title: Recurrent severe invasive pneumococcal disease in an adult with previously unknown hyposplenia.
abstract: BACKGROUND
  The risk of life-threatening and invasive infections with encapsulated bacteria is increased in patients with hyposplenia or asplenia. We report a case of recurrent invasive pneumococcal meningitis in a woman with previous unknown hyposplenia. She was vaccinated after the first episode of meningitis and developed sufficient levels of pneumococcal antibodies. The pneumococcal strains isolated were serotype 7 F and 17 F. To our knowledge, there has been no previously reported case of recurrent invasive pneumococcal disease in a pneumococcal vaccinated adult with hyposplenia and apparently sufficient antibody response.
  
  
  METHODS
  We report the course of a 38-year-old Caucasian woman presenting with recurrent episodes of invasive pneumococcal disease (IPD) and previously unknown hyposplenia. Hyposplenia was discovered during the second episode of IPD and no underlying medical condition was found. Despite immunization against S. pneumoniae and measurement of what was interpreted as protective levels of serotype-specific IgG antibodies after vaccination, the patient suffered from a third episode of IPD.
  
  
  CONCLUSIONS
  Individuals with predisposing medical conditions or a history of severe infections with encapsulated bacteria should be screened for spleen dysfunction. If splenic function is impaired, prevention against severe invasive infection with encapsulated bacteria are a major priority.
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, DK 2100, Rigshospitalet, Denmark. Vibe.Cecilie.Ballegaard@regionh.dk.|Department of Microbiology & Infection Control, Statens Serum Institute, Copenhagen, Denmark. Vibe.Cecilie.Ballegaard@regionh.dk.
authors.forename: Vibe C
authors.initials: VC
authors.lastname: Ballegaard
authors.affiliation: Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark. Lone.Schejbel.Dupont@regionh.dk.
authors.forename: Lone
authors.initials: L
authors.lastname: Schejbel
authors.affiliation: Department of Microbiology & Infection Control, Statens Serum Institute, Copenhagen, Denmark. HOF@ssi.dk.
authors.forename: Steen
authors.initials: S
authors.lastname: Hoffmann
authors.affiliation: Department of Microbiological Diagnostics & Virology, Statens Serum Institute, Copenhagen, Denmark. BJK@ssi.dk.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Kantsø
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, DK 2100, Rigshospitalet, Denmark. cfischer@dadlnet.dk.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Fischer
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D012008:Recurrence; D012720:Severity of Illness Index; D013158:Splenic Diseases / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology