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

Details

• Alternative Title:
  J Infect
• Personal Author:
  Crew, Page E. ; McNamara, Lucy ; Waldron, Peter E. ; McCulley, Lynda ; Jones, S. Christopher ; Bersoff-Matcha, Susan J.
• Description:
  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 eculizumab U.S. approval (2007) through January 31, 2018.
  
  Results
  
  We identified seven FAERS reports (including one case also reported in the literature) of non- meningococcal, non-gonococcal Neisseria disease, including N. sicca (mucosa)/subflava (n=2), N. cinerea (n=2), N. sicca (mucosa) (n=1), N. mucosa (n=1, with concurrent alpha-hemolytic Streptococcus bacteremia), and N. flavescens (subflava) (n=1). Four cases had sources of patient immunosuppression in addition to eculizumab. Three patients had sepsis (n=2) or septic shock (n=1). Five patients were bacteremic. All patients were hospitalized; the infections resolved with antibiotics.
  
  Conclusions
  
  Our search identified seven cases of disease from typically commensal Neisseria spp. In eculizumab recipients. These findings suggest that any Neisseria spp. identified from a normally sterile site in an eculizumab recipient could represent true infection warranting prompt treatment.
  
  
• Subjects:
  Article Bacteremia Eculizumab Neisseria Cinerea Neisseria Mucosa Neisseria Subflava Nonpathogenic Neisseria
• Source:
  J Infect. 78(2):113-118
• Pubmed ID:
  30408494
• Pubmed Central ID:
  PMC7224403
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHS/United States
• Volume:
  78
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8e8f5d55a8532b40120534976cb79425dce81df84700fd66c4b2681c634e2a64
• Download URL:
  https://stacks.cdc.gov/view/cdc/88018/cdc_88018_DS1.pdf
• File Type:
  [PDF - 80.67 KB ]