Primary pseudomonas meningitis in an adult, splenectomized, multitransfused thalassaemia major patient.
A 19-year-old splenectomized, multitransfused female patient with beta-thalassaemia major developed primary meningitis due to P. putida. Her blood cultures were negative. P. putida is an unusual nosocomial organism to cause primary meningitis. Infection due to this organism carries high mortality. However, owing to early diagnosis and energetic treatment this patient survived without any sequelae. A review of serious infections over the last 7 years in patients in our thalassaemia care centre revealed 11 serious infections among our splenectomized patients (n = 46) and none in the non-splenectomized group (n = 106). Surprisingly, all overwhelming infections (23.8% in the splenectomized group) were caused by Gram-negative bacilli like Klebsiella, Pseudomonas, Aeromonas and Campylobacter species. As all our splenectomized patients had prior pneumococcal vaccination and oral penicillin prophylaxis, overwhelming septicaemia due to S. Pneumoniae was successfully prevented, but an increasing incidence of overwhelming sepsis due to Gram-negative bacilli, against which no vaccination or suitable prophylactic antibiotics are available, is now posing a new threat to this vulnerable group of patients.
Ghosh
K
K
Department of Haematology, College of Medicine, Sultan Qaboos University, Sultanate of Oman, India.
Daar
S
S
Hiwase
D
D
Nursat
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use; D015913:Chelation Therapy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003676:Deferoxamine / Q000009:adverse effects / Q000627:therapeutic use; D004198:Disease Susceptibility; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D007194:India / Q000453:epidemiology; D007501:Iron / Q000378:metabolism; D019190:Iron Overload / Q000188:drug therapy; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D016958:Pseudomonas putida / Q000302:isolation & purification*; D012189:Retrospective Studies; D013156:Splenectomy; D017086:beta-Thalassemia / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy
D002614:Chelating Agents; D007501:Iron; D003676:Deferoxamine