Bacterial meningitis in hematopoietic stem cell transplant recipients: a population-based prospective study

Abstract

We performed a nationwide prospective cohort study on the epidemiology and clinical features of community-acquired bacterial meningitis. Patients with a medical history of autologous or allogeneic hematopoietic stem cell transplantation (HSCT) were identified from the cohort performed from March 2006 to October 2014. Fourteen of 1449 episodes (1.0%) of bacterial meningitis occurred in patients with a history of HSCT. The incidence of bacterial meningitis in HSCT recipients was 40.4 per 100 000 patients per year (95% confidence interval (CI) 23.9-62.2), which is 30-fold (95% CI 18-51; P<0.001) higher compared with persons without HSCT. Incidence was higher in allogeneic HSCT compared with autologous HSCT (70.0 vs 15.8 per 100 000 patients per year). Causative organisms were Streptococcus pneumoniae in 11 patients, Neisseria meningitidis in two and Streptococcus mitis in one patient. Mortality was 3 of 14 (21%) and 6 of 11 (55%) survivors had sequelae. Nine of 11 patients (82%) with pneumococcal meningitis were infected with a serotype included in the 23-valent pneumococcal polysaccharide vaccine, of whom four developed meningitis despite vaccination. In conclusion, HSCT recipients have a substantially increased risk compared with the general population of acquiring bacterial meningitis, which is mostly due to S. pneumoniae, and disease is associated with high mortality and morbidity. Vaccination is important to prevent disease although vaccine failures did occur.

Methods for Rapid Diagnosis of Meningitis Etiology in Adults

“…Cryptococcal meningitis risk is also high among solid organ transplant recipients and those with cirrhosis [40,41]. Patient who have undergone hematopoietic stem cell transplant (HSCT) are also at increased risk for infectious meningitis, particularly those having undergone allogenic HSCT [42]. S. pneumoniae, N. meningitidis and Aspergillus spp.…”

Invasive Bacterial Infections in Subjects with Genetic and Acquired Susceptibility and Impacts on Recommendations for Vaccination: A Narrative Review

“…hSCT transplant recipients are at risk of IMD due to total body irradiation, which induces a hyposplenism, and especially the progressive loss of specific antibodies, which has been documented in the literature for meningococci [35]. Solid organ transplant recipients may also be at risk for IMD due to immunosuppressive treatment [36].…”

Immunization Strategies to Span the Spectrum of Immunocompromised Adults

“…105 HSCT Recent reviews have been prepared by Chong et al 106 and Kamboj et al 107 on vaccinations for HSCT recipients. Persons who have undergone HSCT have higher rates of IPD [108][109][110] and higher rates of complications from influenza infection. 111 Receipt of influenza vaccine in the same season as influenza infection has been associated with decreased severity of infection in persons with HSCT and SOT.…”