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Averbuch D, Tridello G, Wendel L, Itälä-Remes M, Oren I, Karas M, Blijlevens N, Beguin Y, Broers A, Calore E, Cattaneo C, Isaksson C, Robin C, Gadisseur A, Maertens J, De Becker A, Lueck C, Metafuni E, Pichler H, Popova M, Ram R, Yeshurun M, Mikulska M, Camara RDL, Styczynski J. Listeria monocytogenes Infections in Hematopoietic Cell Transplantation Recipients: Clinical Manifestations and Risk Factors. A Multinational Retrospective Case-Control Study from the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:712.e1-712.e12. [PMID: 38621480 DOI: 10.1016/j.jtct.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
Listeriosis is rare after hematopoietic stem cell transplantation (HCT). Little is known about listeriosis in this population. In this retrospective international case-control study, we evaluated 41 listeriosis episodes occurring between 2000 and 2021 in HCT recipients (111 transplant centers in 30 countries) and assessed risk factors for listeriosis by comparisons with matched controls. The 41 listeriosis episodes (all due to Listeria monocytogenes [LM]) occurred in 30 allogeneic (allo)-HCT recipients and 11 autologous (auto)-HCT recipients at a median of 6.2 months (interquartile range [IQR], 1.6 to 19.3 months) post-HCT. The estimated incidence was 49.8/100,000 allo-HCT recipients and 13.7/100,000 auto-HCT recipients. The most common manifestations in our cohort were fever (n = 39; 95%), headache (n = 9; 22%), diarrhea, and impaired consciousness (n = 8 each; 20%). Four patients (10%) presented with septic shock, and 19 of 38 (50%) were severely lymphocytopenic. Thirty-seven patients (90%) had LM bacteremia. Eleven patients (27%) had neurolisteriosis, of whom 4 presented with nonspecific signs and 5 had normal brain imaging findings. Cerebrospinal fluid analysis revealed high protein and pleocytosis (mainly neutrophilic). Three-month mortality was 17% overall (n = 7), including 27% (n = 3 of 11) in patients with neurolisteriosis and 13% (n = 4 of 30) in those without neurolisteriosis. In the multivariate analysis comparing cases with 74 controls, non-first HCT (odds ratio [OR], 5.84; 95% confidence interval [CI], 1.10 to 30.82; P = .038); and lymphocytopenia <500 cells/mm3 (OR, 7.54; 95% CI, 1.50 to 37.83; P = .014) were significantly associated with listeriosis. There were no statistically significant differences in background characteristics, immunosuppression, and cotrimoxazole prophylaxis between cases and controls. HCT recipients are at increased risk for listeriosis compared to the general population. Listeriosis cause severe disease with septic shock and mortality. Neurolisteriosis can present with nonspecific signs and normal imaging. Lymphocytopenia and non-first HCT are associated with an increased risk of listeriosis, and cotrimoxazole was not protective.
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Affiliation(s)
- Dina Averbuch
- Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
| | - Gloria Tridello
- European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
| | - Lotus Wendel
- European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
| | - Maija Itälä-Remes
- Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland
| | - Ilana Oren
- Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland; Infectious Diseases Unit, Rambam Medical Center, Haifa, Israel
| | - Michal Karas
- Allogeneic Stem Cell Transplant Unit, Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yves Beguin
- Department of Hematology, CHU of Liège and University of Liège, Liège, Belgium
| | - Annoek Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabetta Calore
- Pediatric Hematology-Oncology and Stem Cell Transplant Division, University Hospital of Padova, Italy
| | | | | | - Christine Robin
- Department of Hematology, APHP Henri Mondor Teaching Hospital, Créteil, France
| | - Alain Gadisseur
- Department of Hematology, Stem Cell Transplantation & Coagulation Disorders, Antwerp University Hospital, Edegem, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ann De Becker
- Department of Hematology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Catherina Lueck
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Elisabetta Metafuni
- Department of Diagnostic Imaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Rome, Italy
| | - Herbert Pichler
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marina Popova
- Bone Marrow Transplantation, RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Ron Ram
- Bone Marrow Transplantation Unit, Hematology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | | | - Jan Styczynski
- Department of Paediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Oyama T, Kageyama K, Araoka H, Mitsuki T, Yamaguchi K, Kaji D, Taya Y, Nishida A, Ishiwata K, Takagi S, Yamamoto H, Yamamoto G, Asano-Mori Y, Uchida N, Wake A, Makino S, Taniguchi S. Clinical and microbiological characteristics of bacterial meningitis in umbilical cord blood transplantation recipients. Int J Hematol 2022; 116:966-972. [PMID: 35932398 DOI: 10.1007/s12185-022-03425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Bacterial meningitis is a rare but severe infectious complication after hematopoietic stem cell transplantation. However, its clinical features were previously not clear. We reviewed the cases of 7 patients diagnosed with bacterial meningitis with a positive cerebrospinal fluid culture among 1147 patients who underwent cord blood transplantation (CBT) at our institution between September 2007 and September 2020. The diagnosis was made on day + 5- + 45, and 5 patients developed bacterial meningitis before neutrophil engraftment. The causative organisms were all Gram-positive cocci: Enterococcus faecium and Enterococcus gallinarum (2 patients each), and Staphylococcus haemolyticus, Streptococcus mitis/oralis, and Rothia mucilaginosa (1 patient each). Six patients developed bacterial meningitis secondary to prior or concomitant bacteremia caused by the same bacterium. Five patients had received anti-MRSA agents at onset: vancomycin in 3, teicoplanin in 1, and daptomycin in 1. After diagnosis of bacterial meningitis, linezolid was eventually used for 6 patients. Two patients with E. gallinarum were alive at day + 1380 and + 157 after CBT, respectively, whereas 5 patients died 17-53 (median 43) days after the onset of bacterial meningitis. Breakthrough meningitis in CBT can occur even during the use of anti-MRSA drugs, and intensive antibiotic treatment is necessary.
