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Supportive care with rest and hydration
0%
0/35
Blood and amniotic fluid cultures
40%
14/35
Vaginal and stool cultures
20%
7/35
Empiric ceftriaxone therapy
6%
2/35
Empiric ampicillin therapy
29%
10/35
Select Answer to see Preferred Response
The patient was most likely infected by consumption of Listeria monocytogenes in unpasteurized cheese or milk. Diagnosis of listeriosis can only be made through culture of sterile fluid such as blood, amniotic fluid, or spinal fluid. Listeriosis is 17 times more common in pregnant women compared to the general population. In most cases, maternal symptoms are mild and limited to constitutional symptoms such as fever and malaise. In contrast, the neonatal presentation is severe and fatal in 20 to 30% of cases. Common manifestations in the newborn include sepsis, pneumonia, meningitis, and a pathognomonic finding called granulomatous infantiseptica, which is characterized by widespread microabscesses and granulomas. Zolotor et al. provide an update on routine prenatal care. Foods that can be contaminated with Listeria monocytogenes include unpasteurized dairy products and soft cheeses, delicatessen foods, undercooked hot dogs and cold cuts, unwashed fruits and vegetables, and smoked seafoods. Kirkham and Berkowitz performed a survey of 827 practitioners regarding their knowledge of Listeriosis during pregnancy. They found that few (18%) of physicians were aware of the increased risk of listeriosis during pregnancy, and only 33% actively counseled their pregnant patients on the risk factors for Listeria monocytogenes infection. Figure A is an infant with granulomatous infantiseptica Incorrect Answers: Answer 1: A serious infection should be ruled out in this patient with further testing. Answer 3: Vaginal and fecal carriage is present in the general population, and culture of these sites is ineffective for diagnosis of listeriosis. Answer 4: Appropriate diagnostic cultures should be obtained prior to starting antibiotic therapy. Ceftriaxone is an ineffective antibiotic choice for Listeria monocytogenes. Answer 5: Ampicillin is a preferred antibiotic choice for listeriosis, but diagnostic cultures from appropriate sites should be obtained first.
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