Clinical Oncology NewsArboviral Infections Pose Serious Risks to Patients on Rituximab

Enhanced Risk of Arboviral Infections in Rituximab Patients: Implications for Diagnosis and Treatment

In light of recent findings, physicians are urged to consider the elevated risk of neuroinvasive arboviral infections among patients undergoing rituximab therapy. A comprehensive study has highlighted the significant challenges in diagnosing and managing infections in this population, underscoring the necessity for heightened vigilance and advanced diagnostic approaches. This summary distills the crucial insights and recommendations for healthcare professionals, aiming to foster improved patient outcomes through awareness and strategic care.

Key Points:

• Rituximab-associated Risks: Patients on rituximab face a high risk of developing neuroinvasive diseases following arboviral infections, with a mortality rate exceeding 70% among those diagnosed.
• Diagnostic Challenges: Traditional serological testing often fails in rituximab patients due to B-cell depletion, necessitating molecular testing to detect viral RNA for accurate diagnosis.
• Study Findings: A review identified 21 rituximab patients with arboviral diseases, all presenting with severe neuroinvasive manifestations; more than 70% succumbed to their infections.
• Infection Characteristics: The majority were infected with the West Nile virus, alongside other noted arboviruses. Infections typically occurred between June and September, shortly after the latest rituximab dose.
• Symptomatology and Outcomes: Symptoms ranged from febrile illness to severe neurological impairments, with a significant portion of patients experiencing long-term disabilities or death.
• Prevention and Awareness: There are no established treatments for arboviral diseases, highlighting the importance of preventive measures and the need for increased awareness among clinicians and patients about the risks associated with B-cell depleting therapies.
• Clinical Implications: Physicians should consider the risk of severe arboviral infections in patients with B-cell depletion and adapt their diagnostic approach to include molecular testing.
• Research Limitations: The study’s retrospective nature and the absence of data on newer anti-CD20 and anti-CD19 agents suggest areas for further investigation.

“Clinicians should be aware that because of the profound B-cell depletion caused by rituximab and similar therapies, patients often cannot mount an antibody response to the infection. So they need molecular testing to detect the viral RNA for diagnosis, which is not the usual testing we recommend for most cases of domestic arboviral disease.”
– Carolyn V. Gould, MD, CDC’s Division of Vector-Borne Diseases, Fort Collins, CO

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