Listeriosis: Two Reported Cases From Iran

Listeria monocytogenes, a gram-positive bacillus growing in 4˚c, is a ubiquitous pathogen with food-borne transmission, mostly. Listeriosis is an uncommon disease in a healthy immunocompetent individual, whereas two thirds of listeriosis cases have occurred in immunocompromised persons in whom it causes high mortality rate. The rest of listeriasis cases (1/3) have been seen in pregnant women in whom it causes high fatality rate due to abortion, full-term stillbirth or neonatal infections. Although listeriosis is increasingly recognized as a cause of life-threatening disease, there are certain countries (particularly Asian countries) that have reported only a few cases or have failed to report even a single case. Because of the absence of a perfect study or even a few reported cases of listeriosis in Iran, it was decided to report two cases of perinatal and nonperinatal infections with listeria monocytogenes. The first patient was a 63-year-old woman with diabetes mellitus. She was a known case of idiopathic myelofibrosis from 10 years ago who was hospitalized because of fever and chill. At first she was diagnosed with myocardial infarction, due to elevation of cardiac enzymes(CPK, CPK-MB, Troponin T) and ST segment depression in EKG, but finally, on the 4th day of admission, the patient became lethargic and had respiratory distress, pulmonary edema, loss of conciousness and blood pressure depression. On the 5th day, she expired because of respiratory and cardiac arrest. The blood cultures of her were positive for listeria monocytogenes for two times. The second patient was a 30-year-old woman at the 20th week of gestation. She was a known case of systemic lupus erythematosus(SLE), under treatment of corticosteroid, who was admitted for fever. After two days, doctors terminated the pregnancy for her because of fetal heart rate decrease. Then, the fever was reduced and finally the patient was discharged from hospital with good condition. Listeria monocytogenes was isolated three times from patient’s blood cultures.