Fulminant Pneumococcal Infections in 'Normal' Asplenic Hosts

doi:10.1001/archinte.1977.03630230022009

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Vol. 137 No. 11, November 1977

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Fulminant Pneumococcal Infections in 'Normal' Asplenic Hosts

Venu Gopal, MB, BS; Alan L. Bisno, MD

Arch Intern Med. 1977;137(11):1526-1530.

Abstract

Five asplenic persons with no other detectable underlying diseaseshad overwhelming pneumococcemia. Four of the patients had undergonesplenectomy for trauma, and the fifth had asplenia as an isolatedcongenital abnormality. Including the cases presented here,there are now at least 26 reported instances of fatal or life-threateningpneumococcal infections in otherwise-normal asplenic patients.Thus, splenectomy per se is associated with an increased riskof overwhelming pneumococcemia. Although the magnitude of therisk is low, mortality associated with these infections is high.Analysis of the clinical data strongly suggests that undiagnosedfebrile episodes in asplenic persons should be treated promptlywith antibiotics while awaiting culture results. This strategyshould be adopted regardless of the age of the patient or hisgeneral state of health. The observation that a limited numberof pneumococcal serotypes, particularly type XII, appear topredominate in these cases suggests that pneumococcal vaccinemight be highly efficacious in preventing overwhelming post-splenectomypneumococcal infections in otherwise-normal hosts.

(Arch Intern Med 137:1526-1530, 1977)

Author Affiliations

From the Division of Infectious Diseases, Department of Medicine, University of Tennessee Center for the Health Sciences, Memphis.

Footnotes

Accepted for publication Nov 1, 1976.

Reprint requests to Department of Medicine, University of Tennessee,951 Court Ave, Room 241-D, Memphis, TN 38163 (Dr Bisno).

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