Listeria Meningitis Associated with Infliximab

Abstract

The listeria infection in our patient was a possible adverse event of infliximab according to the Naranjo probability scale. Because the majority of listeria infections occur in patients who are immunosuppressed, it would be reasonable to provide education for healthcare professionals on preventing these infections in all patients receiving immunosuppressants, including anti-TNF-alpha therapy. Those at risk due to their underlying health conditions should also be monitored closely.

Anti-tumor necrosis factor α F(ab')2 antibody fragments protect in murine polymicrobial sepsis: Concentration and early intervention are fundamental to the outcome

“…To do this it is necessary to standardize markers that make it possible to assess the immunological status of the patients in order to evaluate if any therapy with anti-cytokine antibodies could be benefi cial or not to a particular patient. Recent results, which show that chimeric anti-TNFa monoclonal antibodies administered chronically to patients with rheumatoid arthritis increase susceptibility to infection in some patients [50][51][52][53][54], support the need to reassess doses, timing and possible duration of the anti-cytokine therapies. In conclusion, this study demonstrates that neither high nor very low concentrations of anti-TNFa are the most adequate for treating polymicrobial sepsis, since they did not signifi cantly improve survival of mice challenged with CLP.…”

DifferentialRequirements for Soluble and Transmembrane Tumor Necrosis Factor in theImmunological Control of Primary and SecondaryListeria monocytogenesInfection

“…The two commonly used TNF antagonists are the monoclonal antibody infliximab and the soluble TNFRII fusion protein etanercept (30). Infliximab, which has high affinity for both solTNF and memTNF, has been associated with a higher frequency of infectious complications, such as tuberculosis reactivation and listerial meningitis, than etanercept, which binds predominantly to solTNF (2,9,35). Indeed, this is consistent with our findings that memTNF is sufficient to orchestrate protective immunity against a low-dose Listeria infection but cannot fully compensate for the lack of solTNF during a high-dose infection.…”

Bacterial meningitis associated with infliximab

“…Other adverse reactions, affecting the central nervous system including headache have been described [8]. Several cases in the literature demonstrate the occurrence of aseptic meningitis during infliximab treatment, while others demonstrate the presence of listeria meningitis [9][10][11][12]. This case is the first in literature to our knowledge that shows the occurrence of bacterial meningitis (Streptococcus pneumoniae) in association with infliximab treatment.…”