Fatal Post-Splenectomy Pneumococcal Sepsis Despite Pneumococcal Vaccine and Penicillin Prophylaxis

Brivet, F.; Herer, Bertrand; Frémaux, A.; Dormont, J; Tchernia, Gil

doi:10.1016/s0140-6736(84)92729-6

Cited by 39 publications

(11 citation statements)

References 4 publications

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“…Some guidelines have also recommend that the asplenic individual receive the conjugated Hemophilus and meningococcal vaccines [5,18,23,24]. Vaccination should never result in a false sense of security since sporadic cases of pneumococcal and other vaccine failures have been reported in appropriately immunized persons, some of whom have also been taking prophylactic antibiotics [9,10,22,25].…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate use of the pneumococcal vaccine has become increasingly important with the emergence of antibiotic-resistant strains of pneumococci [7,8]. Unfortunately, the pneumococcal vaccine is not uniformly effective and other organisms may also be responsible for OPSI [7,9,10]. For these reasons, patient education and counseling at the time of splenectomy is equally as important as appropriate vaccination policies and procedures [1,2,11].…”

Section: Introductionmentioning

confidence: 99%

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Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

2000

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An audit was performed of the documentation of pneumococcal vaccination in splenectomy patients in three major hospitals involving a geographical population base of 350,000 patients in British Columbia, Canada. Overall, 111 of the 164 hospitalized splenectomy patients (68%) had received pneumococcal vaccination. Of elective splenectomy cases, only 11 of 55 (20%) had been vaccinated prior to surgery, as is currently recommended. One hundred fifty-five patients (95%) had splenectomy status mentioned in the discharge summary. However, only 35 (21%) had mention of vaccination status, 10 (6%) mention of the need for future revaccination, and only 8 (5%) notation of the possibility of future infectious risks. The rate of pneumococcal vaccination was as satisfactory as any reported in the literature to date. However, there is need for improved education in relation to the timing of vaccination and discharge summary documentation. A checklist for potential splenectomy patients may aid in improving this situation as may geographically based splenectomy registries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

2000

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“…As Streptococcus pneumoniae is the most frequent cause of OPSI syndrome, vaccination and continuous antibiotic prophylaxis have been recommended [3-51. But OPSI syndrome may occur nonetheless [6][7][8][9][10] and several additional risk factors have been identified which increase the risk for OPSI syndrome in asplenic patients. A very important factor seems to be the age of the patient.…”

Section: Introductionmentioning

confidence: 99%

Overwhelming postsplenectomy infection with vaccine-typeStreptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis

et al. 1997

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This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V. The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition. Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation. Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency. Furthermore, she required amputation of all her toes because of severe necrosis. No type-specific pneumococcal antibody titers were detected during and after infection. It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination. Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S. pneumoniae in patients after splenectomy.

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“…long term antibiotic prophylaxis, mainly after childhood splenectomy, and pneumococcal vaccination. Despite the widespread use of these measures, OPSI still oc curs and still carries an unacceptably high mortality [1,4,6,7,10,13,22], In the nonimmune animal, the spleen is the most active organ in clearing the blood from pneumococci [31]. Splenectomy therefore results in a deficient antibody-independent clearing mecha nism in the reticuloendothelial system.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Antibody Levels and Protective Efficacy against Pneumococci in Two Immunoglobulin Preparations for Intravenous Use

Offenbartl¹,

Gullstrand²,

Prellner³

et al. 1986

Int Arch Allergy Immunol

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Passive immunization with modern intravenous immunoglobulin preparations might be used prophylactically in individuals at extreme risk of contracting postsplenectomy sepsis or therapeutically in established infections. Since pneumococci are the predominant causative organisms, we determined antibodies against 14 pneumococcal serotypes in two commercially available immunoglobulin preparations (two batches of each) using enzyme-linked immunosorbent assay. The four batches were remarkably similar in antibody content. Low levels against some clinically important serotypes, i.e. types 3, 8 and 18C were recorded. The protective effect of one batch of each preparation aganst type 1 pneumococci was documented in splenectomized rats.

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Fatal Post-Splenectomy Pneumococcal Sepsis Despite Pneumococcal Vaccine and Penicillin Prophylaxis

Cited by 39 publications

References 4 publications

Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

Overwhelming postsplenectomy infection with vaccine-typeStreptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis

Comparison of Antibody Levels and Protective Efficacy against Pneumococci in Two Immunoglobulin Preparations for Intravenous Use

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