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I, II
0%
0/31
I, III, IV
77%
24/31
I, V
II only
III, IV
19%
6/31
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Following a splenectomy, patients should be vaccinated for H. influenzae, N. meningitidis, and S. pneumoniae. Encapsulated bacteria have capsules which serve as an antiphagocytic virulence factor. These bacteria include S. pneumoniae, H. influenzae type B, N. meningitidis, E. coli, Salmonella, K. pneumoniae, and group B Strep. The immune systems combats these organisms by opsonizing and then clearing them by the spleen. Thus, asplenic patients have decreased ability to opsonize organisms and are at increased risk of infection with encapsulated bacteria. Asplenic patients are recommended to have the S.pneumoniae, H. influenzae, and N. meningitidis vaccines to prevent such infection. Brigden reviews the detection, education and management of the asplenic or hyposplenic patient. She states fulminant, potentially life-threatening infection is a major long-term risk after splenectomy or in persons who are functionally hyposplenic as a result of various systemic conditions. Most of these infections are caused by encapsulated organisms such as pneumococci, Haemophilus influenzae and meningococci. Management of patients with these conditions includes a combination of immunization, antibiotic prophylaxis and patient education. Saraceni and Schwed-Lustgarten present a case of pneumococcal sepsis-induced purpura fulminans in an asplenic adult patient. They state acute perturbations in the hemostatic balance of anticoagulation and procoagulation precede the manifestation of purpura fulminans, a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin. Hallmarks include small vessel thrombosis, tissue necrosis and disseminated intravascular thrombosis and early intravenous antibiotic administration and hemodynamic support are cornerstones in management. Figure A demonstrates a positive FAST exam demonstrating free fluid in Morrison's pouch. Figure B is a CT scan demonstrating a severe grade V splenic laceration. Figure C demonstrates a gross image of a removed spleen that sustained a severe splenic laceration. Incorrect answers: Answers 1,4: Asplenic patients are not at increased for tetanus infections (answer II) and since this patient is up to date with her vaccinations/boosters, the tetanus vaccine is not indicated. Answer 3: Asplenic patients are not at increased for Hepatitis B infections (answer V) and are thus not recommended (any more so than the general population) to obtain the Hepatitis B vaccine. Answer 5: Asplenic patients require all 3 (H. influenzae, N. meningitidis, and S. pneumoniae) vaccine, not just N. meningitidis, and S. pneumoniae.
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