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asplenic patient

Th J M Verheij
The lifetime risk of dying from sepsis is approximately 2-3% in persons with (functional) asplenia. Both patients and their physicians are not always fully aware of these risks and the implementation of preventive measures is insufficient. Physicians should inform both patients and colleagues on the consequences of lost splenic function. Primary care physicians should screen their lists for patients with (functional) asplenia and offer these patient adequate preventive measures when needed.
2016: Nederlands Tijdschrift Voor Geneeskunde
Bridget E Barber, Matthew J Grigg, Timothy William, Tsin W Yeo, Nicholas M Anstey
BACKGROUND: Haemoglobinuria is an uncommon complication of severe malaria, reflecting acute intravascular haemolysis and potentially leading to acute kidney injury. It can occur early in the course of infection as a consequence of a high parasite burden, or may occur following commencement of anti-malarial treatment. Treatment with quinine has been described as a risk factor; however the syndrome may also occur following treatment with intravenous artesunate. In Malaysia, Plasmodium knowlesi is the most common cause of severe malaria, often associated with high parasitaemia...
2016: Malaria Journal
Thomas J Marrie, Gregory J Tyrrell, Sumit R Majumdar, Dean T Eurich
OBJECTIVES: Most are aware of pneumococcal infection as a complication of splenectomy and the increased risk of severe invasive pneumococcal disease (IPD) in asplenic patients. However little is known of the current status of this entity in a population with an active pneumococcal conjugate vaccine program for children. METHODS: All IPD cases reported from 2000 to 2014 in Northern Alberta, Canada were collected prospectively. Socio-demographic variables, clinical characteristics, and IPD-related outcomes were compared between patients with and without a spleen using the Student t-test, Chi-square test, or Fisher's exact test, as appropriate...
August 30, 2016: International Journal of Infectious Diseases: IJID
Andrew J Hale, Mary LaSalvia, James E Kirby, Allison Kimball, Rachel Baden
Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock...
2016: IDCases
R I Claassen, C Savelkoul, M A Schouten, D H T Tjan
Post-splenectomy sepsis is a serious condition with high mortality rates. We present a case of a 64-year-old patient with a medical history of splenectomy who was referred to the Emergency Department with a fever, shivers, and an altered mental state. The symptoms had started twelve hours before. Upon arrival in the hospital the patient was tachypnoeic, hypotensive and febrile. Blood cultures were taken and broad-spectrum antibiotics were started. He was directly admitted to the Intensive Care Unit with severe sepsis of unknown aetiology...
2016: Nederlands Tijdschrift Voor Geneeskunde
Maliha Khan, Cheng C Yin, Amber Yates, Kate J Newberry, Srdan Verstovsek
Primary myelofibrosis (PMF) is rarely diagnosed in children, and in most cases in children younger than 3 years old. Pediatric PMF generally follows a benign course and is usually managed supportively with blood transfusions and prophylactic antibiotics for infections. We present a case of a 17-year-old girl diagnosed with PMF at the age of 14 years. A computed tomography scan performed at the time of an appendectomy showed congenital asplenism. To our knowledge, this is only the third case of myelofibrosis and congenital asplenism to be reported in the literature...
July 11, 2016: Journal of Pediatric Hematology/oncology
Heba Hussein, Ronald S Brown
A review of the published literature revealed that discourse on the topic of antibiotic prophylaxis guidelines for the asplenic dental patient is limited and that guidelines regarding this issue have not been updated for years. The review determined that the professional protocol for the treatment of asplenic dental patients has changed over the last 30 years, particularly with reference to adult patients. Furthermore, as dentists and physicians now understand that blood-borne bacteremias are produced from everyday occurrences such as chewing and toothbrushing, bacteremias secondary to dental procedures are no longer viewed as seriously as in the past; therefore, the guidelines for antibiotic prophylaxis have changed...
