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Primary pseudomonas meningitis in an adult, splenectomized, multitransfused thalassaemia major patient
1Department of Haematology, College of Medicine, Sultan Qaboos University, Sultanate of Oman, India.
Abstract:
A 19-year-old splenectomized, multitransfused female patient with beta-thalassaemia major developed primary meningitis due to P. putida. Her blood cultures were negative. P. putida is an unusual nosocomial organism to cause primary meningitis. Infection due to this organism carries high mortality. However, owing to early diagnosis and energetic treatment this patient survived without any sequelae. A review of serious infections over the last 7 years in patients in our thalassaemia care centre revealed 11 serious infections among our splenectomized patients (n = 46) and none in the non-splenectomized group (n = 106). Surprisingly, all overwhelming infections (23.8% in the splenectomized group) were caused by Gram-negative bacilli like Klebsiella, Pseudomonas, Aeromonas and Campylobacter species. As all our splenectomized patients had prior pneumococcal vaccination and oral penicillin prophylaxis, overwhelming septicaemia due to S. Pneumoniae was successfully prevented, but an increasing incidence of overwhelming sepsis due to Gram-negative bacilli, against which no vaccination or suitable prophylactic antibiotics are available, is now posing a new threat to this vulnerable group of patients.
Insights
Splenectomized patients with beta-thalassaemia major face increased risk of Gram-negative bacterial infections, particularly P. putida meningitis. Early diagnosis and treatment are crucial for survival in this vulnerable population.
Area of Science:
- Infectious Diseases
- Hematology
- Microbiology
Background:
- Beta-thalassaemia major patients often undergo splenectomy and require frequent transfusions, altering immune function.
- Splenectomy increases susceptibility to encapsulated bacteria, necessitating prophylactic measures like pneumococcal vaccination and penicillin.
- Gram-negative bacilli are increasingly recognized as significant pathogens in immunocompromised individuals.
Observation:
- A 19-year-old splenectomized patient with beta-thalassaemia major developed P. putida meningitis, an unusual and severe presentation.
- Blood cultures were negative, highlighting diagnostic challenges in P. putida infections.
- A 7-year review showed 11 serious infections in 46 splenectomized patients, none in 106 non-splenectomized patients.
Findings:
- Overwhelming infections in splenectomized patients were exclusively caused by Gram-negative bacilli (Klebsiella, Pseudomonas, Aeromonas, Campylobacter).
- Pneumococcal sepsis was prevented by vaccination and penicillin prophylaxis.
- A concerning rise in Gram-negative bacillary sepsis poses a new threat due to lack of targeted vaccines or prophylaxis.
Implications:
- Splenectomy in beta-thalassaemia major patients necessitates vigilance for Gram-negative infections.
- Current prophylactic strategies are effective against S. pneumoniae but insufficient for Gram-negative pathogens.
- Development of new vaccines or prophylactic antibiotics against Gram-negative bacilli is critical for this high-risk group.