LISTERIOSIS IN BONE-MARROW TRANSPLANT RECIPIENTS - INCIDENCE, CLINICAL-FEATURES, AND TREATMENT

Cultures of blood and/or cerebrospinal fluid from four of 1,013 bone m arrow transplant recipients treated at our center between January 1972 and April 1994 were positive for Listeria monocytogenes. The overall occurrence of listeriosis was 0.39 case per 100 transplantations. Allo graft recipients had received prior treatment with parenteral methylpr ednisolone, thus supporting an association between listeriosis and cor ticosteroids. Treatment with parenteral ampicillin (200 mg/[kg . d]) a nd gentamicin is recommended for a minimum of 3 weeks before oral ther apy. Two patients with penicillin allergies in this study failed to re spond to chloramphenicol-based therapeutic regimens. Recurrent meningi tis occurred in two patients, and the therapeutic use of intrathecal g entamicin/vancomycin did not confer a survival advantage (i.e., the pa tients did not survive).