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Clinical and microbiological characteristics of bacterial meningitis in umbilical cord blood transplantation recipients

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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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References

  1. van Veen KE, Brouwer MC, van der Ende A, van de Beek D. Bacterial meningitis in hematopoietic stem cell transplant recipients: a population-based prospective study. Bone Marrow Transpl. 2016;51(11):1490–5.

    Article  Google Scholar 

  2. van de Beek D, Brouwer M, Hasbun R, Koedel U, Whitney CG, Wijdicks E. Community-acquired bacterial meningitis. Nat Rev Dis Primers. 2016;3(2):16074.

    Article  Google Scholar 

  3. Tsukada Y, Nagayama H, Mori T, Shimizu T, Sato N, Takayama N, et al. Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor. Bone Marrow Transplant. 2003;31(1):69–72.

    Article  CAS  PubMed  Google Scholar 

  4. Johnson H, Burd ME, Sharp SE. A 53-year-old stem cell transplant recipient with meningitis and bacteremia. J Clin Microbiol. 2011;49(12):4031.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fujiwara S, Muroi K, Kikuchi S, Kawano-Yamamoto C, Matsuyama T, Mori M, et al. Development of streptococcus meningitis and Epstein-Barr virus reactivation after non-T-cell-depleted human leukocyte antigen-haploidentical peripheral blood stem cell transplantation based on feto-maternal microchimerism. Leuk Lymphoma. 2007;48(3):640–2.

    Article  CAS  PubMed  Google Scholar 

  6. Radice C, Muñoz V, Castellares C, Casanova M, Serrano D, Carrión R, et al. Listeria monocytogenes meningitis in two allogeneic hematopoietic stem cell transplant recipients. Leuk Lymphoma. 2006;47(8):1701–3.

    Article  CAS  PubMed  Google Scholar 

  7. Barocci S, Mancini A, Canovari B, Petrelli E, Sbriscia-Fioretti E, Licci A, et al. Listeria monocytogenes meningitis in an immunocompromised patient. New Microbiol. 2015;38(1):113–8.

    PubMed  Google Scholar 

  8. Haase R, Sauer H, Dagwadordsch U, Foell J, Lieser U. Successful treatment of Bacillus cereus meningitis following allogenic stem cell transplantation. Pediatr Transplant. 2005;9(3):338–41.

    Article  PubMed  Google Scholar 

  9. Higa T, Tasaka T, Kubo Y, Nakagiri I, Sano F, Matsuhashi Y, et al. Successful treatment of meningoencephalitis caused by methicillin-resistant Staphylococcus aureus with intravenous linezolid in an allogeneic cord blood stem cell transplant recipient. Scand J Infect Dis. 2008;40(11–12):990–2.

    Article  PubMed  Google Scholar 

  10. Knoll BM, Hellmann M, Kotton CN. Vancomycin-resistant Enterococcus faecium meningitis in adults: case series and review of the literature. Scand J Infect Dis. 2013;45(2):131–9.

    Article  CAS  PubMed  Google Scholar 

  11. Wiesmayr S, Tabarelli W, Stelzmueller I, Nachbaur D, Boesmueller C, Wykypiel H, et al. Listeria meningitis in transplant recipients. Wien Klin Wochenschr. 2005;117(5–6):229–33.

    Article  PubMed  Google Scholar 

  12. Yamamoto H. Single cord blood transplantation in Japan; expanding the possibilities of CBT. Int J Hematol. 2019;110(1):39–49.

    Article  PubMed  Google Scholar 

  13. Blennow O, Ljungman P, Sparrelid E, Mattsson J, Remberger M. Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations. Transpl Infect Dis. 2014;16(1):106–14.

    Article  CAS  PubMed  Google Scholar 

  14. Takagi S, Ogura S, Araoka H, Uchida N, Mitsuki T, Yuasa M, et al. The impact of graft cell source on bloodstream infection in the first 100 days after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2021;56(7):1625–34.

    Article  PubMed  Google Scholar 

  15. Sullivan TD, LaScolea LJ Jr, Neter E. Relationship between the magnitude of bacteremia in children and the clinical disease. Pediatrics. 1982;69(6):699–702.

