title: [Fulminant pneumococcal sepsis in two splenectomized patients].
abstract: Two 41-year-old women, who had previously been splenectomized, were admitted to the intensive-care unit due to fulminant sepsis. On admission, petechiae and ecchymoses characterised the clinical presentation of both patients. Laboratory tests revealed the presence of renal insufficiency and thrombocytopenia with disseminated intravascular coagulation. Streptococcus pneumoniae with serotypes (24 and 38) not included in the current polyvalent pneumococcal vaccine were found in blood cultures from both patients. One patient died as a result of a refractory septic shock. The other patient, who had never been vaccinated with the polyvalent pneumococcal vaccine, survived the sepsis. The clinical course of a fulminant Streptococcus pneumoniae sepsis in both asplenic patients underlines the importance of vaccination. It is also important to educate the patient about seeking immediate medical help if an infection is suspected on the basis of these symptoms. Vaccination does not provide complete protection.
authors.affiliation: Afd. Interne Geneeskunde, Intensive Care Beademing, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen.
authors.forename: P A M
authors.initials: PA
authors.lastname: de Vries
authors.forename: A K L
authors.initials: AK
authors.lastname: Oei-Reyners
authors.forename: A V M
authors.initials: AV
authors.lastname: Möller
authors.forename: W
authors.initials: W
authors.lastname: Timens
authors.forename: J E
authors.initials: JE
authors.lastname: Tulleken
authors.forename: T S
authors.initials: TS
authors.lastname: van der Werf
mesh_terms: D058186:Acute Kidney Injury; D000328:Adult; D016470:Bacteremia / Q000209:etiology* / Q000517:prevention & control; D004211:Disseminated Intravascular Coagulation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011008:Pneumococcal Infections / Q000209:etiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012703:Serotyping; D012772:Shock, Septic / Q000209:etiology; D013156:Splenectomy / Q000009:adverse effects*; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D013921:Thrombocytopenia; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines