Sepsis posesplenectomía
Síndrome de Austrian como forma de presentación
Palabras clave:
ESPLENECTOMÍA, SEPSIS, SÍNDROME DE AUSTRIAN
Resumen
Los pacientes esplenectomizados poseen un riesgo aumentado de sufrir infecciones invasivas por microorganismos encapsulados como Streptococcus pneumoniae. La asociación de neumonía, meningitis y endocarditis causada por Streptococcus pneumoniae constituye un cuadro muy poco frecuente en la actualidad conocido como síndrome de Austrian. Ambas representan entidades extremadamente graves y con elevada mortalidad. El diagnóstico precoz y comienzo inmediato del tratamiento intensivo y multidisciplinario son factores claves para el pronóstico de los pacientes. Presentamos un caso de enfermedad neumocóccica invasiva en un paciente esplenectomizado, discutiendo algunos de los aspectos más importantes para la prevención y el tratamiento de estos cuadros.
Citas
(1) Brigden ML, Pattullo AL. Prevention and management of overwhelming postsplenectomy infection-an update. Crit Care Med 1999; 27(4):836-42.
(2) Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect 2001; 43(3):182-6.
(3) Austrian R. The syndrome of pneumococcal endocarditis, meningitis and rupture of the aortic valve. Trans Am Clin Climatol Assoc 1956-1957; 68:40-7.
(4) Aygencel G, Dizbay M, Turkoglu MA, Tunccan OG. Cases of OPSI syndrome still candidate for medical ICU. Braz J Infect Dis 2008; 12(6):549-51.
(5) Lynch AM, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 1996; 10(4):693-707.
(6) Moffett SL. Overwhelming postsplenectomy infection: managing patients at risk. JAAPA 2009; 22(7):36-9.
(7) Bagnulo H, Calvo E, Barros A. Sepsis fulminante en el esplenectomizado: de qué se trata. Paciente Crit (Uruguay) 1997; 10:s47-9.
(8) Dalal A, Ahmad H. Austrian syndrome (pneumococcal pneumonia, meningitis, and endocarditis): a case report. Am J Med Sci 2008; 336(4):354-5.
(9) Aronin SI, Mukherjee SK, West JC, Cooney EL. Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis 1998; 26(1):165-71.
(10) Gonzalez-Juanatey C, Testa A, Mayo J, Gonzalez-Gay MA. Austrian syndrome: report of two new cases and literature review. Int J Cardiol 2006; 108(2):273-5.
(11) Hristea A, Nicolae D, Luka AI, Constantinescu RM, Aramã V, Tãnãsescu R. Invasive pneumococcal infections: Austrian syndrome. Rom J Intern Med 2009; 47(1):93-6.
(12) Steckelberg JM, Murphy JG, Ballard D, Bailey K, Tajik AJ, Taliercio CP, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991; 114(8):635-40.
(13) Poulsen JB, Moser C, Espersen K, Moller K. Austrian syndrome. BMJ Case Rep 2011; 2011. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062056/pdf/bcr.09.2010.3368.pdf Consulta: oct de 2012
(14) Bagnulo H. Sepsis fulminante en el esplenectomizado. In: Correa H, ed. Sepsis tratamiento intensivo de las infecciones graves. Montevideo: Oficina del Libro FEFMUR; 2004:411-5.
(15) Midon ME, Goldoni F, Souza SG, Miyasato JN. Austrian Syndrome: case report. Arq Bras Cardiol 2011; 97(3):e50-2.
(16) Siles Rubio JR, Anguita Sánchez M, Castillo Domínguez JC, Ramírez Moreno A, Pavlovic D, Berjillos Cortés F, et al. Síndrome de Austrian (endocarditis, meningitis y neumonía por Streptococcus pneumoniae): a propósito de un caso poco frecuente. Rev Esp Cardiol 1998; 51(12):1006-8.
(17) Hortal M, Lovgren M, de la Hoz F, Agudelo CI, Brandileone MC, Camou T, et al. Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance. Microb Drug Resist 2001; 7(4):391-401.
(18) Morgan TL, Tomich EB. Overwhelming post-splenectomy infection (OPSI): a case report and review of the literature. J Emerg Med 2012; 43(4):758-63.
(19) du Cheyron D, Lesage A, Le Page O, Flais F, Leclercq R, Charbonneau P. Corticosteroids as adjunctive treatment in Austrian's syndrome (pneumococcal endocarditis, meningitis, and pneumonia): report of two cases and review of the literature. J Clin Pathol 2003; 56(11):879-81.
(20) Brigden ML. Detection, education and management of the asplenic or hyposplenic patient. Am Fam Physician 2001; 63(3):499-506
(21) El-Alfy MS, El-Sayed MH. Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention? Hematol J 2004; 5(1):77-80.
