POST-SPLENECTOMY INFECTION IN INFANTS AND CHILDREN

PEDIATRICS ◽  
1960 ◽  
Vol 25 (6) ◽  
pp. 941-951
Author(s):  
Tom W. Robinson ◽  
Phillip Sturgeon
Keyword(s):  
Splenic Rupture ◽  
Severe Infection ◽  
Underlying Disease ◽  
Thrombocytopenic Purpura ◽  
Median Period ◽  
Life Threatening ◽  
Severe Infections ◽  
Total Splenectomy ◽  
Very High ◽  
In Infants And Children

Fatal or life-threatening infection occurred in 13 members of a post-splenectomy population of 110 individuals followed for a median period of 6 years. Division of the population into two groups, one group predisposed to infection by the basic disease and/or the treatment which led to splenectomy and another non-predisposed group, revealed a distinct difference in the hazard. The non-predisposed group of 63 individuals had only one severe infection; this experience does not suggest risk of a very high order. Our Experience combined with that of others reporting cases in this category, provides a total splenectomy population of 205 with but two severe infections. It is evident that splenectomy carries a very low risk of post-operative infection when done over the age of 6 months for the generally accepted indications of splenic rupture, congenital spherocytic anemia, and idiopathic thrombocytopenic purpura. In the 47 individuals in this study predisposed to infection by their underlying disease, the incidence of severe post-operative infection was approximately 25%. No relation to age at time of splenectomy was evident. Ten of the 12 infections occurred within 12 years of operation. No attempt has been made to assess how great an increase, if any, this represents over a non-splenectomized control population similarly predisposed to infection. Our Experience, in addition to that of others, in the group predisposed to infection by their underlying disease, makes a total splenectomy population of 85; 23 (27%) of this group suffered severe post-operative infections.

scholarly journals Clinical Features and Outcomes of Fusobacterium Species Infections in a Ten-Year Follow-up

2017 ◽  
Vol 3 (4) ◽  
pp. 141-147 ◽  
Author(s):  
Rafael Garcia-Carretero ◽  
Marta Lopez-Lomba ◽  
Blanca Carrasco-Fernandez ◽  
Maria Teresa Duran-Valle
Keyword(s):  
Septic Shock ◽  
Clinical Features ◽  
Severe Infection ◽  
Clinical Spectrum ◽  
Identifiable Risk Factor ◽  
Computerized Records ◽  
Life Threatening ◽  
Severe Infections ◽  
Fusobacterium Species

Abstract Objective: Although uncommon, Fusobacterium infections have a wide clinical spectrum, ranging from local pharyngeal infections to septic shock. Our aim was to characterize and analyze the clinical features and outcomes in patients with Fusobacterium infections, and determine which variables were able to predict a poor outcome. Methods: We conducted a retrospective, hospital-based study using the computerized records of a second-level Spanish general hospital, serving a population of 155,000 inhabitants. The cohort was enrolled among patients cared for at the hospital between 2007 and 2016. Demographic, clinical data, microbiological characterization and outcomes at discharge, were analyzed. Results: We collected data for all 26 patients over a 10-year period (annual incidence of 1.78 per 100,000), with an incidence of bacteremia of 0.53 cases per 100,000 population per year. F. nucleatum and F. necrophorum were the most frequent isolations (53.8% and 38.5%, respectively). F. necrophorum was found to be associated with a younger population. Although we found no deaths attributable to Fusobacterium, 15 patients (57%) were found to have severe infections due to this pathogen, and 7 patients (26.9%) were admitted to the Intensive Care Unit (ICU). The only identifiable risk factor for a severe infection (sepsis, septic shock or ICU admission) was the presence of bacteremia. Conclusions: Fusobacterium infections are uncommon. F. necrophorum tends to cause infection in younger individuals, while F. nucleatum has a preference for older patients. The clinical spectrum is wide, ranging from local, non-severe infections, such as sinusitis or pharyngitis, to abscess formation and life-threatening infections.

scholarly journals Trimethoprim–sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis

2018 ◽  
Vol 77 (10) ◽  
pp. 1440-1447 ◽  
Author(s):  
Andreas Kronbichler ◽  
Julia Kerschbaum ◽  
Seerapani Gopaluni ◽  
Joanna Tieu ◽  
Federico Alberici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Infections ◽  
Severe Infection ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Life Threatening ◽  
Severe Infections ◽  
Prophylactic Use ◽  
Grade 3 ◽  
Tract Infections

