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The Clinical and Laboratorial Characteristic of
Listeriosis in Children
Aizhan Begimkulova 1 *, Ayaulym Tolegenova 1, Kainar Bekmurat 1, Ibadulla Zhansaya 1
1 Department of Pediatric Infectious Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
ABSTRACT
Introduction: Listeriosis is an acute infectious disease caused by Listeria monocytogenes, and characterized by fever, general intoxication, polymorphism of clinical symptoms and signs, preferentially affecting lymphoid organs, the central nervous system and developing mononuclear reaction in peripheral blood. At the present time, the incidence of listeriosis in Kazakhstan is characterised by pronounced territorial inequality. There is a high activity of epizootic and epidemic processes of listeriosis in urban centers, as evidenced by the pronounced tendency of morbidity increase in high-urbanized regions with developed public catering network and centralized storage of agricultural commodities, high infection rate among people in urban areas. Methods: In the present paper we have analyzed medical records of 55 pediatric patients with listeriosis under the age from infants to 14 years, who were undergoing inpatient treatment in the Municipal Clinical Hospital for the Infectious Diseases of Children in Almaty, for the period between 2013 and 2015. The diagnosis was confirmed based on clinical and laboratory findings. Results: The listeriosis cases were confirmed by laboratory analyses using bacterial examination and serological test through passive hemagglutination test (PHAT) in conjunction with the method of enzyme-linked immunosorbent assay (high-titered IgG) or separately, as well as PCR was used. There were taken the following materials for culturing: blood, urine, feces, nasopharyngeal washings, and blood for PCR assay. Conclusion: Primary generalized listeriosis amounted to 36.4% (20 cases) among other forms of the disease in children. Proportion of patients with a severe form of listeriosis amounted to a half of the investigated patients 56.4% (31 cases). At the present time, the principal form of listeriosis in children remains single-agent infection 69.0% (38 cases). Polymorphism of listeriosis clinical manifestations make more difficult early diagnostics, thus, in more than a half of the cases 69.1% (38 cases) the patients were admitted to the hospital with erroneous diagnoses.
KEYWORDS
Communicable Diseases, Listeria Monocytogenes, Rodentia, Fever
How to cite this article: Begimkulova A, Tolegenova A, Bekmurat K, Ibadulla Zh. The Clinical and Laboratorial Characteristic of Listeriosis
in Children. Int Stud J Med. 2016; 2 (1): 31-37
INTRODUCTION
Listeriosis is an acute infectious disease caused by Listeria monocytogenes, and characterized by fever, general intoxication, polymorphism of clinical symptoms and signs, preferentially affecting lymphoid organs, the central nervous system and developing mononuclear reaction in peripheral blood [1].
At the present time, the incidence of listeriosis in Kazakhstan is characterised by pronounced territorial inequality. There is a high activity of epizootic and epidemic processes of listeriosis in urban centers, as evidenced by the pronounced tendency of morbidity increase in high-urbanized regions with developed public catering network and centralized storage
Recieved: 3 March 2016/ Accepted: 21 March 2016/ Published online: 31 March 2016
* Address for Correspondence: Aizhan Begimkulova, 160031 Pakhtakor-2 District, Quarter 194-891, Symkent, Kazakhstan. Tel.: +7-775-389-6169; Email: aijan.2793@ mail.ru
of agricultural commodities, high infection rate among people in urban areas [4]. According to the World Health Organization, the annual incidence of listeriosis in the world is from 2 to 3 cases per 1 million population. Listeria is equally distributed on all continents, in all countries, regardless of the environment and social well-being.
Various species of rodents serve as a source and reservoir of the infection. The infectious agent can be detected in wild and domestic animals. They shed Listeria with urine, feces, milk, nasal secretion[12].
Alimentary route is a most often channel ofinfection for humans, when they are eating Listeria-contaminated meat and dairy products, and drink infected water; the infection also can be transferred by airborne dust and through nonpercutaneous channel of infection (when contacting with infected animals), diaplacental and intrapartum routes (when the infectious matter is
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ingested with amniotic fluid). All population groups, especially children of early age, are amenable to listeriosis [2].
The disease occurrence is reported year-round, but its maximum falls on spring-and-summer period [3].
The Listeria's ability to develop into the L-form and parasitize intracellularly causes the listeriosis' tendency to lingering and chronic progression of the disease, possibility of latent forms and bacteria carrying[13,14]
METHODS
The aim of the research was to identify clinical and laboratory features of listeriosis in children from infants to 14 years in modern times.
