title: Invasive group B streptococcal infection in a patient with post splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension.
abstract: BACKGROUND
  Splenectomy in patients with liver cirrhosis (LC) is expected to become more common owing to its efficacy on portal hemodynamics. In this report we describe an alarming case of group B streptococcus (GBS) infection after splenectomy in a patient with LC.
  
  
  METHODS
  A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure. The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission. Pulmonary examination revealed significant wheezing during inspiration and expiration, but no crackles and stridor. Chest radiography and CT showed no infiltrates. A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made. Four days after admission, GBS infection was confirmed by blood culture and penicillin G was administered. Antibiotics were given intravenously for a total of 12 days.
  
  
  RESULTS
  The patient was discharged on the 12th day after admission.
  
  
  CONCLUSIONS
  Although efficacy of splenectomy in patients with LC has been reported, immune status should be evaluated for a longer period. Patients who have undergone splenectomy are highly susceptible to bacteria; moreover, LC itself is an independent risk factor for mortality in patients with sepsis. Since prophylaxis against GBS has not been established, immediate action should be taken. Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC, particularly the expected increase of splenectomy performed in LC patients.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Arisa
authors.initials: A
authors.lastname: Manabe
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Hikari
authors.initials: H
authors.lastname: Matsumura
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Egawa
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hamaya
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Nastuyo
authors.initials: N
authors.lastname: Shinohara
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Koshiro
authors.initials: K
authors.lastname: Takano
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
keywords: Group B streptococcal infection; Liver cirrhosis; Splenectomy