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Colegio de Medicina Interna de México.

2014, Number 5

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Med Int Mex 2014; 30 (5)

Overwhelming postsplenectomy infection secundary to Streptococcus pneumoniae in liver transplantation

Carrillo-Esper R, Peña-Pérez CA, de los Monteros-Estrada IE, de la Torre-León T, Rosales-Gutiérrez AO, Nava-López JA, Zepeda-Mendoza AD, Pérez-Calatayud ÁA, Díaz-Carrillo MA, Rangel-Olascoaga CR, Lazcano-Romero I

Language: Spanish
References: 53
Page: 591-601
PDF size: 778.99 Kb.


ABSTRACT

Patients with splenectomy or splenic dysfunction are likely to suffer from severe infections and sepsis. This syndrome is called overwhelming postsplenectomy infection (OPSI). We present an adult case of OPSI syndrome secondary to Streptococcus pneumoniae, seven years after having performed splenectomy for mesenteric thrombosis with splenic venous involvement and antecedent of orthotopic liver transplantation. OPSI syndrome is associated with a high mortality. The course is rapid, the clinical symptoms are serious and the prognosis is poor. It is important for splenectomized patients to receive immunizations, antibiotic prophylaxis and seek medical attention at the earliest sign of minor infection. Public health politics should improve the implementation of guidelines related to the monitoring of splenectomized patients and prophylaxis, diagnosis and treatment of OPSI syndrome and give better information to patients and physicians in relation to this disease.


REFERENCES

  1. Weintraub LR. Splenectomy: Who, when and why? Hosp Pract 1994;29:27-34.

  2. Rowley DA. The formation of circulating antibody in the splenectomized human being following intravenous injection of heterologous erythrocytes. J Immunol 1950:65;515-521.

  3. Dellinger RP, Levy MM, Carlet JM, Bion J, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327.

  4. Hosea SW, Brown EJ, Hamburger MI, Frank MM. Opsonic requirements for intravascular clearance after splenectomy. N Engl J Med 1981;304:245.

  5. Styrt B. Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990;88:33.

  6. Lynch AM, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 1996;4:693-707.

  7. Green JB, Shackford SR, Sise MJ, Fridlund P. Late septic complications in adults following splenectomy for trauma: A prospective analysis in 144 patients. J Trauma 1986;26:999-1004.

  8. Brigden ML. Overwhelming post-splenectomy infection-still a problem. West J Med 1992;157:440-443.

  9. Jones P, Leder K, Woolley I, Cameron P, et al. Postsplenectomy infection. Strategies for prevention in general practice. Australian Family Physician 2010;39:383-386.

  10. Morris DH, Bullock FD. The importance of the spleen in resistance to infection. Ann Surg 1919:70;513-521.

  11. O’Donnell FJ. The value of splenectomy in Banmti’s disease. Br Med J 1929;824.

  12. King H, Shumacker HB Jr. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 1952:136;239- 242.

  13. Schwartz PE, Sterioff S, Mucha P, Melton III LJ, Offord KP. Postsplenectomy sepsis and mortality in adults. JAMA 1982;248:2279-2283.

  14. Demeshek W. Hypoesplenism. JAMA 1955;157:613.

  15. Doll DC, List AF, Yarbro JW. Functional hyposplenism. South Med J 1987;80:999-1006.

  16. Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011;378:86-97.

  17. Weitzman S, Aisenberg AC. Fulminant sepsis after the successful treatment of Hodgkin’s disease. Am J Med 1977;62:47.

  18. Kyaw MH, Holmes EM, Toolis F, Wayne B, et al. Evaluation of severe infection and survival after splenectomy. Am J Med 2006;119:1-276.

  19. Gopal V, Bisno AL. Fulminant pneumococcal infections in “normal” asplenic hosts. Arch Intern Med 1977;137:1526.

  20. Zarrabi MH, Rosner F. Serious infections in adults following splenectomy for trauma. Arch Intern Med 1984;144:1421.

  21. Thomsen RW, Schoonen WM, Farkas DK, Riis A, et al. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med 2009;151:546-555.

  22. Stryker RM, Orton DW. Overwhelming postsplenectomy infection. Ann Emerg Med 1988;17:161-164.

  23. Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg 1991;78:716- 721.

  24. Holdsworth R, Irving A, Cuschieri A. Postsplenectomy sepsis and its mortality rate actual versus perceived risks. Br J Surg 1991;78:1031-1038.

  25. Spencer SP, Gupta SM. The spleen: diagnosis of splenic diseases using radiolabeled tracers. Crit Rev Lab Sci 1989;27:299-318.

  26. Peter AM, Ryan PFJ, Klonizakis I, Elkon KB, et al. Measurement of splenic function in humans using heat damaged autologous red blood cells. Scand J Haematol 1981;27:374- 380.