July 2016: General Dentistry
Rhonda J Hammerquist, Kimberly A Messerschmidt, April A Pottebaum, Thaddaus R Hellwig
PURPOSE: The recommended immunizations for adult asplenic patients are reviewed. SUMMARY: Patients without a spleen are at risk of developing overwhelming postsplenectomy infections due to encapsulated organisms, mainly pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib). Due to the high mortality rates associated with these infections, vaccinations are recommended as a preventive measure. It is challenging to ensure optimal immunizations in these high-risk patients due to the number of recommended vaccines, the availability of multiple formulations, and the inability to administer specific formulations at the same time, as well as differences in subsequent vaccine administration schedules...
May 1, 2016: American Journal of Health-system Pharmacy: AJHP
Hollis R O'Neal, Alexander S Niven, George H Karam
The critically ill, asplenic patient presents a variety of management challenges. Historically, the focus of the care of the asplenic population has been the prevention and management of infection, including the often-fatal overwhelming post-spenectomy infection with encapsulated organisms such as Streptococcus pneumoniae. Recently, however, there has been increasing recognition of the spleen's function in areas outside of immunity, as the asplenic state has been recognized as a risk factor for such vascular complications as thrombosis and pulmonary hypertension due to dysregulated inflammation and coagulation...
April 8, 2016: Chest
Theocharis Koufakis, Ioannis Gabranis, Marianneta Chatzopoulou, Anastasios Margaritis, Maria Tsiakalou
We here report a case of Legionnaires' disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severe Legionella infections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients with Legionella infection cannot be excluded, deserving further investigation in the future...
2015: Case Reports in Infectious Diseases
Robin L Jump, Richard Banks, Brigid Wilson, Michelle M Montpetite, Rebecca Carter, Susan Phillips, Federico Perez
We developed a "virtual clinic" to improve pneumococcal vaccination among asplenic adults. Using an electronic medical record, we identified patients, assessed their vaccination status, entered orders, and notified patients and providers. Within 180 days, 38 of 76 patients (50%) received a pneumococcal vaccination. A virtual clinic may optimize vaccinations among high-risk patients.
December 2015: Open Forum Infectious Diseases
Hendt P Versteegh, Stephen D Adams, Sally Boxall, David M Burge, Michael P Stanton
AIM: Antenatal detection of right-sided stomach (dextrogastria) is rare, and its significance in regards to intestinal rotation is unclear. We aimed to review all cases of antenatally-diagnosed dextrogastria in our regional fetal medicine unit over 10years. METHODS: A retrospective case-note review of patients identified from a prospectively-maintained database was performed. RESULTS: Twenty cases of antenatally-diagnosed dextrogastria were identified from 2004 to 2014...
February 2016: Journal of Pediatric Surgery
Semiha Bahceci Erdem, Ferah Genel, Baris Erdur, Erhan Ozbek, Nesrin Gulez, Timur Mese
The absence of a spleen is a well-known risk factor for severe bacterial infections, especially due to encapsulated bacteria. Congenital asplenia can be part of multiple congenital abnormalities as in heterotaxy including Ivemark syndrome with congenital anomalies of the heart or great vessels, or it can be isolated, which is extremely rare. In these cases, asplenia is an important factor effecting mortality. In this report, the clinical courses of five children with asplenia and concomitant minor or complex cardiac anomalies are presented...
2015: Central-European Journal of Immunology
Wioletta Rożej-Bielicka, Hanna Stypułkowska-Misiurewicz, Elżbieta Gołąb
Babesiosis is an emerging parasitic, anthropo-zoonotic tick-borne disease, seldom diagnosed in humans. Caused by Protozoa, Babesia (also called Piroplasma) intraerytrocytic piriform microorganism. Infection of vertebrates is transmitted by ticks. Out of more than 100 Babesia species/genotypes described so far, only some were diagnosed in infected humans, mostly B. microti, B. divergens and B. venatorum (Babesia sp. EU1). Infection in humans is often asymptomatic or mild but is of a particular risk for asplenic individuals, those with congenital or acquired immunodeficiencies, and elderly...
