Pneumococcal septic arthritis after splenectomy in Felty's syndrome

Article Abstract:

Felty's syndrome is characterized by three features: rheumatoid arthritis, splenomegaly (enlarged spleen), and decreased levels of platelets (cells important in blood clotting) or decreased numbers of neutrophils (white blood cells important in inflammation). This triad of conditions is present in one percent of patients with rheumatoid arthritis. Low levels of platelets and other complications can require splenectomy (removal of spleen), placing these patients at risk for severe sepsis (systemic infection). A case is described of a 32-year-old woman with Felty's syndrome who developed pneumococcal septic arthritis following splenectomy. Pneumococcal infections are caused by a group of 85 or more types of bacteria, and can result in pneumonia or other serious infections. Recovery occurs as the immune system develops antibodies against the specific type of infecting bacteria. The risk for developing severe pneumococcal sepsis after splenectomy is high among patients with Felty's syndrome. Most individuals, including this patient, are given pneumococcal vaccine prior to surgery to promote the formation of antibodies against the major types of pneumococcal bacteria. It is possible that this woman, like some other patients with rheumatoid arthritis, responded ineffectively to immunization. She developed septic arthritis of the knees and an unusual complication that was diagnosed as pneumococcal-associated kidney disease. She was treated with penicillin for six months, and arthritis and kidney function gradually improved. Blood tests showed that the patient had produced antibodies against only 2 of the 23 types of pneumococci molecules in the vaccine, but had vigorously responded to the infecting bacteria. The case indicates the potential risk of pneumococcal infection among patients with Felty's syndrome who undergo splenectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Risk factors, Arthritis, Infectious, Infectious arthritis, Streptococcus pneumoniae

---

A 27-year experience with splenectomy for Gaucher's disease

Article Abstract:

Gaucher's disease is an inherited metabolic condition that causes massive enlargement of the spleen. The accepted treatment is surgical removal of the entire spleen. Because of the risk of fatal infection and the potential for bone and liver disease after splenectomy, partial splenectomy is considered preferable by some surgeons. A retrospective study was undertaken of patients undergoing splenectomy for Gaucher's disease over the past 27 years. The records of 48 patients were reviewed to determine both the short and long-term results of treatment. Total splenectomy was performed on 35 patients (73 percent), and partial splenectomy on 13 patients (27 percent). There was one death following surgery; this patient had undergone total splenectomy. Thirteen patients had postoperative complications. Within an average follow-up period of 25 months, 11 patients (23 percent) who had undergone total splenectomy showed accelerated bone disease. None of the partial splenectomy patients had evidence of accelerated bone disease. Since surgery, eight patients have died; four deaths were from malignancies that occurred after total splenectomy. These findings indicate that both total and partial splenectomy can be performed safely with minimal increased illness. Total splenectomy is associated with more aggressive bone disease and a tendency to develop malignancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Evaluation, Surgery, Gaucher's disease

---

Continued need for pneumococcal prophylaxis after splenectomy

Article Abstract:

The functions of the spleen are to produce lymphocytes and monocytes, which are types of blood cells; to store and release blood cells; and to filter bacteria and particles, such as aged, nonfunctioning red blood cells, from the circulation. Splenectomy, surgical removal of the spleen, is often associated with an increased incidence of bacterial infections, 70 percent of which are caused by the bacterium Streptococcus pneumoniae, and the remaining caused by Haemophilus influenzae and Neisseria meningitidis. Although most infections develop within two years following surgery, the risk of developing bacterial infections persists throughout life. Drug treatment with the antibiotic penicillin and pneumococcal vaccination may decrease the incidence of infection in patients who have undergone a splenectomy. The importance of these preventive measures is demonstrated by two cases in which the patients did not receive prophylaxis or preventive treatment and developed fatal pneumococcal infections. The children who underwent the procedure died from pneumococcal infection five and eight years after the removal of their spleens. Immunization against pneumococcal bacteria and daily treatment with penicillin are recommended to prevent life-threatening infection in patients who have undergone a splenectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Pneumococcal vaccine, Pneumococcal vaccines, Bacterial infections

Similar abstracts:

• Abstracts: Types of atrophic gastritis in patients with primary Sjogren's syndrome. Auricular chondritis and diffuse proliferative glomerulonephritis in primary Sjogren's syndrome
• Abstracts: Prenatal prediction of risk of the fetal hydantoin syndrome. Increased nuchal translucency as a marker for fetal chromosomal defects
• Abstracts: Views of a chiropractic critic: your real enemy is yourself. Sacroiliac and lower extremity pains as presenting symptoms in sarcoidosis
• Abstracts: Views of a chiropractic critic: your real enemy is yourself. part 2 Philosophy and the future of chiropractic
• Abstracts: The role of fibrinogen in staphylococcal adherence to catheters in vitro. Emergence of ciprofloxacin-resistant coagulase-negative staphylococcal skin flora in immunocompromised patients receiving ciprofloxacin

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.