Fatal Nongroupable <i>Neisseria meningitidis</i> Disease in Vaccinated Patient Receiving Eculizumab

Nolfi‐Donegan, Deirdre; Konar, Monica; Vianzon, Vianca; MacNeil, Jessica R.; Cooper, James N.; Lurie, Perrianne; Sedivy, Judi; Wang, Xin; Granoff, Dan M.; McNamara, Lucy A.

doi:10.3201/eid2408.180228

Cited by 38 publications

(31 citation statements)

References 13 publications

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“…Similarly, the terminal complement pathway inhibitor, eculizumab, which is used to treat paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome, is associated with up to 2,000-fold increased incidence of invasive meningococcal disease. This includes disease caused by unencapsulated strains, such as the US_NmUC strain, that would not normally cause disease in healthy individuals [15]. These individuals are recommended to receive meningococcal vaccination and long-term penicillin prophylaxis [16].…”

Section: Implications Of the Emergence Of Meningococci Adapted To Thementioning

confidence: 99%

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

et al. 2020

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Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its ‘parent’ strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.

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Section: Implications Of the Emergence Of Meningococci Adapted To Thementioning

confidence: 99%

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

et al. 2020

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“…Since eculizumab blocks the terminal complement pathway, which is required for serum bactericidal activity, patients treated with eculizumab are at more than a 1000‐fold increased risk of meningococcal disease . While no deaths were reported in the paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome studies, fatal infections have subsequently been reported . In the U.S., 52% of meningococcal disease are caused by serogroups A, C, Y or W‐135 and 48% by serogroup B.…”

Section: Eculizumabmentioning

confidence: 99%

Preventing infectious complications when treating non‐malignant immune‐mediated hematologic disorders

2019

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Immunosuppressants, targeted antibody therapies, and surgical splenectomy are amongst the treatment choices for immune-mediated non-malignant hematologic disorders, with infection being the most common non-hematological adverse event from these therapies. Corticosteroids are associated with a length-of-treatment and dose-dependent risk for infection, including opportunistic infections. Screening and antimicrobial prophylaxis against tuberculosis, Strongyloides stercoralis, and Pneumocystis jirovecii pneumonia, are indicated in selected patients on steroids and with certain risk factors for infection. Rituximab is associated with hepatitis B virus reactivation. All patients planned to be started on rituximab should be screened for hepatitis B surface antigen and total core antibody, with antiviral prophylaxis given depending on test results. In eculizumab treated patients, immunization against meningococcal serogroups ACWY and B is recommended. In addition, some guidelines suggest antibiotic prophylaxis for the duration of eculizumab treatment. In splenectomized patients, counseling and immunization are cornerstones of infection prevention. Several federal and society guidelines about immunizations and prophylactic antimicrobial therapies for patients treated with various immunosuppressive agents exist and are summarized in this manuscript in a clinical-focused table. In addition, management suggestions are made where no formal guidelines exist. 2 | PATIENT COUNSELING An important part of infectious disease prevention in immunocompromised patients entails the education of the patient, family, and friends. Household and other close contacts of persons with altered immunocompetence should be educated in hand hygiene and avoid contact with the patient when they are experiencing an infectious process. 12 Proper food and water hygiene measures are important to prevent

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“…in addition to the known risk of N. meningitidis disease. Further, recent data suggest that patients receiving eculizumab are at risk for meningococcal infections caused by nongroupable strains, which do not usually cause invasive disease in healthy people [16,24]. The patients in this series may be exhibiting a similar susceptibility to severe infection by species that rarely pose a risk for invasive infection in healthy individuals.…”

Section: Discussionmentioning

confidence: 77%

Unusual Neisseria species as a cause of infection in patients taking eculizumab

Crew

McNamara

Waldron

et al. 2019

Journal of Infection

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Background-Non-meningococcal, non-gonococcal Neisseria spp. are typically commensal and rarely cause invasive disease. Eculizumab is a terminal complement inhibitor that increases susceptibility to meningococcal disease, but data on disease caused by typically-commensal Neisseria spp. are lacking. This series describes postmarketing reports of typically-commensal Neisseria spp. disease in patients receiving eculizumab. Methods-We searched the FDA Adverse Event Reporting System (FAERS) and medical literature for reports of commensal Neisseria spp. disease in patients receiving eculizumab, from

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Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab

Cited by 38 publications

References 13 publications

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

Preventing infectious complications when treating non‐malignant immune‐mediated hematologic disorders

Unusual Neisseria species as a cause of infection in patients taking eculizumab

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