, Volume 47, Issue 3, pp 489–492 | Cite as

Vaccine strain Listeria monocytogenes bacteremia occurring 31 months after immunization

  • Elias Fares
  • Cindy B. McCloskey
  • Andres Gutierrez
  • Michael Princiotta
  • Linda J. Salinas
  • Douglas A. DrevetsEmail author
Case Report



Listeria monocytogenes is a food-borne, facultative intracellular bacterium that causes severe diseases such as sepsis and meningoencephalitis in immunocompromised hosts. Because it stimulates robust T-lymphocyte-mediated responses, attenuated L. monocytogenes are candidate vaccine vectors for tumor immunotherapy.


We report a case of bacteremia caused by vaccine strain L. monocytogenes (Axalimogene filolisbac) occurring 31 months after immunization against human papilloma virus (HPV) associated cervical cancer.


Receipt of a L. monocytogenes-based vaccine is a novel risk factor for delayed L. monocytogenes bacteremia.


Immunotherapy Live vaccine Recurrent listeriosis. Listeria vaccine 



The authors thank Jennifer C. Hunter and Brendan R. Jackson of the Centers for Disease Control and Prevention, Atlanta, GA for assistance with manuscript preparation. We also thank members of the CDC Enteric Diseases Laboratory Branch for pulsed-field electrophoresis analysis, whole-genome sequencing, and whole-genome sequencing analysis: Cheryl L. Tarr, Katie Roache, Zuzana Kucerova, Steven Stroika, and Lee S. Katz.

Compliance with ethical standards

Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. EF, CM, LS, and DD are not affiliated with, nor received any funding from Advaxis, Inc. AG and MP are current employees of Advaxis, Inc.

Ethics statement

The clinical trial under which the patient received experimental immunotherapy and subsequent review of her records were done with the approval of the Institutional Review Board at OUHSC.


  1. 1.
    Lorber B. Listeria monocytogenes. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Saunders; 2015. pp. 2383–90.Google Scholar
  2. 2.
    Silk BJ, Mahon BE, Griffin PM, Gould LH, Tauxe RV, Crim SM, et al. Listeria illness, deaths, and outbreaks—United States, 2009–2011. MMWR. 2013;62:228–452.Google Scholar
  3. 3.
    Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017;17:510–9. Scholar
  4. 4.
    Wood LM, Paterson Y. Attenuated Listeria monocytogenes: a powerful and versatile vector for the future of tumor immunotherapy. Front Cell Infect Microbiol. 2014;4:1–22. Scholar
  5. 5.
    Maciag PC, Radulovic S, Rothman J. The first clinical use of a live-attenuated Listeria monocytogenes vaccine: a Phase I safety study of Lm-LLO-E7 in patients with advanced carcinoma of the cervix. Vaccine. 2009;27:3975–83. Scholar
  6. 6.
    Miles BA, Monk BJ, Safran HP. Mechanistic insights into ADXS11-001 Human papillomavirus-associated cancer immunotherapy. Gynecol Oncol Res Pract. 2017;4:9. Scholar
  7. 7.
    McLauchlin J, Audurier A, Taylor AG. Treatment failure and recurrent human listeriosis. J Antimicrob Chemother. 1991;27:851–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Levett PN, Bennett P, O’Donaghue K, Bowker K, Reeves D, MacGowan A. Relapsed infection due to Listeria monocytogenes confirmed by random amplified polymorphic DNA (RAPD) analysis. J Infect. 1993;27:205–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Sauders BD, Wiedmann M, Desjardins M, Fenlon C, Davenport N, Hibbs JR, et al. Recurrent Listeria monocytogenes infection: relapse or reinfection with a unique strain confirmed by molecular subtyping. Clin Infect Dis. 2001;33:257–9. Scholar
  10. 10.
    Ciceri G, Gori M, Bianchi S, Corrado G, Panisi P, Papa A, et al. Molecular evidence of Listeria monocytogenes infection relapse in a severe case of endocarditis. JMM Case Rep. 2017;4:e005115. Scholar
  11. 11.
    Radoshevich L, Cossart P. Listeria monocytogenes: towards a complete picture of its physiology and pathogenesis. Nat Rev Microbiol. 2017;16:32. Scholar
  12. 12.
    Advaxis. ADXS11-001 Investigator Brochure V.15. Lm-LLO Immunotherapy for the treatment of HPV-associated cancers. 2018.Google Scholar
  13. 13.
    Denham JD, Lee DH, Castro M, Pandya S, Aslam S, Nanjappa S, et al. Two cases of disseminated infection following live organism anti-cancer vaccine administration in cancer patients. Int J Infect Dis. 2018;72:1–2. Scholar
  14. 14.
    Drevets DA. Listeria monocytogenes virulence factors that stimulate endothelial cells. Infect Immun. 1998;66:232–8.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Charlier C, Leclercq A, Cazenave B, Desplaces N, Travier L, Cantinelli T, et al. Listeria monocytogenes–associated joint and bone infections: a study of 43 consecutive cases. Clin Infect Dis. 2012;54:240–8. Scholar
  16. 16.
    Lemon KP, Freitag NE, Kolter R. The virulence regulator PrfA promotes biofilm formation by Listeria monocytogenes. J Bacteriol. 2010;192:3969–76. Scholar
  17. 17.
    Einhorn TA, Gerstenfeld LC. Fracture healing: mechanisms and interventions. Nat Rev Rheumatol. 2015;11:45–54. Scholar
  18. 18.
    Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12:252–64.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stein MN, Fong L, Tutrone RF, Mega AE, Lobo M, Hong Q, et al. KEYNOTE-046: ADXS-PSA plus pembrolizumab (pembro) in metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol. 2018;36(suppl):abstr 5019.CrossRefGoogle Scholar
  20. 20.
    Becattini S, Littmann ER, Carter RA, Kim SG, Morjaria SM, Ling L, et al. Commensal microbes provide first line defense against Listeria monocytogenes infection. J Exp Med. 2017. Scholar

Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2018

Authors and Affiliations

  • Elias Fares
    • 1
    • 5
  • Cindy B. McCloskey
    • 2
  • Andres Gutierrez
    • 3
  • Michael Princiotta
    • 3
  • Linda J. Salinas
    • 1
  • Douglas A. Drevets
    • 1
    • 4
    Email author
  1. 1.Section of Infectious Diseases, Department of Internal MedicineUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  2. 2.Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  3. 3.Advaxis, IncPrincetonUSA
  4. 4.Medical ServicesDepartment of Veterans Affairs Medical CenterOklahoma CityUSA
  5. 5.ErieUSA

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