Asplenia congénita y purpura fulminans neumocóccico en paciente pediátrico. Reporte de caso con necropsia y revisión del tema

Katalina S. Bertrán, Alejandro F. Donoso, Pablo R. Cruces, Franco R. Díaz, Daniela S. Amagada

Resultado de la investigación: Review article

7 Citas (Scopus)

Resumen

Absent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially due to encapsulated bacteria. Not knowing this condition may delay medical treatment. Streptococcus pneumoniae is the leading cause of sepsis in these patients. Asplenic patients are at high risk for septic shock and eventually purpura fulminans, a life-threatening condition. We report the case of a 3 years old girl, with mitral stenosis and recurrent pneumonia that was admitted due to fever but in the next few hours presented hypotension, purpura and livedo reticularis. Laboratory test showed leucopenia (3.400/mm3), bandemia (43% of immature forms), thrombocytopenia, hypoprothombinernia and severe lactic acidosis (ph: 7.0 and lactic acid 11 mmol/1). The patient developed septic shock and multiorganic failure. Mechanical ventilation, volume resuscitation, vasoactive drugs and antibiotic therapy was initiated. Ultrasound was performed on the second day, demostrating asplenia. Peripheral blood smear showed Howell-Jolly bodies. Patient had a positive blood culture for penicillin-resistant Streptococcus pneumoniae (serotype 19F). Patient died of intracerebral hemorrhage after 8 days of admission. Necropsy confirmed asplenia and bilateral suprarenal haemorrhage. Absence of spleen can lead to life threatening infections, it is important to recognize it because vaccination and antibiotic prophylaxis can provide life-saving protection. This case provides a reminder to pursue asplenia as a potential underlying mechanism for invasive bacterial infection in children.

Idioma originalSpanish
Páginas (desde-hasta)55-59
Número de páginas5
PublicaciónRevista Chilena de Infectologia
Volumen26
N.º1
EstadoPublished - feb 2009

Huella dactilar

Purpura Fulminans
Pediatrics
Septic Shock
Streptococcus pneumoniae
Bacterial Infections
Erythrocyte Inclusions
Livedo Reticularis
Lactic Acidosis
Purpura
Antibiotic Prophylaxis
Mitral Valve Stenosis
Cerebral Hemorrhage
Leukopenia
Artificial Respiration
Resuscitation
Penicillins
Thrombocytopenia
Hypotension
Lactic Acid
Sepsis

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

Citar esto

Bertrán, Katalina S. ; Donoso, Alejandro F. ; Cruces, Pablo R. ; Díaz, Franco R. ; Amagada, Daniela S. / Asplenia congénita y purpura fulminans neumocóccico en paciente pediátrico. Reporte de caso con necropsia y revisión del tema. En: Revista Chilena de Infectologia. 2009 ; Vol. 26, N.º 1. pp. 55-59.
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abstract = "Absent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially due to encapsulated bacteria. Not knowing this condition may delay medical treatment. Streptococcus pneumoniae is the leading cause of sepsis in these patients. Asplenic patients are at high risk for septic shock and eventually purpura fulminans, a life-threatening condition. We report the case of a 3 years old girl, with mitral stenosis and recurrent pneumonia that was admitted due to fever but in the next few hours presented hypotension, purpura and livedo reticularis. Laboratory test showed leucopenia (3.400/mm3), bandemia (43{\%} of immature forms), thrombocytopenia, hypoprothombinernia and severe lactic acidosis (ph: 7.0 and lactic acid 11 mmol/1). The patient developed septic shock and multiorganic failure. Mechanical ventilation, volume resuscitation, vasoactive drugs and antibiotic therapy was initiated. Ultrasound was performed on the second day, demostrating asplenia. Peripheral blood smear showed Howell-Jolly bodies. Patient had a positive blood culture for penicillin-resistant Streptococcus pneumoniae (serotype 19F). Patient died of intracerebral hemorrhage after 8 days of admission. Necropsy confirmed asplenia and bilateral suprarenal haemorrhage. Absence of spleen can lead to life threatening infections, it is important to recognize it because vaccination and antibiotic prophylaxis can provide life-saving protection. This case provides a reminder to pursue asplenia as a potential underlying mechanism for invasive bacterial infection in children.",
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Asplenia congénita y purpura fulminans neumocóccico en paciente pediátrico. Reporte de caso con necropsia y revisión del tema. / Bertrán, Katalina S.; Donoso, Alejandro F.; Cruces, Pablo R.; Díaz, Franco R.; Amagada, Daniela S.

