[Treatment with rituximab as an opportunity for the prevention of infectious complications].
Rituximab, a monoclonal antibody against the surface antigen of B-lymphocytes CD20 is beeing used in the treatment of numerous hematological, hematooncological and autoimmune disorders. After administration of ritu-ximab, quick and almost complete depletion of B-lymphocytes with the exception of pre-B-lymphocytes and plasma cells occur. Neutropenia and low serum antibody levels in classes IgA, IgM and IgG may also develop. These changes usually persist for 6-12 months, rarely for several years. In the consequence, patients with the rituximab treatment are more prone to infections - usually of bacterial and viral origin. Concomitantly, rituximab treatment influences negatively postvaccination antibody production and therefore adequate preventive measures are necessary before the beginning of the treatment. The authors offer complex overview of actual literature, emphasize adequate education of patients as well as of healthcare providing staff and discuss the vaccination recommendation against preventable communicable diseases like influenza, pneumococcal diseases, tetanus, diphtheria and pertussis.


BACKGROUND
autoimmune disease - immunosupression - infectious complications - prevention - rituximab - vaccination.
Pavel
P
Polák
Miroslav
M
Penka
Petr
P
Smejkal
Gabriela
G
Chlupová
D000906:Antibodies / Q000097:blood / Q000187:drug effects; D000917:Antibody Formation / Q000187:drug effects; D001327:Autoimmune Diseases / Q000188:drug therapy; D001402:B-Lymphocytes / Q000187:drug effects / Q000378:metabolism; D001424:Bacterial Infections / Q000517:prevention & control*; D005260:Female; D006402:Hematologic Diseases / Q000188:drug therapy; D019337:Hematologic Neoplasms / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D009503:Neutropenia / Q000139:chemically induced; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use; D014611:Vaccination; D014777:Virus Diseases / Q000517:prevention & control*
D000906:Antibodies; D007155:Immunologic Factors; D000069283:Rituximab