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.
[en] 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.
Disciplines :
Hematology
Author, co-author :
Averbuch, Dina; Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel. Electronic address: adiana@hadassah.org.il
Tridello, Gloria; European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
Wendel, Lotus; European Society for Blood and Marrow Transplantation, Leiden Study Unit, Leiden, The Netherlands
Itälä-Remes, Maija; Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland
Oren, Ilana; Department of Clinical Haematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland, Infectious Diseases Unit, Rambam Medical Center, Haifa, Israel
Karas, Michal; Allogeneic Stem Cell Transplant Unit, Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
Blijlevens, Nicole ; Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
Beguin, Yves ; Université de Liège - ULiège > Département des sciences cliniques
Broers, Annoek; Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Calore, Elisabetta; Pediatric Hematology-Oncology and Stem Cell Transplant Division, University Hospital of Padova, Italy
Isaksson, Cecilia ; Umea University Hospital, Umea, Sweden
Robin, Christine; Department of Hematology, APHP Henri Mondor Teaching Hospital, Créteil, France
Gadisseur, Alain ; Department of Hematology, Stem Cell Transplantation & Coagulation Disorders, Antwerp University Hospital, Edegem, Belgium
Maertens, Johan; Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
De Becker, Ann ; Department of Hematology, Universitair Ziekenhuis Brussel, Brussels, Belgium
Lueck, Catherina; Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
Metafuni, Elisabetta ; Department of Diagnostic Imaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Rome, Italy
Pichler, Herbert ; Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
Popova, Marina ; Bone Marrow Transplantation, RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Ram, Ron ; Bone Marrow Transplantation Unit, Hematology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Yeshurun, Moshe ; Institution of Hematology, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Mikulska, Malgorzata; Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
Camara, Rafael de la ; Hematology Department, Hospital de la Princesa, Madrid, Spain
Styczynski, Jan; Department of Paediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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.
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