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一例暴发性脑膜炎球菌血症：关键在于补体。

A Case of Fulminant Meningococcemia: It Is All in the Complement.

作者信息

Hawkins Kellie L, Hoffman Mariah, Okuyama Sonia, Rowan Sarah E

机构信息

Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

Denver Health and Hospital Authority, Denver, CO, USA.

出版信息

Case Rep Infect Dis. 2017;2017:6093695. doi: 10.1155/2017/6093695. Epub 2017 Jul 20.

DOI:10.1155/2017/6093695
PMID:28808592
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5541820/
Abstract

Eculizumab is a novel monoclonal antibody that inhibits complement-mediated hemolysis in patients with paroxysmal nocturnal hemoglobinuria (PNH). Complement deficiency is a well-known risk factor for meningococcal infection. We describe a case of a young patient with PNH treated with eculizumab who presented with a life-threatening case of nongroupable meningococcemia. As this new biologic agent becomes more widely prescribed, providers should be aware of the increased risk of meningococcemia. In addition to vaccination, providers may consider the use of oral penicillin for antibiotic prophylaxis against in these cases of functional complement deficiency.

摘要

依库珠单抗是一种新型单克隆抗体，可抑制阵发性夜间血红蛋白尿（PNH）患者的补体介导的溶血。补体缺乏是脑膜炎球菌感染的一个众所周知的危险因素。我们描述了一例接受依库珠单抗治疗的年轻PNH患者，该患者出现了危及生命的不可分组脑膜炎球菌血症病例。随着这种新的生物制剂被更广泛地处方，医疗服务提供者应意识到脑膜炎球菌血症风险的增加。除了接种疫苗外，在这些功能性补体缺乏的病例中，医疗服务提供者可考虑使用口服青霉素进行抗生素预防。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/a150b25ba5fc/CRIID2017-6093695.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/42a4ca2a33d0/CRIID2017-6093695.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/6f86dc5b5627/CRIID2017-6093695.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/a150b25ba5fc/CRIID2017-6093695.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/42a4ca2a33d0/CRIID2017-6093695.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/6f86dc5b5627/CRIID2017-6093695.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6e/5541820/a150b25ba5fc/CRIID2017-6093695.003.jpg

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本文引用的文献

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Updated Recommendations for Use of MenB-FHbp Serogroup B Meningococcal Vaccine - Advisory Committee on Immunization Practices, 2016.B群脑膜炎球菌结合疫苗（MenB-FHbp）使用的更新建议 - 免疫实践咨询委员会，2016年
MMWR Morb Mortal Wkly Rep. 2017 May 19;66(19):509-513. doi: 10.15585/mmwr.mm6619a6.
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Serologic response to meningococcal vaccination in patients with paroxysmal nocturnal hemoglobinuria (PNH) chronically treated with the terminal complement inhibitor eculizumab.阵发性夜间血红蛋白尿（PNH）患者长期接受终末补体抑制剂依库珠单抗治疗后对脑膜炎球菌疫苗的血清学反应。
Ann Hematol. 2017 Apr;96(4):589-596. doi: 10.1007/s00277-017-2924-y. Epub 2017 Jan 26.
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利妥昔单抗治疗阵发性睡眠性血红蛋白尿症患者并发非荚膜性脑膜炎奈瑟菌败血症：病例报告及文献复习。
Front Immunol. 2023 Oct 2;14:1269325. doi: 10.3389/fimmu.2023.1269325. eCollection 2023.
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Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales and Northern Ireland (2010/11 to 2018/19).英格兰、威尔士和北爱尔兰侵袭性脑膜炎奈瑟菌分离株的抗生素耐药性（2010/11 年至 2018/19 年）。
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现场记录：应用依库珠单抗治疗的国际旅行者感染脑膜炎奈瑟菌 - 美国，2015 年。
MMWR Morb Mortal Wkly Rep. 2016 Jul 15;65(27):696-7. doi: 10.15585/mmwr.mm6527a3.
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MMWR Recomm Rep. 2013 Mar 22;62(RR-2):1-28.
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Meningococcal sepsis complicating eculizumab treatment despite prior vaccination.尽管之前接种过疫苗，但依库珠单抗治疗仍并发脑膜炎球菌败血症。
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Multicenter phase 3 study of the complement inhibitor eculizumab for the treatment of patients with paroxysmal nocturnal hemoglobinuria.补体抑制剂依库珠单抗治疗阵发性夜间血红蛋白尿症患者的多中心3期研究。
Blood. 2008 Feb 15;111(4):1840-7. doi: 10.1182/blood-2007-06-094136. Epub 2007 Nov 30.