Overwhelming postsplenectomy sepsis in a patient with burns: a case report and a rational approach to treatment.
Overwhelming postsplenectomy sepsis is a dreaded sequel of splenectomy. The rate of overwhelming sepsis in children after splenectomy for trauma is reported to be 10 to 30 times that of the general population. Episodes of pneumonia, septicemia, and meningitis in adults after a splenectomy are 166 times more common than in the general population. The care of a patient with burns and asplenia presents many unique management challenges to the burn physician. Awareness of the development of overwhelming postsplenectomy sepsis and its most common infecting organisms is crucial. The specific immunologic deficiencies of reduced immunoglobulin production and cell-mediated immunity that exist in patients after a splenectomy may be compounded by burn injury. Specific treatment recommendations for patients with burns and asplenia are lacking. We report a fatal case of overwhelming sepsis in a patient with asplenia and with an 8% total body surface area partial-thickness burn, and we review the pathogenesis of overwhelming postsplenectomy sepsis. We focus on treatment recommendations regarding the use of prophylactic antimicrobials, intravenous immunoglobulin replacement therapy, and pneumococcal polyvalent vaccine to standardize the care of the patient with burns and asplenia and reduce infectious morbidity and deaths.
Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230, USA.
T M
TM
Bradley
E C
EC
Smoot
D R
DR
Graham
J O
JO
Kucan
J
J
Hussmann
D000328:Adult; D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines / Q000008:administration & dosage; D002056:Burns / Q000276:immunology / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007108:Immune Tolerance; D007116:Immunization, Passive; D008297:Male; D009894:Opportunistic Infections / Q000276:immunology / Q000628:therapy*; D022242:Pneumococcal Vaccines; D012772:Shock, Septic / Q000276:immunology / Q000628:therapy*; D013156:Splenectomy; D013203:Staphylococcal Infections / Q000276:immunology / Q000628:therapy*; D014946:Wound Infection / Q000276:immunology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines