Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA.
Division of Neurology, Department of Clinical Neurosciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Clin Infect Dis. 2023 Mar 21;76(6):1142-1148. doi: 10.1093/cid/ciac766.
With increasing use of rituximab and other B-cell depleting monoclonal antibodies for multiple indications, infectious complications are being recognized. We summarize clinical findings of patients on rituximab with arboviral diseases identified through literature review or consultation with the Centers for Disease Control and Prevention. We identified 21 patients on recent rituximab therapy who were diagnosed with an arboviral disease caused by West Nile, tick-borne encephalitis, eastern equine encephalitis, Cache Valley, Jamestown Canyon, and Powassan viruses. All reported patients had neuroinvasive disease. The diagnosis of arboviral infection required molecular testing in 20 (95%) patients. Median illness duration was 36 days (range, 12 days to 1 year), and 15/19 (79%) patients died from their illness. Patients on rituximab with arboviral disease can have a severe or prolonged course with an absence of serologic response. Patients should be counseled about mosquito and tick bite prevention when receiving rituximab and other B-cell depleting therapies.
随着利妥昔单抗和其他 B 细胞耗竭单克隆抗体在多种适应证中的应用不断增加，感染性并发症也越来越受到关注。我们通过文献回顾或与疾病预防控制中心（Centers for Disease Control and Prevention）的咨询，总结了利妥昔单抗治疗患者中 arboviral 疾病的临床发现。我们发现 21 例近期接受利妥昔单抗治疗的患者被诊断为西尼罗河病毒、蜱传脑炎病毒、东部马脑炎病毒、卡奇谷病毒、詹姆斯敦峡谷病毒和波瓦桑病毒引起的 arboviral 疾病。所有报告的患者均有神经侵袭性疾病。20 例（95%）患者的 arboviral 感染诊断需要进行分子检测。中位疾病持续时间为 36 天（范围，12 天至 1 年），19 例中有 15 例（79%）患者死于疾病。患有 arboviral 疾病的利妥昔单抗治疗患者可能会出现严重或延长的病程，且缺乏血清学反应。在接受利妥昔单抗和其他 B 细胞耗竭治疗时，应告知患者预防蚊虫和蜱虫叮咬。
