- Understanding of the significance and health implications of asplenia in a cohort of patients with haemaglobinopathy: possible benefits of a spleen registry. [Journal Article]
- HHematology 2017 Dec 13; :1-5
- CONCLUSIONS: This study examined knowledge and attitudes about splenectomy in a cohort of haemoglobinopathy patients in an Australian tertiary referral centre. The majority had good or fair knowledge with a strong association of some elements of post-splenectomy care with being placed on a spleen registry and having received targeted education. Implementation of systematic approaches by medical staff is likely to be the main benefit of a clinical registry approach in this setting.
- Immunogenicity, safety and reactogenicity of the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in 2-17-year-old children with asplenia or splenic dysfunction: A phase 3 study. [Journal Article]
- VVaccine 2017 Sep 25; 35(40):5331-5338
- CONCLUSIONS: PHiD-CV was immunogenic and well tolerated in 2-17-year-old children with asplenia or splenic dysfunction. Clinical Trial Registry: www.clinicaltrials.gov, NCT01746108.
- Risk Factors for Severe Infection, Hospitalization, and Prolonged Antimicrobial Therapy in Patients with Babesiosis. [Journal Article]
- AJAm J Trop Med Hyg 2017; 97(4):1218-1225
- Babesiosis is an emerging tick-borne disease transmitted by the hard tick Ixodes scapularis, which also transmits Lyme disease. Better gradation of prognostic indicators are needed to determine which...
Babesiosis is an emerging tick-borne disease transmitted by the hard tick Ixodes scapularis, which also transmits Lyme disease. Better gradation of prognostic indicators are needed to determine which patients may develop serious complications requiring hospitalization, and to provide early guidance on appropriate therapy. In this study, we evaluated 128 patients with smear or real time polymerase chain reaction-confirmed Babesia microti infections over a period of 16 years. Patients with asplenia or immunocompromising conditions were more likely to have severe infection (P < 0.01), require hospitalization (P < 0.01), or receive prolonged courses of antimicrobials (P < 0.01). Nausea or vomiting (P < 0.01) and diarrhea (P < 0.01) along with hyperbilirubinemia (P < 0.01) were predictive of severe infection, hospitalization, and prolonged antimicrobial therapy. Patients with concurrent Lyme disease were less likely to require hospitalization and had similar severity of disease and length of antibiotic treatment compared with those without Lyme disease.
- Postsplenectomy vaccination guideline adherence: Opportunities for improvement. [Journal Article]
- JAJ Am Assoc Nurse Pract 2017; 29(10):612-617
- CONCLUSIONS: Despite uniform education prior to discharge, most patients undergoing splenectomy for trauma were unaware of the risks for sepsis and did not follow recommended guidelines for risk reduction.Improvements that have direct implications for advanced practice included the need to refer for vaccination, educate regarding infection risks, and facilitate rapid access to antibiotic treatment.
- Conjugate and 23-valent pneumococcal polysaccharide booster vaccination in asplenic patients with thalassemia major: A randomized clinical trial study. [Journal Article]
- CJCaspian J Intern Med 2017; 8(1):16-22
- CONCLUSIONS: It can be concluded that PCV vaccine before PPV can be more effective in asplenic thalassemia major patients as a booster dose.
- Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic. [Journal Article]
- AJAm J Med 2017; 130(7):856-861
- CONCLUSIONS: Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.
- Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand. [Review]
- IMIntern Med J 2017; 47(8):848-855
- People with asplenia/hyposplenism are at increased risk of fulminant sepsis, which carries a high mortality rate. A range of preventive measures is recommended although there is ongoing evidence that...
People with asplenia/hyposplenism are at increased risk of fulminant sepsis, which carries a high mortality rate. A range of preventive measures is recommended although there is ongoing evidence that knowledge of and adherence to these strategies is poor. There have been significant changes in recommended vaccinations since the previously published recommendations in 2008. We provide current recommendations to help Australian and New Zealand clinicians in the prevention of sepsis in patients with asplenia and hyposplenia. The guideline includes Australian epidemiological data, preferred diagnostic techniques and recommendations for optimal antimicrobial prophylaxis and vaccination protocols.
