Related Experiment Videos
Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory
S Tauro1, D Dobie, G Richardson
1Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust, UK.
Abstract:
Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues.
Insights
Patients who undergo splenectomy or stem cell transplant are at high risk for encapsulated bacterial infections. This case highlights a challenging relapse of penicillin-resistant pneumococcal sepsis despite prophylaxis, underscoring the need for careful regimen selection.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Patients undergoing splenectomy or allogeneic stem cell transplantation (alloBMT) face increased risk of overwhelming infections from encapsulated bacteria.
- Prophylaxis typically involves immunization and sometimes lifelong antibiotics.
Observation:
- A patient with refractory T cell lymphoma underwent splenectomy and matched unrelated donor (MUD) marrow transplantation.
- Despite immunization and 8 months of prophylactic phenoxymethylpenicillin, the patient experienced three episodes of relapsing overwhelming sepsis.
- Blood cultures consistently isolated penicillin-resistant Streptococcus pneumoniae (serogroup 6, subtype 6B) with a minimum inhibitory concentration (MIC) of 2.0.
Findings:
- The patient was treated successfully with intravenous cephalosporins for each sepsis episode.
- Due to recurrent infections with penicillin-resistant pneumococcus, prophylactic levofloxacin was initiated for 12 months.
Implications:
- This case underscores the challenges in selecting appropriate prophylactic regimens for immunocompromised patients.
- Effective treatment of sepsis in these high-risk populations requires careful consideration of antimicrobial resistance.
- The management of encapsulated bacterial infections post-splenectomy and alloBMT remains a complex clinical issue.