2015: Przegla̧d Epidemiologiczny
Sait Murat Doğan, Ahmet Aykas, Evrim Şefika Yücel, Gökalp Okut, Cenk Şimşek, Kürşat Çayhan, Baha Zengel, Adam Uslu
OBJECTIVE: Splenectomy poses a lifelong threat for the development of uncontrolled sepsis despite vaccination. As it is impractical to measure the levels of each antibody against 23 most frequent bacterial serotypes, different surrogate markers of immune response should be identified. MATERIAL AND METHODS: Forty-eight patients with benign disorders were vaccinated with Pneumo-23 and Act-HIB before or at the day of surgery. The immunological response and opsonization capacity of the patients after splenectomy was analyzed through the quantitative measurement of IgG, IgM, C3, and C4 titers; flow-cytometric analysis of (CD3+) T-lymphocytes and (CD19+) B-lymphocytes; and isolation of CD27+ B cells by immunomagnetic positive selection...
2015: Ulusal Cerrahi Dergisi
Allison Paine, Tadashi Miya, Brandon J Webb
Q fever is an uncommon but likely underreported zoonotic infection. Severe hyperferritinemia has been associated with hemophagocytic lymphohistiocytosis and other infectious diseases. In this study, we report a case of Coxiella burnetii infection in an asplenic patient complicated by severe hyperferritinemia and bone marrow infiltration. In this case, the marked ferritin elevation may have been an indicator of profound systemic macrophage activation due to preferential intracellular infection of this cell type by C burnetii, perhaps exacerbated by altered mononuclear phagocyte system function in the setting of asplenia...
December 2015: Open Forum Infectious Diseases
Ernest Kuchar, Katarzyna Miśkiewicz, Monika Karlikowska
The spleen acts as a blood filter and lymphopoietic organ. Asplenic and hyposplenic individuals are more susceptible to serious infections caused by encapsulated bacteria but they can be protected by antibiotic prophylaxis and immunizations. Recent progress in vaccinology means prophylaxis is now successful in the vast majority of serious infections with pneumococci, meningococci and Haemophilus influenzae type b responsible for the majority of cases of overwhelming sepsis in asplenic patients. Current guidelines are coherent...
December 2015: British Journal of Haematology
Alexandre Balaphas, Jeremy Meyer, Stephan Harbarth, Gaél Amzalag, Léo H Buhler, Philippe Morel
Spleen gathers numerous functions and plays a critical role in immunity against encapsulated bacteria. Anatomical injuries or physiological spleen dysfunctions can lead to complete (asplenism) or partial (hyposplenism) functional deficits and expose the patient to the risk of fulminant sepsis, as well as to thromboembolic complications. The purpose of this article is to provide the primary care physician with the tools needed to identify functional disorders of the spleen and to prevent their complications...
June 17, 2015: Revue Médicale Suisse
V Atquet, F Lienart, M Vaes
We describe a woman aged 37  years, affected with Hashimoto's thyroiditis, detected since the age of 17, with gonadic insufficiency with anti-ovarian antibodies since the age of 22  years and Addison's disease since 24  years old. At that moment, the diagnosis of autoimmune polyendocrine syndrome (APS) was made. Concomitant to this diagnosis, thrombocytosis was detected and aetiological assessment revealed an atrophy of the spleen. Differential diagnoses of APS and hyposplenism will be discussed. We will look at a possible association between these two pathologies...
December 2015: Acta Clinica Belgica
Samar Medani, Patrick O'Callaghan
Infective endocarditis (IE) is a life-threatening condition often manifesting as a multisystem disease; its heterogeneous features present a diagnostic challenge. We report two cases of IE masquerading as rare extracardiac complications: a splenectomised patient with a periarticular ankle abscess and acute encephalopathy; and a young man with a cutaneous vasculitis following a spontaneous intracerebral haemorrhage. In both cases, the diagnosis was suspected following detection of afebrile bacteraemia and confirmed with echocardiography...
2015: BMJ Case Reports
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