En: Revista Chilena de Infectologia, Vol. 26, N.º 1, 02.2009, p. 55-59.

Resultado de la investigación: Review article

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T1 - Asplenia congénita y purpura fulminans neumocóccico en paciente pediátrico. Reporte de caso con necropsia y revisión del tema

AU - Bertrán, Katalina S.

AU - Donoso, Alejandro F.

AU - Cruces, Pablo R.

AU - Díaz, Franco R.

AU - Amagada, Daniela S.

PY - 2009/2

Y1 - 2009/2

N2 - Absent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially due to encapsulated bacteria. Not knowing this condition may delay medical treatment. Streptococcus pneumoniae is the leading cause of sepsis in these patients. Asplenic patients are at high risk for septic shock and eventually purpura fulminans, a life-threatening condition. We report the case of a 3 years old girl, with mitral stenosis and recurrent pneumonia that was admitted due to fever but in the next few hours presented hypotension, purpura and livedo reticularis. Laboratory test showed leucopenia (3.400/mm3), bandemia (43% of immature forms), thrombocytopenia, hypoprothombinernia and severe lactic acidosis (ph: 7.0 and lactic acid 11 mmol/1). The patient developed septic shock and multiorganic failure. Mechanical ventilation, volume resuscitation, vasoactive drugs and antibiotic therapy was initiated. Ultrasound was performed on the second day, demostrating asplenia. Peripheral blood smear showed Howell-Jolly bodies. Patient had a positive blood culture for penicillin-resistant Streptococcus pneumoniae (serotype 19F). Patient died of intracerebral hemorrhage after 8 days of admission. Necropsy confirmed asplenia and bilateral suprarenal haemorrhage. Absence of spleen can lead to life threatening infections, it is important to recognize it because vaccination and antibiotic prophylaxis can provide life-saving protection. This case provides a reminder to pursue asplenia as a potential underlying mechanism for invasive bacterial infection in children.

AB - Absent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially due to encapsulated bacteria. Not knowing this condition may delay medical treatment. Streptococcus pneumoniae is the leading cause of sepsis in these patients. Asplenic patients are at high risk for septic shock and eventually purpura fulminans, a life-threatening condition. We report the case of a 3 years old girl, with mitral stenosis and recurrent pneumonia that was admitted due to fever but in the next few hours presented hypotension, purpura and livedo reticularis. Laboratory test showed leucopenia (3.400/mm3), bandemia (43% of immature forms), thrombocytopenia, hypoprothombinernia and severe lactic acidosis (ph: 7.0 and lactic acid 11 mmol/1). The patient developed septic shock and multiorganic failure. Mechanical ventilation, volume resuscitation, vasoactive drugs and antibiotic therapy was initiated. Ultrasound was performed on the second day, demostrating asplenia. Peripheral blood smear showed Howell-Jolly bodies. Patient had a positive blood culture for penicillin-resistant Streptococcus pneumoniae (serotype 19F). Patient died of intracerebral hemorrhage after 8 days of admission. Necropsy confirmed asplenia and bilateral suprarenal haemorrhage. Absence of spleen can lead to life threatening infections, it is important to recognize it because vaccination and antibiotic prophylaxis can provide life-saving protection. This case provides a reminder to pursue asplenia as a potential underlying mechanism for invasive bacterial infection in children.

KW - Asplenia

KW - Howell-Jolly bodies

KW - Pneumococcal sepsis

KW - Purpura fulminans

KW - Streptococcus pneumoniae

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M3 - Review article

C2 - 19350161

AN - SCOPUS:62949099487

VL - 26

SP - 55

EP - 59

JO - Revista Chilena de Infectologia

JF - Revista Chilena de Infectologia

SN - 0716-1018

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