  27. Corazza GR, Ginaldi L, Zoli G, Frisoni M, et al. Howell-Jolly body counting as a measure of splenic function: A reassessment. Clin Lab Haematol 1990;12:269-275.

  28. Lane PA, O’Connell JL, Lear JL, Rogers ZR, et al. Functional asplenia in hemoglobin SC disease. Blood 1995;85:2238- 2244.

  29. Department of Health. Immunisation Against Infectious Disease (The Green Book) HMSO, London 2010. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_079917 (accessed on 09 September 2011).

  30. Working party of the British Committee for Standards in Haematology Clinical Haematology Task Force. Guidelines for the prevention and treatment of infection in patients with an absent of dysfunctional spleen. BMJ 1996;312:430- 434.

  31. Stanford E, Print F, Falconer M, Lamden K, et al. Immune response to pneumococcal conjugate vaccine in asplenic individuals. Human Vaccination 2009;5:85-91.

  32. Balmer P, Cant AJ, Borrow R. Anti-pneumococcal antibody titre measurement: what useful information does it yield? J Clin Pathol 2007;60:345-350.

  33. Shatz DV. Vaccination considerations in the asplenic patient. Expert Rev Vaccines 2005;4:27-34.

  34. Harji DP, Jaunoo SS, Mistry P, Nesargikar PN. Immunoprophylaxis in asplenic patients. Int J Surg 2009;7:421-423.

  35. Musher DM, Ceasar H, Kojic EM, Musher BL, et al. Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine. J Infect Dis 2005;191:1063- 1067.

  36. Whitney CG. Preventing pneumococcal disease. ACIP recommends pneumococcal polysaccharide vaccine for all adult age > or = 65. Geriatrics 2003;58:20-22,25.

  37. Davies JM, Barnes R, Milligan D. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002;2:440- 443.

  38. Davies JM, Lewis MP, Wimperis J, Rafi I, et al. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force. Br J Haematol 2011;155:308-317.

  39. Jockovich M, Mendelhall NP, Sombeck MD, Talbert JL, et al. Long-term complications of laparotomy in Hodgkin’s disease. Ann Surg 1994;219:615-621;discussion, 621-624.

  40. Ambrosino DM, Siber GR. Simultaneous administration of vaccines for Haemophilus influenzae type B, pneumococci and meningococci. J Infect Dis 1986;154:893-896.

  41. Salisbury DM, Begg NT, editors. Immunisation against infectious disease. London: HMSO, 1996.

  42. Mourtzzoukou E, Pappas G, Peppas G, Falgas ME. Vaccination of asplenic or hyposplenic adult. Br J Surg 2008;95:273- 280.

  43. Pao M, Papadopoulos EB, Chou J, Glenn H, et al. Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccine (HIB) in paediatric and adult recipients of an allogeneic hematopoietic stem cell transplantation (alloHCT). Biology of Blood and Marrow Transplantation 2008;14:1022-1030.

  44. Snape MD, Perret KP, Ford KJ. Immunogenicity of a tetravalent meningococcal glycoconjugate vaccine in infants; a randomized controlled trial. J Ame Med Ass 2008;299:173- 184.

  45. Riddington C, Owusu-Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Systematic Review 2002;68:157-162.

  46. Cummins D, Heuschkel R, Davies SC. Penicillin prophylaxis in children with sickle cell disease in Brent. Br Med J 1991;302:989-990.

  47. William BM, Thawani N, Sae-Tia S, Corazza GR. Hyposplenism: A comprehensive review. Part II: Clinical manifestations, diagnosis and treatment. Haematology 2007;12:89-98.

  48. Malangoni MA, Dillon LD, Klamer TW, Condon RL. Factors influencing the risk of early and late serious infection in adult after splenectomy for trauma. Surgery 1984;96:775-783.

  49. Keenan RD, Boswell T, Milligan DW. Do post-splenectomy patients take prophylactic penicillin? Br J Haematol 1999;105:509-510.

  50. Spickett GP, Bullimore J, Wallis J, Smith S, Sounders P. Northern region asplenia register analysis of first two years. J Clin Pathol 1999;52:424-429.

  51. Davidson RN, Wall RA. Prevention and management of infections in patients without a spleen. Clin Microbiol Infect 2001;7:657-660.

  52. Woolley I, Jones P, Spelman D, Gold L. Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic. Australian and New Zealand Journal of Public Health 2006;30:558-561.

  53. Takeda K, Morioka D, Kumamoto T, Matsuo K, et al. A survival case of ABO-incompatible liver transplantation complicated with severe preoperative infection and subsequent overwhelming postsplenectomy infection. Transplantation Proc 2009;41:3941-3944.




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