暴发性紫癜--脑膜炎球菌感染或脾切除术后败血症

O. Samodova, E. Krieger, A. V. Emel’yancev, E. E. Yakusheva, K. V. Haritonova
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摘要

文章介绍了两例临床病例,描述了脾切除术后和先天性脾发育不良导致的化脓性感染的特殊性。最严重的后遗症是脾切除术后压迫性感染(OPSI-综合征),其特点是在首次出现症状的 12-24 小时内死亡率很高(50%-70%)。肺炎链球菌、b 型流感嗜血杆菌、脑膜炎奈瑟菌是 OPSI 综合征的常见病原体。OPSI 综合征的非特异性流感样前驱症状可能导致诊断延误。与脾切除术后败血症相关的综合征之一是暴发性紫癜(purpura fulminans),需要与脑膜炎球菌感染进行鉴别诊断。然而,有一半的暴发性肺炎球菌紫癜发生在脾切除术后或脾切除术后的患者身上。在第一例临床病例中,患者入院时被初步诊断为全身性脑膜炎球菌感染,但脾功能不全的患者不能排除肺炎球菌感染的诊断,随后经实验室检查确诊为肺炎球菌感染。鉴于脾切除术后暴发性败血症的高风险和及时诊断的困难,脾切除术后感染的预防策略主要分为三大类--疫苗接种、抗生素预防和患者(患者父母)教育。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Purpura fulminans – meningococcal infection or postsplenectomy sepsis
The article presents two clinical cases with description of peculiarities of septic infection occurred after splenectomy and due to congenital splenic hypoplasia.Decreased immune defense resulted from splenectomy leads to severe infections with a high risk of death. The most severe sequela is overwhelming postsplenectomy infection (OPSI-syndrome) which is characterized by high mortality rate (50-70%) within 12-24 hours from the onset of the first symptoms. The main risk factors of postsplenectomy sepsis are a condition which became an indication for splenectomy, the immune status of the patient, age and the time period after splenectomyStreptococcus pneumoniae, Haemophilus infuenzae type b, Neisseria meningitidis are commonly identified etiological factors of OPSI-syndrome. The diagnosis could be delayed due to nonspecific flu-like prodromal symptoms of the OPSI-syndrome. Delay in the diagnosis and treatment of sepsis may increase the risk of death.One of the syndromes associated with post-splenectomy sepsis is fulminant purpura (purpura fulminans), which requires differential diagnosis with meningococcal infection. However, half of the cases of fulminant pneumococcal purpura occur in patients with asplenia or hyposplenia. In the first clinical case, a preliminary diagnosis of generalized meningococcal infection was made on admission, but the diagnosis of pneumococcal infection could not be excluded in asplenic patient and was subsequently confirmed by laboratory tests.Given the high risk of fulminant postsplenectomy sepsis, and the difficulties of timely diagnosis, the preventive strategy of infections after splenectomy falls into three major categories- vaccination, antibiotic prophylaxis, and patient (patient’s parents) education.Improving healthcare workers’ knowledge is required to ensure prompt diagnosis of hyposplenism, adequate risk assessment of postplenectomy infection and prevention of OPSI-syndrome.
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