ObjectiveWe aimed to assess risk factors for the development of severe infection in patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) receiving rituximab.Methods192 patients with AAV were identified. Univariate and multivariate analyses were performed to identify risk factors for severe infection following rituximab. Severe infections were classified as grade ≥3 as proposed by the Common Terminology Criteria for Adverse Events V.4.0.Results95 severe infections were recorded in 49 (25.52%) patients, corresponding to an event rate of 26.06 per 100 person-years. The prophylactic use of trimethoprim–sulfamethoxazole was associated with a lower frequency of severe infections (HR 0.30, 95% CI 0.13 to 0.69), while older age (HR 1.03, 95% CI 1.01 to 1.05), endobronchial involvement (HR 2.21, 95% CI 1.14 to 4.26), presence of chronic obstructive pulmonary disease (HR 6.30, 95% CI 1.08 to 36.75) and previous alemtuzumab use (HR 3.97, 95% CI 1.50 to 10.54) increased the risk. When analysis was restricted to respiratory tract infections (66.3% of all infections), endobronchial involvement (HR 4.27, 95% CI 1.81 to 10.06), severe bronchiectasis (HR 6.14, 95% CI 1.18 to 31.91), higher neutrophil count (HR 1.19, 95% CI 1.06 to 1.33) and major relapse (HR 3.07, 95% CI 1.30 to 7.23) as indication for rituximab use conferred a higher risk, while refractory disease (HR 0.25, 95% CI 0.07 to 0.90) as indication had a lower frequency of severe infections.ConclusionsWe found severe infections in one quarter of patients with AAV receiving rituximab. Trimethoprim–sulfamethoxazole prophylaxis reduced the risk, while especially bronchiectasis and endobronchial involvement are risk factors for severe respiratory infections.

scholarly journals Diagnosis and Treatment of Atraumatic Splenic Rupture: Experience of 8 Cases

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Jian Liu ◽  
Yanyu Feng ◽  
Ang Li ◽  
Chunqing Liu ◽  
Fei Li
Keyword(s):  
Splenic Rupture ◽  
Diagnosis And Treatment ◽  
Etiological Factors ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
Grade Ii ◽  
Atraumatic Splenic Rupture ◽  
Total Splenectomy ◽  
Traumatic Splenic Rupture ◽  
Enhanced Computed Tomography

Atraumatic splenic rupture (ASR) is rare but life threatening. In this study, we retrospectively described our experience on the diagnosis and treatment of 8 patients (male: 6; female: 2; mean age: 49.6) with ASR. ASR accounted for 3.2% (8/251) of the splenic ruptures. The clinical presentation of ASR was similar to traumatic splenic rupture (TSR). The sensitivity of ultrasound and contrast-enhanced computed tomography (CECT) in ASR diagnosis was 57.1% and 85.7%, respectively. According to the classification of the American Association for the Surgery of Trauma (AAST), 2 cases were classified as grade II splenic ruptures, 4 cases were classified as grade III ruptures, 1 case was classified as grade IV rupture, and 1 case was not classified. All the spleens became swollen, and hematomas were observed in 6 patients. Total splenectomy was recommended in most cases. At least 62.5% (5/8) of the patients with 7 etiological factors belonged to “atraumatic-pathological splenic rupture.” Local inflammation and cancer were the most common etiological factors.

Thrombotic Thrombocytopenic Purpura: Mechanism for Effectiveness of Plasmapheresis

1979 ◽  
Author(s):  
J. G. Kelton ◽  
P. B. Neame ◽  
I. Walker ◽  
A. G. Turpie ◽  
J. McBride ◽  
...  
Keyword(s):  
Platelet Count ◽  
Thrombotic Thrombocytopenic Purpura ◽  
The Other ◽  
Unknown Etiology ◽  
Normal Range ◽  
Antiplatelet Antibody ◽  
Thrombocytopenic Purpura ◽  
Serious Illness ◽  
Normal Platelet ◽  
Very High

Thrombotic thrombocytopenic purpura (TTP) is a rare but serious illness of unknown etiology. Treatment by plasmapheresis has been reported to be effective but the mechanism for benefit is unknown. We have investigated the effect of plasmapheresis in 2 patients with TTP by quantitating platelet associated IgG (PAIgG) levels prior to and following plasmapheresis. Both patients had very high levels of PAIgG at presentation (90 and A8 fg IgG/platelet respectively, normal 0-5). in both, the PAIgG levels progressively fell to within the normal range and the platelet count rose following plasmapheresis. One patient remained in remission with normal platelet counts and PAIgG levels. The other relapsed after plasmapheresis and the PAIgG level rose prior to the fall in platelet count. Plasmapheresis was repeated and resulted in normalization of both the platelet count and PAIgG level. It is suggested that plasmapheresis removes antiplatelet antibody or immune complexes which may be of etiological importance in this illness.

