October 2024
A 28-year-old pregnant woman presents to your urgent care with diarrhea, nausea, vomiting, low-grade fever (100.5˚F), and body aches. She is 24 weeks pregnant and reports regular prenatal check-ups, no significant past medical history, and no known allergies. You ask her if she has eaten deli meat or cheese, any unpasteurized dairy products or soft cheese, cold smoked fish such as lox, or prepared salads, but she can’t remember if she has eaten any of those foods recently. Upon examination, her heart rate is mildly elevated, her abdomen is tender (especially in the lower quadrants), and there are no signs of preterm labor. Laboratory studies indicate normal urinalysis, mild leukocytosis,
and her blood culture is positive for Listeria monocytogenes. What is the best initial treatment step for this patient?
- Advise complete bed rest at home and expectant management with close monitoring.
- Refer her to the emergency department for hospital admission, supportive care, and fetal monitoring.
- Refer her to the emergency department for immediate surgical intervention to perform an emergency cesarean section.
- Discharge her with a prescription for oral rehydration therapy for at-home administration. Instruct her to follow-up with her obstetrician within 2 days.
Click to see the answer
Answer: B. Refer this patient to the emergency department for hospital admission and fetal monitoring.
That this pregnant patient tested positive for Listeria is of grave concern. It is unlikely that listeriosis will harm the mother in this case; however, the infection can have serious consequences for her developing baby, especially if the mother is not treated promptly. You recalled that it is uncommon for pregnant women who have listeriosis to suffer from dehydration due to the vomiting and diarrhea. Administration of intravenous antibiotics is the most important initial management step for this mother’s condition, as it is crucial to treat the Listeria infection and prevent complications for the mother and the fetus.
You referred the patient to the closest emergency department for hospital admission, supportive care for her symptoms (hydration and antipyretics), and fetal monitoring. You learned a few days later that mother and baby were doing well.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
