Pneumococcal Meningitis during Antiviral Treatment with Interferon and Ribavirin in a Splenectomized Patient with Chronic Hepatitis C – Do Not Miss Vaccination before Starting Therapy

Zusammenfassung

Wir berichten über einen 35-jährigen Patienten mit Pneumokokken-Meningitis während einer antiviralen Therapie mit Interferon (Consensus-Interferon, CIFN) und Ribavirin aufgrund einer chronischen Hepatitis C. Vier Tage nach Symptombeginn wurde eine antibiotische Therapie begonnen. Leider entwickelte der Patient im weiteren Verlauf eine persistierende rechtsseitige Cochleaschwerhörigkeit. Die chronische Hepatitis C heilte aus. Im Alter von 14 Jahren war es infolge eines Verkehrsunfalls zur Transfusion mehrerer Erythrozytenkonzentrate und zur Splenektomie gekommen. Ein Impfstoff gegen Streptococcus pneumoniae war zu dieser Zeit noch nicht verfügbar. Splenektomierte Patienten ohne entsprechenden Impfschutz sollten daher vor Einleitung einer immunmodulatorischen Therapie eine Vakzinierung gegen Pneumokokken erhalten.

Abstract

We report on a 35-year-old man who developed pneumococcal meningitis while receiving antiviral therapy with interferon (consensus interferon, CIFN) and ribavirin for chronic hepatitis C. Antibiotic therapy was started four days after the onset of symptoms. Unfortunately, the patient developed a persisting right-sided cochlear hearing impairment. Antiviral therapy led to sustained viral response of hepatitis C. At the age of 14 years he had experienced a hemorrhagic shock after a traffic accident, received multiple blood transfusions and undergone a splenectomy. He had not received vaccination against Streptococcus pneumoniae. This case report reminds us that splenectomized patients without previous pneumococcal vaccination should receive such vaccination before immunomodulatory treatment.

Schlüsselwörter

Hepatitis C - bakterialle Meningitis - Pneumococcus - Interferon - Ribavirin - non-response - Vakzinierung - Splenektomie

Key words

Hepatitis C - bacterial meningitis - Pneumococcus - Interferon - Ribavirin - non-response - vaccination - splenectomy

References

• 1 Örtqvist A, Hedlund J, Kalin M. Streptococcus pneumoniae: epidemiology, risk factors, and clinical features.  Sem Resp Crit Care Med. 2005;  26 563-574
• 2 Bisharat N, Omari H, Lavi I. et al . Risk of infection and death among post-splenectomy patients.  J Infect. 2001;  43 182-186
• 3 Durand M L, Calderwood S B, Weber D J. et al . Acute bacterial meningitis in adults. A review of 493 episodes.  N Engl J Med. 1993;  328 21-28
• 4 Schuchat A, Robinson K, Wenger J D. et al . Bacterial meningitis in the United States in 1995. Active Surveillance Team.  N Engl J Med. 1997;  337 970-976
• 5 Kastenbauer S, Pfister H W. Pneumococcal meningitis in adults – spectrum of complications and prognostic factors in a series of 87 cases.  Brain. 2003;  126 1015-1025
• 6 Scheld M, Koedel U, Nathan B. et al . Pathophysiology of bacterial meningitis: mechanisms of neuronal injury.  J Infect Dis. 2002;  186 (Suppl 2) S225-233
• 7 Global burden of hepatitis C Working Group . Global burden of disease (GBD) for hepatitis C.  J Clin Pharmacol. 2004;  44 20-29
• 8 Manns M P, Wedemeyer H, Cornberg M. Treating viral hepatitis C: efficacy, side effects, and complications.  Gut. 2006;  55 1350-1359
• 9 Cooper C L, Al-Bedwawi L, Lee C. et al . Rate of infectious complications during interferon-based therapy for hepatitis C is not related to neutropenia.  Clin Infect Diseases. 2006;  42 1674
• 10 Puoti M, Babudieri S, Rezza G. et al . Use of pegylated interferons is associated with an increased incidence of infections during combination treatment of chronic hepatitis C: a side effect of pegylation?.  Antiviral Therapy. 2004;  9 627-630
• 11 Vander T, Medvedovsky M, Hallevy C. et al . Listeria monocytogenes meningitis in a patient with chronic hepatitis C infection, treated by interferon alpha and ribavirin.  Infection. 2003;  46 70-71
• 12 Cornberg M, Hadem J, Herrmann E. et al . Treatment with daily consensus interferon (CIFN) plus ribavirin in non-responder patients with chronic hepatitis C: A randomized open-label pilot study.  J Hepatol. 2006;  44 291-301
• 13 Robert-Koch-Institut. Empfehlungen der Ständigen Impfkommission (STIKO) am Robert-Koch-Institut 2006.  Epidemiologisches Bulletin. 2006;  30 235-254
• 14 Dear K, Holden J, Andrews R. et al . Vaccines for preventing pneumococcal infection in adults.  Cochrane Database Syst Rev. 2003;  4 CD000422
• 15 Melegaro A, Edmunds W J. The 23-valent pneumococcal polysaccharide vaccine, I: Efficacy of PPV in the elderly: a comparison of meta-analyses.  Eur J Epidemiol. 2004;  19 353-563
• 16 Butler J C, Breiman R F, Campbell J F. et al . Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations.  JAMA. 1993;  270 1826-1831
• 17 Potthoff A, Sarhaddar J, Wiegand J. et al . Spontaneous resolution of chronic hepatitis C virus infection after antiviral therapy and relapse.  Hepatol Res. 2005;  31 18-23