In the present paper we have analyzed medical records of 55 pediatric patients with listeriosis under the age from infants to 14 years, who were undergoing inpatient treatment in the Municipal Clinical Hospital for the Infectious Diseases of Children in Almaty, for the period between 2013 and 2015. The diagnosis was confirmed based on clinical and laboratory findings. We investigated children by age, gender.
Age-dependent features: 1) 0-1 years: 6 children; 2) 1-3 years: 19 children; 3) 3-7 years: 11 children; 4) 7-14 years: 19 children. Gender-dependent features: 1) Girls: 27 children; 2) Boys: 25 children.
We conducted a statistical processing of Student's. Method for calculating the Student t-test. The listeri-osis cases were confirmed by laboratory analyses using bacterial examination and serological test through passive hemagglutination test (PHAT) in conjunction with the method of enzyme-linked immunosorbent assay (high-titered IgG) or separately, as well as PCR was used. There were taken the following materials for culturing: blood, urine, feces, nasopharyngeal washings, and blood for PCR assay.
In recent years, the problem of diseases caused by zoogenous infections remains in the spotlight not only for infectious disease physicians but for different medical specialists as well [5.6]. Based on current knowledge of the listeriosis clinical pattern, we may consider that there is no a pathognomonic symptom of this disease, which can definitely evidence this infection. A variety of clinical progression of zooge-nous infections is expressed in various forms and de-
grees of lesions in organs and systems, complications occurrence and different periods of convalescence [7], including listeriosis in children. Despite its prevalence and widespread increase in incidence, clinical and laboratory diagnostics of the concurrent infection (listeriosis + yersiniosis) in children pose the greatest difficulty for pre-admission diagnosing [8].
We conducted a statistical processing of Student's. Significant polymorphism of listeriosis clinical manifestations, polysystemic affect, similarities with other infectious and somatic diseases often make more difficult to determine a diagnosis. This increases the role of laboratory diagnosis. There were taken the following materials for culturing: blood, urine, feces, nasopharyngeal washings for zoogenous infections [10].
RESULTS
According to V. Timchenko classification (2001), listeriosis in our examined children from infants to 14 year was found in the following forms: primary generalized in 36.4% (20 cases), anginose in 14.5% (8 cases), oculoglandular in 1.8% (1 case), mononucle-osis-like in 3.6% (2 cases), gastrointestinal in 1.8% (1 cases), acute febrile in 1.8% (1 case), recrudescent in 5.5% (3 cases), secondary generalized in 1, 8% (1 case), chronic in 1.8% (1 case), and in the form of concurrent infection in 30.9% (17 cases). Out of all children there suffered from recurrent type of listeriosis 3 children.
DISCUSSION AND CONCLUSION
In the age-adjusted listeriosis incidence rate, frequency of the disease was reported in young and schoolage children in equal proportions 34.5% (19 cases), followed by frequency of the disease in children of preschool age 20.0% (11 cases), the least incidence rate was in infants, it was of 10.9% (6 cases).
There were no gender-dependent difference in listeriosis incidence rate: 51.92% (27 cases) in girls and 48.0% (25 cases) in boys. The listeriosis cases was reported year-round, but the incidence maximum coincided with spring and summer seasons (in April and May it was of 21.82% (12 cases) in each month). The listeriosis incidence rate was 69.0% (38 cases) as a single-agent infection, 30.9% (17 cases) as a concurrent infection, and in 23.6%(13) of these cases it was listeriosis in combination with Yersiniosis. There have not been found any differences in
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Fig. 1. The occurrence of age-related features of the studied children
Fig. 2. Sex differences in the incidence of listeriosis
21,82% 21,82%
1,82%
January Februry March April May June July September
25,00%
20.00%
15.00%
10.00%
5.00%
0.00%
Fig. 3. Dependence of clinical manifestations of listeriosis from season 33 http://isjm.kaznmu.kz/ 2016 | No 1 | VOLUME 2 | ISJM
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Fig. 5. The incidence of listeriosis severe and moderate forms
Fig. 6. The frequency of the studied children poliadenopathy ISJM | VOLUME 2 | No 1 | 2016 http://isjm.kaznmu.kz/ 34
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incidence of severe and moderate forms of listeriosis: in 56.36% (31 cases) it was severe, in 43.64% (24 cases) moderate. Fever is still the guiding infectious pathology syndrome of childhood 81.82% (45 cases) . In 100% of patients the disease was of acute onset with the body temperature rise, and in 23.6% (13 cases) of the children it was above 39.0 C [16].
