Page 23 - Delaware Medical Journal - March 2018
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CASE REPORT
TREATMENT AND PROPHYLAXIS IN THE ASPLENIC PATIENT:
Pneumococcus
•Sequential PCV13 and PPSV23
•Revaccination with PPSV23 5 years later and at age 65
H. influenzae
1 dose Hib vaccine
Meningococcus
•Meningococcal quadrivalent vaccine
•Revaccinate every 5 years
Influenza
Inactivated influenza vaccine annually
Other vaccines
•HAV
•HBV
•Tdap once as
substitute
HAV=hepatitis A Vaccine; HBV= hepatitis B vaccine; Hib=haemophilus influenzae type B; PCV13=13- valent pneumococcal conjugate vaccine; PPSV23=23-valent pneumococcal polysaccharide vaccine; Td=tetanus-diphtheria toxoid booster; Tdap=tetanus-diphtheria-acellular pertussis
daily antibiotic treatment. Because the risk of sepsis is low in adults, the use of daily antibiotic treatment for adults is debatable.10
Asplenic patients should be given antibiotics to take at the onset of fever over Common antibiotics are amoxicillin- in patients with penicillin allergy. The infection, such as fever, chills, sore throat, or cough. After taking antibiotics, patients should immediately go to the nearest emergency department for further workup and treatment.11
In conclusion, the diagnosis and treatment of sepsis in the asplenic patient is one of utmost importance. Streptococcus pneumoniae remains the leading cause of fulminant sepsis in this population; however, with the administration of the pneumococcal vaccine, its incidence has slowly been dropping. It is important as physicians to be able to identify splenic dysfunction on peripheral smear
since many patients may not have a history of splenectomy, such as the patient presented in this case. Finally, all patients who have been be vaccinated and given home antibiotics infection.
TAKE HOME POINTS
■ Sepsis in the asplenic patient is a rapidly progressive and fatal course if not treated promptly.
■ The most common cause of sepsis in the asplenic patient is streptococcus pneumoniae; other culprits include Neisseiria meningitidis, hemophillus capnocytophagia.
■ The presence of Howell-Jolly bodies on peripheral smear is pathognomonic for splenic dysfunction.
■ Recommended vaccinations for patients who are functionally asplenic include:
■ All patients with asplenia should have antibiotics on hand for prophylaxis.12 sign of infection (fever, cough, sore throat, immediately go to the nearest emergency department for evaluation and treatment.
CONTRIBUTING AUTHORS
■ JEENA ZACHARIAH, MD is currently a third year Chief Resident at the Saint Francis Family Medicine Residency Program in Wilmington, Delaware.
■ JOHN D’ AMBROSIO, DO is currently the Chairperson of the Critical Care Committee at Saint Francis Hospital in Wilmington, Delaware.
REFERENCES
1. Kuchar E, Miskiewicz K, Karlikowska M.
A review of guidance on immunization
in persons with defective or deficient splenic function. British Journal of Haematology. https://www.ncbi.nlm.nih.gov/ pubmed/26315210. Published December 2015. Accessed May 22, 2017.
2. Rubin LG, Schaffner W. Care of the Asplenic Patient. New England Journal of Medicine. 2014;371(4):349-356. doi:10.1056/ nejmcp1314291.
3. M.-H. Dai, N. Shi, C. Xing, Q. Liao, T.-P. Zhang, G. Chen, W.-M. Wu, J.-C. Guo, Z.-W. Liu, Y.-P. Zhao Splenic preservation in laparoscopic distal pancreatectomy. British Journal of Surgery 104:4, 452-462 , 22 Dec 2016
4. Brian K. Yorkgitis. Primary Care of the Blunt Splenic Injured Adult. The American Journal of Medicine. 130:3, 365.e1-365.e5. Mar 2017
5. Krause P.J., Gewurz B.E., Hill D., Marty
F.M., Vannier E., Foppa I.M. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infec Dis. 2008; 46 (3):370.
6. Society, Canadian Paediatric. “Preventing and treating infection in children with asplenia or hyposplenia.” Position statements and practice points/ Canadian Paediatric society. N.p, 1 May 2014. Web July 22,2017
7. Pilishivi T., Lexau C., Farley M.M Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010; 201:32-41. PMD 19947881
8. Davies JM, Lewis MP, Wimperis J, et al. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Br J Haematol. 2011; 155:308
9. William BM. Corazza GR. Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology. 2007;12:1–13.
10. Castagnola E. Fioredda F. Prevention
of life-threatening infections due to encapsulated bacteria in children with hyposplenia or asplenia: a brief review of current recommendations for practical purposes.
Eur. J. Haematol. 2003;71:319–326.
11. Mathew H, Dittus C, Malek A, Negroiu A. Howell-Jolly bodies on peripheral smear leading to the diagnosis of congenital hyposplenism in a patient with septic shock. Clinical Case Reports. https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC4551333/#b1. Published August 2015
12. Di Sabatino A, Carsetti R, Corazza GR. Post- Splenectomy and Hyposplenic states.
Lancet. 2011; 378:86
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