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Case Report

Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma

Bone Marrow Transplantation volume 26, pages 1017–1019 (2000)Cite this article

Abstract

Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neiserria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues. Bone Marrow Transplantation (2000) 26, 1017–1019.

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References

  1. King H, Shumacker HB Jr . Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy Ann Surg 1952 136: 239–242

    Article  CAS  Google Scholar 

  2. Pearson HA, Gallagher D, Chilcote R et al. Development pattern of splenic dysfunction in sickle cell disorders Pediatrics 1985 76: 392–397

    CAS  PubMed  Google Scholar 

  3. Rogers TR, Joshi R, White S et al. Severe pneumococcal infection and splenic atrophy occurring as complications of graft-versus-host disease after haplotype mismatched marrow transplants Exp Hematol 1983 2: (Suppl. 13) 123–124

    Google Scholar 

  4. Working Party of British Committee for Standards in Haematology, Haematology Task Force . Guidelines for the prevention and treatment of infection in patients with absent or dysfunctional spleen BMJ 1996 312: 430–434

    Article  Google Scholar 

  5. Steele RW, Warrier R, Unkel PJ et al. Colonization with antibiotic-resistant Streptococcus pneumoniae in children with sickle cell disease J Pediatr 1996 128: 531–535

    Article  CAS  Google Scholar 

  6. Winston DJ, Ho WG, Schiffman G et al. Pneumococcal vaccination of recipients of bone marrow transplants Arch Intern Med 1983 143: 1735–1737

    Article  CAS  Google Scholar 

  7. Avanzini MA, Carra AM, Maccario R et al. Antibody response to pneumococcal vaccine in children receiving bone marrow transplantation J Clin Immunol 1995 15: 137–144

    Article  CAS  Google Scholar 

  8. Holdsworth RJ, Irving AD, Cuschieri A . Postsplenectomy sepsis and its mortality rate: actual versus perceived risks Br J Surg 1991 78: 1031–1038

    Article  CAS  Google Scholar 

  9. Siber GR, Weitzman SA, Aisenberg AC et al. Impaired antibody response to pneumococcal vaccine after treatment for Hodgkin's disease New Engl J Med 1978 299: 442–448

    Article  CAS  Google Scholar 

  10. Zarrabi MH, Rosner F . Rarity of failure of penicillin prophylaxis to prevent postsplenectomy sepsis Arch Intern Med 1986 146: 1207–1208

    Article  CAS  Google Scholar 

  11. Johnson AP, Speller DC, George RC et al. Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995 BMJ 1996 312: 1454–1456

    Article  CAS  Google Scholar 

  12. Jacobs M . Drug-resistant Streptococcus pneumoniae: rational antibiotic choices Am J Med 1999 106: 19S–25S

    Article  CAS  Google Scholar 

  13. Engels EA, Lau J, Barza M . Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis J Clin Oncol 1998 16: 1179–1187

    Article  CAS  Google Scholar 

  14. Biedenbach DJ, Jones RN . The comparative antimicrobial activity of levofloxacin tested against 350 clinical isolates of streptococci Diagn Microbiol Infect Dis 1996 25: 47–51

    Article  CAS  Google Scholar 

  15. Fu KP, Lafredo SC, Foleno B et al. In vitro and in vivo antibacterial activities of levofloxacin (L-ofloxacin), an optically active ofloxacin Antimicrob Agents Chemother 1992 36: 860–866

    Article  CAS  Google Scholar 

  16. Pfaller MA, Jones RN . Comparative antistreptococcal activity of two newer fluoroquinolones, levofloxacin and sparfloxacin Diagn Microbiol Infect Dis 1997 29: 199–201

    Article  CAS  Google Scholar 

  17. Piddock LJ . New quinolones and Gram-positive bacteria Antimicrob Agents Chemother 1994 38: 163–169

    Article  CAS  Google Scholar 

  18. Novak R, Henriques B, Charpentier E et al. Emergence of vancomycin tolerance in Streptococcus pneumoniae Nature 1999 399: 590–593

    Article  CAS  Google Scholar 

  19. Machesky KK, Cushing RD . Overwhelming postısplenectomy infection in a patient with penicillin-resistant Streptococcus pneumoniae Arch Fam Med 1998 7: 178–180

    Article  CAS  Google Scholar 

  20. Obaro SK, Monteil MA, Henderson DC . The pneumococcal problem BMJ 1996 312: 1521–1525

    Article  CAS  Google Scholar 

  21. Leemans R, Manson W, Snijder JA et al. Immune response capacity after human splenic autotransplantation: restoration of response to individual pneumococcal vaccine subtypes Ann Surg 1999 229: 279–285

    Article  CAS  Google Scholar 

  22. Jakobsen H, Saeland E, Gizurarson S et al. Intranasal immunization with pneumococcal polysaccharide conjugate vaccines protects mice against invasive pneumococcal infections Infect Immun 1999 67: 4128–4133

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Evans DIK . Fatal post-splenectomy sepsis despite prophylaxis with penicillin and pneumococcal vaccine Lancet 1984 1: 1124–1125

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust, Birmingham, UK

    S Tauro & P Mahendra

  2. Department of Microbiology, University Hospital Birmingham NHS Trust, Birmingham, UK

    D Dobie & M Hastings

  3. Russell's Hall Hospital, Birmingham, UK

    G Richardson

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  1. S Tauro
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  2. D Dobie
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  4. M Hastings
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  5. P Mahendra
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Tauro, S., Dobie, D., Richardson, G. et al. Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma. Bone Marrow Transplant 26, 1017–1019 (2000). https://doi.org/10.1038/sj.bmt.1702647

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