Waldenström's disease complicated by recurrent meningococcal arthritis

Impfprophylaxe rekurrierender invasiver Erkrankungen mit Meningokokken

Meningokokkenerkrankungen sind selten, führen jedoch zu einer hohen Morbidität und Mortalität. Das Risiko, sich erneut mit einem anderen oder dem gleichen Serotyp zu infizieren, ist nach durchgemachter Infektion und bei bestimmten Vorerkrankungen wie Komplementdefekten deutlich erhöht.

Die Kommission hält folgendes Vorgehen für sinnvoll:

Kinder und Jugendliche ohne vollständigen Meningokokkenimpfstatus sollten unmittelbar nach Ausheilung einer invasiven Meningokokkenerkrankung eine Impfung mit 4CMenB (Bexero®, Trumenba®) und/oder eine Impfung gegen die Serogruppen A, C, W und Y (Menveo®, Nimenrix®, MenQuadfi®) nach Vorgabe der Fachinformationen erhalten. Ein vorheriges isoliertes Screening auf Komplementdefekte ist für die Impfentscheidung bei diesen Patienten nicht erforderlich.

Recurrent invasive meningococcal infections - quantifying the risk, Germany, 2002 to 2018

Introduction

Invasive meningococcal disease (IMD) is a rare condition with a high case fatality rate. While most patients suffer from one single episode in life, there is anecdotal evidence for recurrent infection.

Aim

The German National Reference Laboratory for Meningococci and Haemophilus influenzae (NRZMHi) analysed IMD cases from 2002 to 2018 to retrospectively quantify the risk of recurrent infection.

Methods

Recurrent IMD was defined as detection of Neisseria meningitidis in a sample of the same patient more than 30 days after the first episode of IMD.

Results

Among 5,854 patients with a median observation period of 9.4 years, 14 suffered a second IMD episode and one patient a third one. The risk of a recurrent IMD was 29.4 per 100,000 person-years for survivors of the first episode. Rare serogroups (Y, W, E and Z) were more common in patients with recurrent IMD (p < 0.0001).

Discussion

Patients surviving IMD were at least at a 50-fold risk of another IMD episode compared with the general population. The study most likely underestimated the risk of recurrent infection. Increased risk may be due to undiagnosed complement deficiencies. The high risk of re-infection argues for vaccination of patients who have survived IMD.

Primary meningococcal arthritis as a presentation of nodal marginal zone lymphoma

A 68-year-old man presented with a 4-day history of worsening knee and arm pain. On examination, there was erythema and swelling of the left knee and both wrists. Joint aspiration grew Neisseria meningitidis Blood tests showed an unusually high total protein level (100 g/L) and an IgM kappa paraprotein band of 45 g/L on protein electrophoresis. CT showed widespread lymphadenopathy, hepatosplenomegaly and multilevel thoracic vertebral collapse. A bone marrow biopsy revealed a lymphoplasmacytic infiltrate and a lymph node biopsy showed features of nodal marginal zone lymphoma with plasmacytic differentiation.

Bacteremia in an immunocompromised patient caused by a commensal Neisseria meningitidis strain harboring the capsule null locus (cnl)

We recently described the capsule null locus (cnl) of constitutively unencapsulated Neisseria meningitidis clonal lineages. cnl meningococci were recovered from healthy carriers at high frequency. We here report on the first case of invasive disease caused by cnl meningococci in a severely immunosuppressed patient with chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplantation. The sequence type 845 strain was extensively typed and, furthermore, shown to be sensitive to serum bactericidal activity.