¹Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY, USA

²Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center Weill Medical College of Cornell University, New York, NY, USA

³Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA

Correspondence to: Dr A Safdar, Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Two Medical Park, Suite-502, Columbia, SC 29203, USA

^aPresent address: Division Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29203, USA

Listeriosis is uncommon in recipients of allogeneic blood, marrow and organ transplantation. Six patients with systemic Listeria monocytogenes infection during 1985-1997 at Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center are described. In two male and four female patients, the median duration from transplantation to isolation of L. monocytogenes was 62.5 (range 29 to 821) days. Among five allogeneic marrow transplant recipients, four (80%) received HLA antigen matched, T cell-depleted grafts from three unrelated and a single related donor. One patient underwent mismatched-related marrow graft transplant. Cord stem cell transplantation was performed in a single patient. Two required therapy for graft-versus-host disease (GVHD). The 13 year incidence of systemic Listeria infections was 0.47 percent. All six presented with fever (>39°C), and L. monocytogenes bloodstream invasion. Mental status changes and meningioencephalitis were observed in two (33.3%). A concurrent primary opportunistic infection was present in five individuals (83.3%), and four (80%) were being treated for acute human cytomegalovirus (HCMV) viremia. Sixty-six percent responded to therapy and two died from unrelated, non-listeric causes. Systemic listeriosis was uncommon in our high-risk allogeneic blood and marrow transplantation population, and response to therapy with parenteral ampicillin and gentamicin was excellent. The association between primary HCMV reactivation and subsequent listeric infection emphasizes the significance of HCMV-related dysfunction in hosts' cellular immune responses, especially in the setting of allogeneic transplantation.

Bone Marrow Transplantation (2002) 29, 913-916. DOI:10.1038/sj/bmt/1703562

Listeria monocytogenes; allogeneic marrow transplantation; human cytomegalovirus