N. meningitidis 감염과 관련된 위험 인자 중에 complement deficiency가 있습니다. Underlying terminal complement 또는 properdin 결핍의 가능성은 10 세 이후에 Neisserial disease가 처음으로 발생한 환자들, N. meningitidis의 특이 혈청 그룹에 감염되거나 재발 또는 재발을 겪는 환자에서에서 더 높았습니다. 이 환자들은 대개 경미한 경과를 보이며 다른 인구 집단에 비해 사망률이 낮습니다(3 ~ 4 % 대 6 ~ 12 %).
Complement deficiency involving early and late components of the complement system have been associated with increased susceptibility to meningococcal infection. In one study including 20 patients with sporadic meningococcal infection, six were demonstrated to have a complement deficiency, three in terminal complement protein(s) and three in multiple factors with accompanying underlying diseases
Terminal complement component deficiency와 관련된 host defense defects은 meningococcal disease 및 disseminated gonococcal disease와 관련이 있습니다.
The host defense defects associated with a terminal complement component deficiency are associated with meningococcal disease and disseminated gonococcal disease. Deficiencies of C3 and properdin are also associated with defective defense against Neisserial species, which is probably due to the key role of these components in efficiently activating C5 to C9. Polymorphisms in the genes for complement factor H (CFH), a regulator of complement activity, have also been associated with meningococcal susceptibility
Eculizumab은 hemolytic uremic syndrome과 paroxysmal nocturnal hemoglobinuria 치료를 위해 사용되는 monoclonal antibody terminal complement inhibitor입니다. Eculizumab을 투약하는 것은 수막구균 질환의 1000배~2000배 발생률 증가와 관련이 있었습니다. 생명을 위협하고 치명적인 뇌수막염 감염이 eculizumab으로 치료 받은 환자에서 발생했습니다. Eculizumab 치료를 하는 환자에서 뇌수막염 감염 예방과 관련된 내용은 별로도 논의합니다.
Host immune defects predisposing to meningitis
|
Host problem |
Organism favored |
Frequency of defect actually leading to infection |
|
Absence of opsonizing antibody |
Streptococcus pneumoniae |
Common in all age groups |
|
Haemophilus influenzae |
Common in very young children |
|
|
Asplenia: surgical or functional |
S. pneumoniae |
Rare |
|
Neisseria meningitidis |
Very rare |
|
|
Complement deficiency |
N. meningitidis |
Very rare |
|
Glucocorticoid excess |
Listeria monocytogenes |
Rare |
|
Cryptococcus neoformans |
Rare |
|
|
HIV infection |
C. neoformans |
About 5 percent eventually get cryptococcal meningitis |
|
S. pneumoniae |
Common presenting illness |
|
|
L. monocytogenes |
Rare |
|
|
Bacteremia/endocarditis |
Staphylococcus aureus; various gram-negative rods |
Rare |
|
Basilar skull fracture |
S. pneumoniae; other upper respiratory tract flora |
Very rare |
HIV: human immunodeficiency virus.
REF. UpToDate 2019.05.06