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Affiliation(s)
- Takashi Oyama
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Kosei Kageyama
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan.
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Takashi Mitsuki
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kyosuke Yamaguchi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Daisuke Kaji
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Yuki Taya
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Shinsuke Takagi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hisashi Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Go Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Yuki Asano-Mori
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Shigeyoshi Makino
- Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
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Listeria monocytogenes septicemia and meningoencephalitis associated with relapsed and refractory follicular lymphoma. J Infect Chemother 2020; 26:619-621. [PMID: 32033853 DOI: 10.1016/j.jiac.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022]
Abstract
Listeria monocytogenes is a foodborne pathogen which causes life-threatening septicemia and meningoencephalitis. Defective cell-mediated immunity is a well-known risk factor of human listeriosis. We herein present a case of 64-year-old Japanese woman with relapsed and refractory follicular lymphoma (FL). Salvage chemoimmunotherapy with cyclophosphamide, vincristine, prednisolone, and obinutuzumab was followed by obinutuzumab maintenance therapy, when a follow-up computed tomography scan revealed recurrent lymphadenopathy. One month later, the patient presented with fever and headache. L. monocytogenes was recovered from an anaerobic blood culture. Cerebrospinal fluid analysis confirmed the presence of meningoencephalitis. The invasive listeriosis was successfully treated with meropenem for three weeks. There were several predisposing factors of invasive listeriosis in our case. Cell-mediated immunity was severely impaired by prior cytotoxic chemotherapy and low-dose prednisolone. Use of a proton pump inhibitor facilitated entry of the microorganism into the host. Under these circumstances, patients with relapsed and refractory FL are susceptible to invasive listeriosis even if they avoid high-level contaminated food products. Of note, physical examination at initial presentation detected periorbital vesiculopustular eruptions with surrounding erythema. Cutaneous listeriosis is a rare but recurrent manifestation which might be occasionally overlooked. Skin eruptions should be carefully examined for early diagnosis.
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Bacterial meningitis in hematopoietic stem cell transplant recipients: a population-based prospective study. Bone Marrow Transplant 2016; 51:1490-1495. [DOI: 10.1038/bmt.2016.181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 11/08/2022]
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Boyle NM, Podczervinski S, Jordan K, Stednick Z, Butler-Wu S, McMillen K, Pergam SA. Bacterial foodborne infections after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014; 20:1856-61. [PMID: 25020101 DOI: 10.1016/j.bbmt.2014.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Abstract
Diarrhea, abdominal pain, and fever are common among patients undergoing hematopoietic cell transplantation (HCT), but such symptoms are also typical with foodborne infections. The burden of disease caused by foodborne infections in patients undergoing HCT is unknown. We sought to describe bacterial foodborne infection incidence after transplantation within a single-center population of HCT recipients. All HCT recipients who underwent transplantation from 2001 through 2011 at the Fred Hutchinson Cancer Research Center in Seattle, Washington were followed for 1 year after transplantation. Data were collected retrospectively using center databases, which include information from transplantation, on-site examinations, outside records, and collected laboratory data. Patients were considered to have a bacterial foodborne infection if Campylobacter jejuni/coli, Listeria monocytogenes, E. coli O157:H7, Salmonella species, Shigella species, Vibrio species, or Yersinia species were isolated in culture within 1 year after transplantation. Nonfoodborne infections with these agents and patients with pre-existing bacterial foodborne infection (within 30 days of transplantation) were excluded from analyses. A total of 12 of 4069 (.3%) patients developed a bacterial foodborne infection within 1 year after transplantation. Patients with infections had a median age at transplantation of 50.5 years (interquartile range [IQR], 35 to 57), and the majority were adults ≥18 years of age (9 of 12 [75%]), male gender (8 of 12 [67%]) and had allogeneic transplantation (8 of 12 [67%]). Infectious episodes occurred at an incidence rate of 1.0 per 100,000 patient-days (95% confidence interval, .5 to 1.7) and at a median of 50.5 days after transplantation (IQR, 26 to 58.5). The most frequent pathogen detected was C. jejuni/coli (5 of 12 [42%]) followed by Yersinia (3 of 12 [25%]), although Salmonella (2 of 12 [17%]) and Listeria (2 of 12 [17%]) showed equal frequencies; no cases of Shigella, Vibrio, or E. coli O157:H7 were detected. Most patients were diagnosed via stool (8 of 12 [67%]), fewer through blood (2 of 12 [17%]), 1 via both stool and blood simultaneously, and 1 through urine. Mortality due to bacterial foodborne infection was not observed during follow-up. Our large single-center study indicates that common bacterial foodborne infections were a rare complication after HCT, and the few cases that did occur resolved without complications. These data provide important baseline incidence for future studies evaluating dietary interventions for HCT patients.