- Capnocytophaga canimorsus – an underestimated danger after dog or cat bite – review of literature [Review]
- PEPrzegl Epidemiol 2016; 70(2):289-295
- Capnocytophaga canimorsus is a gram-negative, capnophilic rod constituting normal bacterial flora of the oral cavity of dogs and cats. It is also considered to be an etiological factor of infections ...
Capnocytophaga canimorsus is a gram-negative, capnophilic rod constituting normal bacterial flora of the oral cavity of dogs and cats. It is also considered to be an etiological factor of infections in human that may lead to multiple complications, i.a. sepsis, endocarditis and meningitis. C. canimorsus poses a serious threat, especially to patients with asplenia, cirrhosis or alcohol abuse. In most cases, infection occurs after a dog bite. Isolation and identification of the bacteria from the biological material is difficult and often delayed because of slow growth of the bacteria on microbiological media. Gold standard for bacteriological identification of C. canimorsus is polymerase chain reaction method. Amoxicillin with clavulanic acid is considered the drug of choice used in prophylaxis of C. canimorsus infections. Based on the data available from the literature, the authors present the epidemiology, risk factors, clinical picture, diagnostic methods and treatment of the C. canimorsus infection.
- Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons - Advisory Committee on Immunization Practices, 2016. [Journal Article]
- MMMMWR Morb Mortal Wkly Rep 2016 Nov 04; 65(43):1189-1194
- At its June 2016 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of meningococcal conjugate vaccine (serogroups A, C, W, and Y; including MenACWY-D [Menactra,...
At its June 2016 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of meningococcal conjugate vaccine (serogroups A, C, W, and Y; including MenACWY-D [Menactra, Sanofi Pasteur] or MenACWY-CRM [Menveo, GlaxoSmithKline]) for persons aged ≥2 months with human immunodeficiency virus (HIV) infection. ACIP has previously recommended routine vaccination of persons aged ≥2 months who have certain medical conditions that increase risk for meningococcal disease (1), including persons who have persistent (e.g., genetic) deficiencies in the complement pathway (e.g., C3, properdin, Factor D, Factor H, or C5-C9); persons receiving eculizumab (Soliris, Alexion Pharmaceuticals) for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria (because the drug binds C5 and inhibits the terminal complement pathway); and persons with functional or anatomic asplenia (including persons with sickle cell disease). Routine vaccination with meningococcal conjugate vaccine is also recommended for all healthy adolescents in the United States (1). This report summarizes the evidence considered by ACIP in recommending vaccination for HIV-infected persons, and provides recommendations and guidance for use of meningococcal conjugate vaccines (serogroups A, C, W, and Y) among HIV-infected persons aged ≥2 months; the majority of meningococcal disease among HIV-infected persons is caused by these four serogroups.
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- Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study. [Journal Article]
- EIEpidemiol Infect 2017; 145(2):397-400
- Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia and is associated with encapsulated organisms, most commonly Streptococcus pneumoniae, but also Haemophilus influe...
Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia and is associated with encapsulated organisms, most commonly Streptococcus pneumoniae, but also Haemophilus influenzae and Neisseria meningitidis. We aimed to estimate the risk of infection in this patient group. We reviewed data collected by the Victorian Spleen Registry in Australia. On registration, all patients are asked about significant infections requiring admission to hospital for intravenous antibiotics; those requiring admission to ICU were defined as OPSI. In the 3274 asplenic patients registered 492 patients reported at least one episode of infection. There were 47 episodes of OPSI requiring intensive care (incidence rate 1·11/1000 patient-years). The risk of OPSI was highest in older patients, and there were no statistically significant differences in incidence by reason for splenectomy except for a higher rate in patients with medical hyposplenia. This study reinforces that post-splenectomy infection is a clinically significant but uncommon complication, and that fulminant infection requiring intensive care is a minority of all infections.