5 Babies Succumb to Rare Disease at UCI Hospital
The neonatologists at UCI Medical Center in Orange thought they had an epidemic on their hands.
Three babies were stillborn because of a rare infection of Listeria monocytogenes. Four more were born with it, and two of those babies died--one minutes after birth, the other just 10 hours after the infection was diagnosed.
“Despite everything we could do, the baby died. It was horrible,” said neonatologist Jack Sills.
An eighth UCI case involved a baby born at County-USC Medical Center in Los Angeles and diagnosed as having the same bacterial infection, then transferred to UCI’s neonatal intensive care unit.
Usually, the neonatal unit sees only one or two cases a year of infection caused by the bacteria said Sills, an assistant professor of pediatrics. Suddenly, within two months, the doctors had seen eight.
“We were starting to see it so much we thought maybe it was an epidemic. We thought maybe it was the new organism of the ‘80s,” Sills said.
Although he could not recall the exact chronology of cases, Sills said there was a growing sense of alarm among the neonatologists, specialists in the care of critically ill newborn babies.
After the third case, he said, “we recognized this was unusual.” Soon after that--on April 23--the neonatal unit received the baby from County-USC, and it was as if a red flag had been waved, he said.
“Not until we got the transfer did we start putting things together,” Sills said, for doctors then realized they were dealing with a regionwide problem. The time had come to notify the county health departments.
The disease, Listeriosis, is fairly innocuous in adults, producing mild flulike symptoms, Sills said. But the organism is carried in the blood, and in the case of a pregnant woman, it automatically infects the placenta, which provides nutrients to the fetus. The baby will get sick, often severely enough to die in the uterus, he said.
Symptons of Infection
Babies suffer symptoms of an infection--respiratory problems, lethargy, poor mobility, rash, lack of interest in feeding and sometimes blood irregularities, Sills said.
But the disease must be diagnosed immediately and treated with antibiotics, he said.
“If you wait, if you’re not quick enough, even an hour can make a difference, the mortality rate can be 80 to 90%,” Sills said.
One baby born with it at the hospital “died a few minutes after birth,” he said.
Another was in the hospital’s nursery and appeared healthy when the baby suddenly turned ill, he said. The baby was 20 hours old when it was transferred to the neonatal unit and a diagnosis was quickly made, Sills said. But the baby was dead 10 hours later.
Even babies who appear healthy and go home can develop the disease two or three weeks later. The source could be the mother, who may still be carrying the bacteria, he said. Or, he said, the bacteria could be present in the house, or the infant could have been a carrier all along. With the older infants, the organism can bring on pneumonia, or it can cause spinal meningitis, he said.
All seven mothers who gave birth to the infected infants had had fevers, “and when we cultured their cervix or stool, the organism was there,” Sills said. All seven were Latino, and none of them died, he said.
The mothers of the stillborn babies had the disease early in their pregnancy, he said.
The disease is easily detected in the infants by growing bacterial cultures, he said. In addition, doctors examine the placentas of all babies who enter the neonatal unit, he said. Infected placentas have “microabscesses,” little pockets of pus, he said.
The baby transferred from County-USC, which was overcrowded, originally went to the neonatal unit at Childrens Hospital of Orange County, in the City of Orange. The baby was later moved to the UCI Medical Center because it was failing and needed the university’s experimental high-frequency ventilator, Sills said. The baby survived and was eventually transferred back to County-USC, he said.
Sills said he did not know whether all the mothers had eaten the Jalisco type cheese that is being blamed for the outbreak. Responsibility for tracing the source of the infection, he said, falls to the epidemiologists at the county health department.
Sills said the Listeria monocytogenes bacteria are commonly found in the soil and around farm animals. They are one of the leading causes of abortions in cattle, he said. The organism thrives in unpasteurized milk, he said.
The most recent case of Listeriosis was diagnosed in an infant about 12 days ago, Sills said.
“The baby’s still here,” the neonatologist said. “He’s going to be a survivor.”