scholarly journals A large-scale investigation into the role of classical HLA loci in multiple types of severe infections, with a focus on overlaps with autoimmune and mental disorders

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ron Nudel ◽  
Rosa Lundbye Allesøe ◽  
Wesley K. Thompson ◽  
Thomas Werge ◽  
Simon Rasmussen ◽  
...  
Keyword(s):  
Autoimmune Disease ◽  
Psychiatric Disorders ◽  
Large Scale ◽  
Viral Infections ◽  
Human Leukocyte ◽  
Severe Infection ◽  
Small Sample ◽  
Disease Etiology ◽  
Hla Alleles ◽  
Severe Infections

Abstract Background Infections are a major disease burden worldwide. While they are caused by external pathogens, host genetics also plays a part in susceptibility to infections. Past studies have reported diverse associations between human leukocyte antigen (HLA) alleles and infections, but many were limited by small sample sizes and/or focused on only one infection. Methods We performed an immunogenetic association study examining 13 categories of severe infection (bacterial, viral, central nervous system, gastrointestinal, genital, hepatitis, otitis, pregnancy-related, respiratory, sepsis, skin infection, urological and other infections), as well as a phenotype for having any infection, and seven classical HLA loci (HLA-A, B, C, DPB1, DQA1, DQB1 and DRB1). Additionally, we examined associations between infections and specific alleles highlighted in our previous studies of psychiatric disorders and autoimmune disease, as these conditions are known to be linked to infections. Results Associations between HLA loci and infections were generally not strong. Highlighted associations included associations between DQB1*0302 and DQB1*0604 and viral infections (P = 0.002835 and P = 0.014332, respectively), DQB1*0503 and sepsis (P = 0.006053), and DQA1*0301 with “other” infections (a category which includes infections not included in our main categories e.g. protozoan infections) (P = 0.000369). Some HLA alleles implicated in autoimmune diseases showed association with susceptibility to infections, but the latter associations were generally weaker, or with opposite trends (in the case of HLA-C alleles, but not with alleles of HLA class II genes). HLA alleles associated with psychiatric disorders did not show association with susceptibility to infections. Conclusions Our results suggest that classical HLA alleles do not play a large role in the etiology of severe infections. The discordant association trends with autoimmune disease for some alleles could contribute to mechanistic theories of disease etiology.

Severe pulmonary complications in Japanese patients after bortezomib treatment for refractory multiple myeloma

Blood ◽  
2006 ◽  
Vol 107 (9) ◽  
pp. 3492-3494 ◽  
Author(s):  
Shigesaburo Miyakoshi ◽  
Masahiro Kami ◽  
Koichiro Yuji ◽  
Tomoko Matsumura ◽  
Masaaki Takatoku ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Adverse Effects ◽  
Gastrointestinal Symptoms ◽  
Japanese Patients ◽  
The United States ◽  
Underlying Disease ◽  
Pulmonary Complications ◽  
Bortezomib Treatment ◽  
Toranomon Hospital ◽  
Life Threatening

Bortezomib is a novel proteasome inhibitor with significant antimyeloma activity. Its frequent adverse effects are manageable, including gastrointestinal symptoms, peripheral neuropathy, and thrombocytopenia. Severe lung toxicity has not previously been reported. Between June 2004 and September 2005, 13 Japanese patients with multiple myeloma were treated with bortezomib in Toranomon Hospital, Juntendo University School of Medicine, and Jichi Medical School. Four of them developed severe pulmonary complications, and 2 died of respiratory failure without progression of underlying disease. To our knowledge, this is the first report on life-threatening pulmonary adverse effects after bortezomib therapy. Previous clinical studies on bortezomib, mostly in the United States and Europe, have shown low incidences of pulmonary adverse effects. Our study suggests that bortezomib can cause serious lung injury, and that its incidence might vary among different ethnicities. Clinicians need to be alert to the possibility.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

scholarly journals Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

2010 ◽  
Vol 18 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Cibele Grothe ◽  
Angélica Gonçalves da Silva Belasco ◽  
Ana Rita de Cássia Bittencourt ◽  
Lucila Amaral Carneiro Vianna ◽  
Ricardo de Castro Cintra Sesso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Severe Infection ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Double Lumen ◽  
One Year ◽  
Very High

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Sign in / Sign up

Export Citation Format

Share Document