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Successful treatment of post-splenectomy sepsis in an 82-year-old male
Abstract:
Six weeks after splenectomy for idiopathic thrombocytopenic purpura an 82-year-old man suddenly became drowsy with pyrexia and neck stiffness. Pneumococcal meningitis was diagnosed and treated with benzyl penicillin. Subsequently, penicillin-sensitive pneumococci (serotype 23) were isolated from both CSF and blood. He recovered fully. Review of recent literature confirms that absence of the spleen predisposes to overwhelming infection with encapsulated organisms in adults as well as in children. Use of pneumococcal vaccine would appear to be a prudent, if untested measure in all patients undergoing splenectomy.
Insights
Splenectomy increases the risk of serious pneumococcal infections in adults. Vaccination against pneumococcus is a recommended preventive measure for patients post-splenectomy.
Area of Science:
- Infectious Diseases
- Immunology
- Clinical Medicine
Background:
- Splenectomy, the surgical removal of the spleen, is a treatment for conditions like idiopathic thrombocytopenic purpura.
- The spleen plays a crucial role in filtering the blood and immune surveillance against encapsulated bacteria.
Observation:
- An 82-year-old male, six weeks post-splenectomy for idiopathic thrombocytopenic purpura, presented with drowsiness, fever, and neck stiffness.
- Clinical presentation was consistent with bacterial meningitis.
Findings:
- Pneumococcal meningitis was diagnosed and successfully treated with benzyl penicillin.
- Penicillin-sensitive Streptococcus pneumoniae (serotype 23) were identified in cerebrospinal fluid and blood cultures.
- The patient achieved a full recovery.
Implications:
- Adults without a spleen are highly susceptible to severe infections caused by encapsulated bacteria.
- Prophylactic pneumococcal vaccination is a potentially beneficial, though not yet widely studied, measure for asplenic individuals.
- Early diagnosis and appropriate antibiotic treatment are critical for managing post-splenectomy infections.