(22) Mourtzoukou EG, Pappas G, Peppas G, Falagas ME. Vaccination of asplenic or hyposplenic adults. Br J Surg 2008; 95(3):273-80.
(23) British Committee for Standards in Haematology, Davies JM, Barnes R, Milligan D. Working Party of the Haematology/Oncology Task Force. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002; 2(5):440-3.
(24) Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61(40):816-9.
(2) Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect 2001; 43(3):182-6.
(3) Austrian R. The syndrome of pneumococcal endocarditis, meningitis and rupture of the aortic valve. Trans Am Clin Climatol Assoc 1956-1957; 68:40-7.
(4) Aygencel G, Dizbay M, Turkoglu MA, Tunccan OG. Cases of OPSI syndrome still candidate for medical ICU. Braz J Infect Dis 2008; 12(6):549-51.
(5) Lynch AM, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 1996; 10(4):693-707.
(6) Moffett SL. Overwhelming postsplenectomy infection: managing patients at risk. JAAPA 2009; 22(7):36-9.
(7) Bagnulo H, Calvo E, Barros A. Sepsis fulminante en el esplenectomizado: de qué se trata. Paciente Crit (Uruguay) 1997; 10:s47-9.
(8) Dalal A, Ahmad H. Austrian syndrome (pneumococcal pneumonia, meningitis, and endocarditis): a case report. Am J Med Sci 2008; 336(4):354-5.
(9) Aronin SI, Mukherjee SK, West JC, Cooney EL. Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis 1998; 26(1):165-71.
(10) Gonzalez-Juanatey C, Testa A, Mayo J, Gonzalez-Gay MA. Austrian syndrome: report of two new cases and literature review. Int J Cardiol 2006; 108(2):273-5.
(11) Hristea A, Nicolae D, Luka AI, Constantinescu RM, Aramã V, Tãnãsescu R. Invasive pneumococcal infections: Austrian syndrome. Rom J Intern Med 2009; 47(1):93-6.
(12) Steckelberg JM, Murphy JG, Ballard D, Bailey K, Tajik AJ, Taliercio CP, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991; 114(8):635-40.
(13) Poulsen JB, Moser C, Espersen K, Moller K. Austrian syndrome. BMJ Case Rep 2011; 2011. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062056/pdf/bcr.09.2010.3368.pdf Consulta: oct de 2012
(14) Bagnulo H. Sepsis fulminante en el esplenectomizado. In: Correa H, ed. Sepsis tratamiento intensivo de las infecciones graves. Montevideo: Oficina del Libro FEFMUR; 2004:411-5.
(15) Midon ME, Goldoni F, Souza SG, Miyasato JN. Austrian Syndrome: case report. Arq Bras Cardiol 2011; 97(3):e50-2.
(16) Siles Rubio JR, Anguita Sánchez M, Castillo Domínguez JC, Ramírez Moreno A, Pavlovic D, Berjillos Cortés F, et al. Síndrome de Austrian (endocarditis, meningitis y neumonía por Streptococcus pneumoniae): a propósito de un caso poco frecuente. Rev Esp Cardiol 1998; 51(12):1006-8.
(17) Hortal M, Lovgren M, de la Hoz F, Agudelo CI, Brandileone MC, Camou T, et al. Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance. Microb Drug Resist 2001; 7(4):391-401.
(18) Morgan TL, Tomich EB. Overwhelming post-splenectomy infection (OPSI): a case report and review of the literature. J Emerg Med 2012; 43(4):758-63.
(19) du Cheyron D, Lesage A, Le Page O, Flais F, Leclercq R, Charbonneau P. Corticosteroids as adjunctive treatment in Austrian's syndrome (pneumococcal endocarditis, meningitis, and pneumonia): report of two cases and review of the literature. J Clin Pathol 2003; 56(11):879-81.
(20) Brigden ML. Detection, education and management of the asplenic or hyposplenic patient. Am Fam Physician 2001; 63(3):499-506
(21) El-Alfy MS, El-Sayed MH. Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention? Hematol J 2004; 5(1):77-80.
(22) Mourtzoukou EG, Pappas G, Peppas G, Falagas ME. Vaccination of asplenic or hyposplenic adults. Br J Surg 2008; 95(3):273-80.
(23) British Committee for Standards in Haematology, Davies JM, Barnes R, Milligan D. Working Party of the Haematology/Oncology Task Force. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002; 2(5):440-3.
(24) Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61(40):816-9.
Publicado
2013-09-30
Cómo citar
1.
Angulo M, Grille P, Bagnulo H. Sepsis posesplenectomía. Rev. Méd. Urug. [Internet]. 30 de septiembre de 2013 [citado 24 de noviembre de 2024];29(3):195-8. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/281
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