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Affiliation(s)
- Nicole M Boyle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Kim Jordan
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Zach Stednick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Susan Butler-Wu
- Laboratory Medicine, University of Washington, Seattle, Washington
| | | | - Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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6
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Hoffman MJ, Stosor V. Central nervous system infections in cancer patients and hematopoietic stem cell transplant recipients. Cancer Treat Res 2014; 161:253-298. [PMID: 24706228 DOI: 10.1007/978-3-319-04220-6_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Central nervous system (CNS) infections in cancer patients present a diagnostic and therapeutic challenge for clinicians. While CNS infections are not frequent complications of cancer, its therapies, or hematopoietic stem cell transplantation, the importance of CNS infections lies in their propensity to result in profound morbidity and substantial mortality in this vulnerable patient population. With an expanding population of patients with malignant disease undergoing more potent and aggressive therapies and with the advent of newer immunomodulatory agents, the incidence of CNS infectious complications is likely to rise. This chapter will summarize the clinical and diagnostic evaluation of potential infections of the CNS in these patients and will discuss particular pathogens of interest with regard to this at-risk patient population.
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Affiliation(s)
- Michael J Hoffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St. Feinberg 16-738, Chicago, IL, 60605, USA,
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7
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Martins IS, da Conceição Faria FC, Miguel MAL, de Sá Colaço Dias MP, Cardoso FLL, de Gouveia Magalhães AC, Mascarenhas LA, Nouér SA, Barbosa AV, Vallim DC, Hofer E, Rebello RF, Riley LW, Moreira BM, Moreira BM. A cluster of Listeria monocytogenes infections in hospitalized adults. Am J Infect Control 2010; 38:e31-6. [PMID: 20570397 DOI: 10.1016/j.ajic.2010.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 02/20/2010] [Accepted: 02/22/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Listeriosis occurs mainly in persons at extremes of age and with immunocompromising conditions. It is believed that most cases of listeriosis are acquired in the community. A cluster of listeriosis in hospitalized patients prompted the present investigation. METHODS We conducted a case series study of listeriosis from August 21, 2006, to June 1, 2007, in a hospital in the city of Rio de Janeiro, Brazil. RESULTS Six patients with Listeria monocytogenes infection were identified: 5 during hospitalization and 1 at a day clinic. By the time the infection was diagnosed, 5 patients had been in the hospital for a mean of 9 days. All patients were elderly (median age, 80 years) and had immunocompromising conditions. Five (83%) patients died. Four patients developed bloodstream infections, 3 caused by serotype 1/2b. Two patients had peritonitis: one caused by serotype 3b and another by serotype 1/2b. Four L monocytogenes isolates belonged to a single pulse-field gel electrophoresis genotype, suggesting a common source. An epidemiologic investigation pointed to the hospital kitchen as the possible contamination. CONCLUSION Data suggest a health care-associated outbreak of listeriosis and highlight the importance of developing guidelines for prevention and treatment of health care-associated foodborne diseases, especially in hospitals with immunocompromised adult patients.
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Metelmann C, Schulz K, Geldschläger-Canda R, Plötz S, Handrick W. [Listeriosis in adults - case reports and review of the literature]. Wien Klin Wochenschr 2010; 122:354-9. [PMID: 20559880 DOI: 10.1007/s00508-010-1385-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/05/2010] [Indexed: 12/19/2022]
Abstract
Listeriosis is a rare disease with increasing incidence occurring mainly in elderly people and patients suffering from underlying diseases and immunosuppressive therapy. On the basis of three case reports and a review of the literature the most important aspects of epidemiology, pathogenesis, clinical manifestations, diagnostics and therapy of listeriosis are discussed.
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Affiliation(s)
- Claudia Metelmann
- Institut für Medizinische Diagnostik Greifswald, Greifswald, Deutschland
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Kohno K, Nagafuji K, Tsukamoto H, Horiuchi T, Takase K, Aoki K, Henzan H, Kamezaki K, Takenaka K, Miyamoto T, Teshima T, Harada M, Akashi K. Infectious complications in patients receiving autologous CD34-selected hematopoietic stem cell transplantation for severe autoimmune diseases. Transpl Infect Dis 2009; 11:318-23. [DOI: 10.1111/j.1399-3062.2009.00401.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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