Causes of fever in pregnant women with acute undifferentiated fever: a prospective multicentric study

Perinatal Infection with Listeria monocytogenes: A 10-Year Hospital-Based Study in Western China

Objective

Listeriosis is a rare but severe foodborne disease that is contracted by the consumption of food contaminated with Listeria, and perinatal listeriosis can cause major adverse pregnancy outcomes. In the current study, we sought to retrospectively analyze 10 years of perinatal outcomes due to listeriosis in western China.

Methods

Based on the isolation of Listeria monocytogenes (L. monocytogenes), we retrospectively reviewed the pregnancy-associated cases of listeriosis from June 2010 to February 2022 at our hospital. We investigated the crude incidence, clinical manifestations, perinatal management, and outcomes of perinatal listeriosis cases.

Results

We diagnosed a total of 28 cases of perinatal listeriosis during the study period at our hospital, including four cases of twin pregnancies. Of the 28 cases, 32.14% (9/28) were infected in the second trimester and 67.86% (19/28) in the third trimester. The fetal or neonatal mortality rate for perinatal listeriosis was high, with a crude fetal mortality rate of 46.88% (15/32) in the 32 offspring and a neonatal mortality rate of 47.06% (8/17) in the 17 live births.

Conclusion

Perinatal listeriosis exhibits high fetal or neonatal mortality. We recommend that appropriate antibiotics be administered in cases of perinatal listeriosis.

Altered serum human cytomegalovirus microRNA levels are common and closely associated with the inflammatory status in patients with fever

Background

Fever has a complicated etiology, and diagnosing its causative factor is clinically challenging. Human cytomegalovirus (HCMV) infection causes various diseases. However, the clinical relevance, prevalence, and significance of HCMV microRNAs (miRNA) in association with fever remain unclear. In the present study, we analyzed the HCMV miRNA expression pattern in the serum of patients with fever and evaluate its clinical associations with occult HCMV infection status in immune disorders.

Methods

We included serum samples from 138 patients with fever and 151 age-gender-matched controls in this study. First, the serum levels of 24 HCMV miRNAs were determined using a hydrolysis probe-based stem-loop quantitative reverse transcription polymerase chain reaction (RT-qPCR) assay in the training set. The markedly altered miRNAs were verified in the validation and testing sets. The serum HCMV IgG/IgM and DNA titers in the testing cohort were also assessed using enzyme-linked immunosorbent assay (ELISA) and RT-qPCR, respectively.

Results

The majority of HCMV miRNAs were markedly upregulated in the serum of fever patients. We selected the five most significantly altered HCMV miRNAs: hcmv-miR-US4-3p, hcmv-miR-US29-3p, hcmv-miR-US5-2-3p, hcmv-miR-UL112-3p, and hcmv-miR-US33-3p for validation. These miRNAs were also significantly elevated in the serum of fever patients in the validation and testing sets compared with the controls. Logistic regression analysis revealed that the five miRNAs were novel potential risk factors for fever. Notably, the serum levels of four of the five confirmed HCMV miRNAs were significantly associated with blood C-reaction protein concentrations. Moreover, the five HCMV miRNA levels were closely correlated with the HCMV DNA titers in the testing cohort.

Conclusion

HCMV infection and activation are common in fever patients and could be novel risk factors for fever. These differentially expressed HCMV miRNAs could enable HCMV activation status monitoring in immune disorders.

Causes and consequences of fever during pregnancy: A retrospective study in a gynaecological emergency department

OBJECTIVE

Fever is a very common reason for emergency consultation during pregnancy, and may be associated with maternal, obstetrical and/or fetal adverse outcomes. The aim of this study was to determine the etiologies and to analyze the maternal or fetal complications of fever in pregnancy.

STUDY DESIGN

A retrospective single center study including all patients who consulted for fever above 38 °C during pregnancy in the gynecological emergency ward from August 2016 to July 2017.

RESULTS

A total of 100 pregnant women who consulted for fever were included. The etiologies were common viral infections (37 %), influenza (21 %), pyelonephritis (11 %), viral gastroenteritis (6%), chorioamnionitis (5%), other (5%). The etiology was unknown for 15 %. Fever was confirmed during consultation in 45/100 patients (45 %). Among patients with confirmed fever, 21/45 (47 %) were hospitalized with a median stay of 3 days [IQR 2-4] and 10/45(22 %) developed fetal or maternal complications. Probabilistic antibiotics were delivered for 34/45, 76 % patients. Only 14/45, 31 % had confirmed bacterial infections. Of the 32 patients with confirmed fever who had no etiologic diagnosis at the initial work-up in the emergency room, 19/32, 59 % received presumptive treatment with amoxicillin against Listeria monocytogenes. None had confirmed listeriosis, and all were probably common viral infections. Among all patients, the complications rate was 13 % and 22 % in the subgroup with fever confirmed at presentation.

CONCLUSIONS

This study quantifies the main etiologies and complications of fever during pregnancy. A challenge is to reduce excessive antibiotic use by improving rapid diagnosis of bacterial and viral infections. Prospective studies are needed to target patients at risk of complications in an optimal way and to study new management strategies.