Eculizumab-Associated Moraxella lacunata Bacteremia and Systemic Inflammatory Response Syndrome in a Toddler with Atypical Hemolytic Uremic Syndrome

Abstract

Moraxella lacunata, a low-virulence Gram-negative coccobacillus, is classically associated with conjunctivitis and upper respiratory tract infections; systemic infections such as sepsis have rarely been reported, especially in children. We describe a 28-month-old girl with atypical hemolytic uremic syndrome and stage II chronic kidney disease on long-term eculizumab therapy who presented with systemic inflammatory response syndrome and was found to have Moraxella lacunata bloodstream infection. Eculizumab, a humanized monoclonal anti-C5 antibody, has been associated with susceptibility to infections with encapsulated bacteria, especially Neisseria meningitidis. This is the first report of an invasive bacterial infection with Moraxella lacunata in a pediatric eculizumab recipient.

Eculizumab's Unintentional Mayhem: A Systematic Review

“…Of the 64 articles found via citation searching, 44 records were assessed for eligibility. After further assessment, it was determined that the review inclusion criteria were met by 10 studies [2,5,6,8,9,10,11,12,13,14]. The PRISMA flow diagram is shown in Figure 1.…”

“…It can, nevertheless, act as an opportunistic pathogen in an immunocompromised host. Bicoll et al's case report is the first to describe Moraxella lacunata bacteremia and SIRS in an immunedeficient child as a result of eculizumab treatment [10]. Moraxella lacunata infection is described in Figure 3.…”

“…Another commensal organism that has been a culprit in causing infection with the use of eculizumab is Moraxella lacunata. It is a gramnegative coccobacillus found in the upper respiratory tract and conjunctiva and is known to cause bacteremia and systemic inflammatory response syndrome (SIRS) in one of the cases receiving eculizumab for aHUS [10]. There have been instances where infections by Pseudomonas aeruginosa, Aspergillus niger, polyomavirus John Cunningham (JC) virus, and herpes simplex virus have been documented while the patient was treated with eculizumab [11].…”

Infective Endocarditis by Moraxella Species: A Systematic Review

“…For example, M. catarrhalis has been shown to colonize the respiratory tract of individuals, sometimes allowing the development of diseases such as otitis media, lower respiratory tract in COPD or older patients, nosocomial pneumonia, sinusitis and bacteremia [ 1 ]. Experience from infections by other species of the Moraxella genus is rare, with few infections being mentioned in the literature, such as keratitis, endophthalmitis, bacteremia, osteomyelitis, septic arthritis and endocarditis, even though reporting of such rare species may be highly influenced by publication bias [ 41 , 48 , 49 , 50 , 51 , 52 , 53 ].…”