Symptoms of general intoxication of varying intensities occurred in 100% of the children and were observed in the setting of hyperthermia, and they were disappearing with the body temperature recovery.
Exanthema appeared in 27.2% (15 cases) of the patients: in 5.4% (3 cases) of the cases it was papular rash, non-confluent and truncal predominance, less often facial; in 21.8% (12 cases) it was punctate rash spreading all over the body, often on the upper extremities.
Since the first day of the disease, lymph nodes were involved in the pathologic process. Polyadenopathy was reported in 63.6% (35 cases) of the patients, local lymph nodes enlargement in 20% (11 cases) of the pediatric patients. There were no gross pathological changes in the enlarged lymph nodes; generalised reaction in all groups of peripheral lymph nodes can be considered as a common infectious-allergic reaction.
The respiratory system impairment was in the form of dry cough in 25.4% (14 cases) of the children, and purulent angina in 10.9% (6 cases). Oropharyngeal hyperemia was reported in 94.5% (52 cases) of the cases [17]. In the middle of the disease, the liver and spleen were involved in the pathologic process. The most common clinical signs of liver involvement were its moderate enlargement and induration. Hepatomegaly was reported in 14.5% (8 cases) of the children, splenomegaly in 3.64% (2 cases). Blood chemistry test has shown hyperbilirubinemia with two-threefold transaminase level increase (ALT, AST) in 29.4% (10 cases) of the patients. The gastrointestinal tract involvement in the form of vomiting was reported in 30.9% (17 cases) of the cases, loose stool in 18.1% (10 cases) [15,18].
Pronounced inflammatory changes in haemogramma were observed in 54.5% (30 cases) of the children, and in 45.4% (25 cases) it was characterized by leukocytosis, in 63.3% (19 cases) of the patients by neutrocytosis with stab neutrophile left deviation,
in 23.6% (13 cases) of the children erythrocyte sedimentation rate was increased to more than 30 mm/hour (in 7.3% (4 cases) of them it was up to 67 mm/hour). Lymphocytosis was reported in 35.0% (14 cases) of the children [9].
In our studies the disease in the form of concurrent infection (listeriosis + yersiniosis) was diagnosed in 23.6% (13 cases) of the children, and this was likely reason for neutrocytosis shown in haemogramma more frequent than lymphocytosis, which is more typical for listeriosis.
Studying epidemiological anamnesis revealed that 81.8% (45 cases) of the children had been in constant contact with pets (cats, dogs), 72.7% (40 cases) of the patients live in separate houses, where there are small rodents (mice, rats) [21].
Conclusions
1. Primary generalized listeriosis was the most frequently observed form of the disease 36.4% (20 cases);
2. Proportion of patients with a severe form of listeriosis amounted to a half of the investigated patients 56.4% (31 cases);
3. The most common symptoms of listeriosis in children were oropharyngeal impairments 94.5% (52 cases), fever 81.8% (45 cases), polyadenopathy 63.6% (35 cases), catarrhal symptoms 45.4% (25 cases);
4. At the present time, the principal form of listeriosis in children remains single-agent infection 69.0% (38 cases).
5. Polymorphism of listeriosis clinical manifestations make more difficult early diagnostics, thus, in more than a half of the cases 69.1% (38 cases) the patients were admitted to the hospital with erroneous diagnoses.
ACKNOLEDGEMENTS
The authors thank Gulnar Onalbayeva, PhD, Associate Professor of the Department of Childhood Infections, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan, for support and help with the paper.
CONFLICT OF INTEREST
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The authors confirm that this article content has no conflicts of interest.
AUTHOR CONTRIBUTION
All authors contributed to the study design. interpretation of the literature data. and the manuscript drafting. All authors read and approved the final version of the manuscript for publication. Research was supported by ISTC №2B1636 and mHH №21.2.42.
ORCID
Aizhan Begimkulova http://orcid.org/0000-0002-8969-3944
Ayaulym Tolegenova http://orcid.org/0000-0002-4813-1398
Kainar Bekmurat http://orcid.org/0000-0001-5731-3241
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