient admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University in October 2022, who experienced intrauterine fetal death and maternal sepsis due to listeria monocytogenes infection. Results:(1) Clinical data: The 25-year-old patient had 22 weeks of amenorrhea and was admitted to the hospital for 2 days of fever and 1 day of intrauterine fetal death. The patient had a dietary habit of consuming raw seafood. Upon admission, a large amount of purulent vaginal discharge was observed, and obstetric ultrasound indicated the disappearance of fetal heart sounds. The following day, a cesarean section was performed. A female stillborn fetus weighing 470 g was delivered, which had a distended abdomen with no other malformations. Postoperatively, the patient continued anti-infective treatment for one week and was discharged after correction of infectious shock. She continued to take oral anti-infective drugs for one week after discharge. At 10 months postpartum outpatient follow-up and 18 months postpartum telephone follow-up, the patient recovered satisfactorily, reported no discomfort, and was preparing for pregnancy. (2) Placental examination: The placental surface was covered with grayish-white areas ranging from the size of a needle tip to about 2 cm in diameter. Edema of the umbilical cord was observed. Various-sized abscesses were seen in the placental parenchyma, involving several villi, with many neutrophil infiltrations. There were many acute inflammatory cell infiltrations in the chorionic villous space with abscess formation, acute chorioamnionitis, and infarcts visible in the surrounding chorionic villi. Acute inflammation of the local chorionic interstitial blood vessels with thickening of the blood vessel wall was observed. Many neutrophils were seen in the amniotic membrane-chorioamnionic membrane gap, with a stage 3, level 2 maternal inflammatory response. Cord umbilical venous inflammation was noted, with no inflammatory cell infiltration of arteries. Wharton jelly edema was seen, with neutrophil infiltration in the interstitium. (3) Microbiological examination: Blood, vaginal secretion, uterine secretion, abdominal secretion, and placental bacterial cultures all showed listeria monocytogenes. Mass spectrometer bacterial identification confirmed listeria monocytogenes infection. After silver staining of the placenta, microorganisms were seen in the center of the abscess and in the amniotic epithelial cells. (4) Pathologic diagnosis showed placental acute chorioamnionitis with maternal inflammatory response stage 3 grade 2, accompanied by umbilical cord phlebitis and fetal inflammatory response stage 1 grade 1, acute intervillositis with abscess formation, and acute villositis with abscess formation. Combined with clinical presentation, this is consistent with listeria monocytogenes infection. Conclusion:The pathological characteristics of listeria monocytogenes infection in the placenta include various-sized abscesses in the placenta involving multiple villi and chorionic interstitial spaces, thickening of the interstitial vascular wall of the chorionic villi, and chorioamnionitis with umbilical cord phlebitis.