    Article  CAS  PubMed  Google Scholar 

  16. Ogata M, Fukuda T, Teshima T. Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transpl. 2015;50(8):1030–6.

    Article  CAS  Google Scholar 

  17. Kittaka S, Hasegawa S, Ito Y, Ohbuchi N, Suzuki E, Kawano S, et al. Serum levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinases-1 in human herpesvirus-6-infected infants with or without febrile seizures. J Infect Chemother. 2014;20(11):716–21.

    Article  CAS  PubMed  Google Scholar 

  18. Adriani KS, Brouwer MC, van de Beek D. Risk factors for community-acquired bacterial meningitis in adults. Neth J Med. 2015;73(2):53–60.

    CAS  PubMed  Google Scholar 

  19. El-Mahallawy H, Samir I, Abdel Fattah R, Kadry D, El-Kholy A. Source, pattern and antibiotic resistance of blood stream infections in hematopoietic stem cell transplant recipients. J Egypt Natl Canc Inst. 2014;26(2):73–7.

    Article  PubMed  Google Scholar 

  20. Chaudhuri A, Martinez-Martin P, Kennedy PG, Andrew Seaton R, Portegies P, Bojar M, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS task force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008;15(7):649–59.

    Article  CAS  PubMed  Google Scholar 

  21. Kessler AT, Kourtis AP. Treatment of meningitis caused by methicillin-resistant Staphylococcus aureus with linezolid. Infection. 2007;35(4):271–4.

    Article  CAS  PubMed  Google Scholar 

  22. Lee DH, Palermo B, Chowdhury M. Successful treatment of methicillin-resistant staphylococcus aureus meningitis with daptomycin. Clin Infect Dis. 2008;47(4):588–90.

    Article  PubMed  Google Scholar 

  23. Monticelli J, Knezevich A, Luzzati R, Di Bella S. Clinical management of non-faecium non-faecalis vancomycin-resistant enterococci infection focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens. J Infect Chemother. 2018;24(4):237–46.

    Article  PubMed  Google Scholar 

  24. van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016;22(Suppl 3):S37-62.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the patients and the physicians, nurses, pharmacists, transplantation coordinator (Ms. Madoka Narita), data managers (Ms. Kaoru Kobayashi and Ms. Rumiko Tsuchihashi), other co-medical staff, and support personnel for their care of the patients involved in the study. We are grateful to Dr. Akiko Yoneyama, a former chief of department of Infectious Diseases, for assistance with the microbiological analysis and discussion. This work was supported by in-hospital research expenses of Toranomon Hospital.

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Authors and Affiliations

  1. Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan

    Takashi Oyama, Kosei Kageyama, Kyosuke Yamaguchi, Daisuke Kaji, Yuki Taya, Shinsuke Takagi, Hisashi Yamamoto, Go Yamamoto, Yuki Asano-Mori, Naoyuki Uchida & Shuichi Taniguchi

  2. Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan

    Hideki Araoka

  3. Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan

    Takashi Mitsuki, Aya Nishida, Kazuya Ishiwata & Atsushi Wake

  4. Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan

    Shigeyoshi Makino

Authors
  1. Takashi Oyama
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  2. Kosei Kageyama
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  3. Hideki Araoka
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  4. Takashi Mitsuki
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  5. Kyosuke Yamaguchi
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  6. Daisuke Kaji
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  7. Yuki Taya
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  8. Aya Nishida
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  9. Kazuya Ishiwata
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  10. Shinsuke Takagi
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  11. Hisashi Yamamoto
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  12. Go Yamamoto
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  13. Yuki Asano-Mori
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  14. Naoyuki Uchida
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  15. Atsushi Wake
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  16. Shigeyoshi Makino
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  17. Shuichi Taniguchi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Takashi Oyama and Kosei Kageyama. The first draft of the manuscript was written by Takashi Oyama and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kosei Kageyama.

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Competing interests

The authors declare no competing financial interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study. The study was approved by the Institutional Review Board of Toranomon Hospital (research number #2194).

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Oyama, T., Kageyama, K., Araoka, H. et al. Clinical and microbiological characteristics of bacterial meningitis in umbilical cord blood transplantation recipients. Int J Hematol 116, 966–972 (2022). https://doi.org/10.1007/s12185-022-03425-6

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  • DOI: https://doi.org/10.1007/s12185-022-03425-6

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