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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The immune response to an intravenous bolus of sheep erythrocytes, a large particulate antigen, was examined in weanling Sprague-Dawley rats after varying reduction in spleen size by splenic artery ligation (SAL) or partial amputation (pSx), and the results were compared with splenectomized (Sx) and sham-operated controls. Whereas SAL and pSx rats both produced higher 5 day (primary response) hemolysin antibody titers (P less than 0.001) than Sx rats, levels were lower (P less than 0.05) than in sham-operated rats with larger spleens (P less than 0.001). A similar heterophile pattern was seen in SAL rats at 22 days (secondary response). Within each group there was a positive correlation between splenic weight and serum hemolysin titer (r greater than 0.81) (P less than 0.001). Whereas spleen weight of sham-operated rats increased only 58%, splenic remnants in pSx rats enlarged 139% to 412%, with the greatest percentage of growth in the smallest remnants (25 mg) and the least in the largest remnants (200 mg). These data demonstrate a measurable immunologic advantage of splenic remnants (hyposplenism) over asplenism. This difference, although suboptimal as compared with that of a whole spleen (eusplenism), nonetheless may bolster body defenses to certain forms of bacterial sepsis.
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PMID:Humoral immunity in experimental hyposplenism. 30 80

A case of pneumococcal sepsis with DIC is reported. The patient had hyposplenism from thorium dioxide administration 23 years previously. Evidences of consumptive coagulopathy were verified by clinical manifestations of shock, generalized petechiae, abnormal hemostatic studies, and autopsy findings. The possible pathogenetic mechanism(s) of DIC in hyposplenism and pneumococcemia are reviewed.
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PMID:Hyposplenism and disseminated intravascular coagulation (DIC) in fulminant pneumococcal sepsis. 88 88

A 50 year old woman presented with pneumococcal septicaemia, septic arthritis, and a lobar pneumonia and was subsequently diagnosed as having systemic lupus erythematosus. The blood film and splenic 99mTc sulphur colloid uptake were normal, although selective functional hyposplenism was shown by the impaired clearance of immunoglobulin coated erythrocytes. Systemic lupus erythematosus presenting with fulminating pneumococcal sepsis in the presence of selective defects in spleen function is previously unreported.
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PMID:Systemic lupus erythematosus presenting as pneumococcal septicaemia and septic arthritis. 232 28

Fatal pneumococcal sepsis due to functional asplenia in a child with systemic lupus erythematosus (SLE) and transient hyposplenism in a 2nd child during an acute flare of SLE are described. Splenic ultrasound examinations and radionuclide spleen scans in 11 other children with SLE were normal. Splenic atrophy and dysfunction is an uncommon but potentially fatal complication of SLE in childhood.
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PMID:Functional asplenia in childhood onset systemic lupus erythematosus. 307 28

To determine whether immunosuppression by total lymphoid irradiation (TLI) slowed deterioration of chronic progressive multiple sclerosis (MS), functional impairment score and blood lymphocyte counts were compared at 6-month intervals through 4 years following treatment of MS patients by either TLI (n = 27) or sham irradiation (n = 21). At each interval, 20 to 30% fewer TLI-treated patients had deteriorated (p less than 0.05 at 6, 12, and 18 months), and the difference in mean functional impairment score between groups became progressively greater (p less than 0.01 at 42 and 48 months). Benefit accrued principally to the 17 TLI-treated patients with absolute blood lymphocyte counts less than 900/mm3 3 months after treatment, whose mean functional impairment score remained within 0.6 units of baseline (p = NS), whereas the ten TLI patients with higher post-treatment lymphocyte counts had progressive deterioration (p less than 0.05 to p less than 0.001 versus TLI-treated patients with lower lymphocyte counts at all intervals except 30 months) and had deteriorated by more than 5 functional scale units by 42 and 48 months. Side effects were minor and complications rare in TLI-treated patients, but one TLI-treated patient developed staphylococcal sepsis. Thus, TLI slows deterioration of chronic progressive MS, with what appears to be enduring benefit through 4 years compartmented to patients with greater induced lymphopenia. Modification of lymphoid irradiation regimens to increase the proportion of MS patients who achieve a favorable degree of lymphopenia and to avert functional hyposplenism may further improve the benefit/risk ratio.
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PMID:Effect of total lymphoid irradiation on functional status in chronic multiple sclerosis: importance of lymphopenia early after treatment--the pros. 329 Jul 13

This case illustrates a unique clinical presentation of primary systemic amyloidosis, namely, overwhelming pneumococcal sepsis. Although there exists a well-established association between hyposplenism and overwhelming bacterial infection, amyloid replacement of the spleen as a primary cause of the hyposplenism has not been reported. Functional hyposplenism in regard to the effect of the spleen on erythrocytes has been reported in cases of diffuse splenic amyloid infiltration. The patient described had a fulminant course and associated disseminated intravascular coagulation, two clinical features more commonly seen in pneumococcemia occurring in asplenic patients as opposed to patients with normal splenic function. He had no predisposing factors, other than amyloid replacement of the spleen, to account for the development of overwhelming pneumococcemia. The immunologic function of the spleen in protection against overwhelming bacterial infection is briefly discussed.
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PMID:Primary amyloidosis with diffuse splenic infiltration presenting as fulminant pneumococcal sepsis. 382 9

Hyposplenism as a complication of celiac sprue confers an increased risk of pneumococcal sepsis, but such patients do not routinely receive pneumococcal vaccine despite reports of overwhelming pneumococcal sepsis. Because antibody response in these patients has not been previously assessed, we measured pre- and postvaccination levels in 10 patients with documented sprue. All demonstrated appropriate acute antibody responses to a polyvalent pneumococcal vaccine. Vaccination of all patients with celiac sprue seems appropriate.
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PMID:Appropriate response to pneumococcal vaccine in celiac sprue. 776 89

Functional hyposplenism, seen in some patients with alcoholic liver disease, may contribute to the increased susceptibility to infections. As hyposplenism does not complicate non-alcohol related chronic liver disease, it is probably secondary to a toxic effect of alcohol. Over a two year period the case notes of 82 patients with alcoholic liver disease, whose splenic function had been assessed by the counting of pitted erythrocytes using differential interference microscopy, were reviewed to monitor mortality and the effects of hyposplenism. Thirteen patients (seven with hyposplenism) had serial measurements of pitted erythrocyte count made to assess the effect of abstinence from alcohol on splenic function. Thirty one of the 82 alcoholic patients had pitted erythrocyte counts greater than 2%. Eighteen of 82 (16%) patients died over the two years and 11 of these had been unable to stop drinking. Only one patient died of sepsis. Five patients (6%) had pitted erythrocyte counts comparable with those in splenectomised patients. In 12 of 13 patients who had abstained from alcohol for two months, the pitted erythrocyte count fell from a median of 3 to 1.3% (mean: 8.1 to 2.6%. p = 0.01). The pitted red cell count in two patients increased. One had abstained, the other had continued to drink heavily. Short term mortality in alcoholics is high, particularly if they continue to drink heavily. Only a few of these deaths are secondary to infection. Splenic function, as assessed by these methods, improves in most patients with abstinence, suggesting that the functional hyposplenism may be a result of a direct toxic effect of alcohol on the spleen.
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PMID:Functional hyposplenism in alcoholic liver disease: a toxic effect of alcohol? 820 May 65

Fulminant pneumococcal sepsis is a rare but life-threatening illness usually occurring in patients with known splenic absence (postsplenectomy) or dysfunction (sickle cell anemia). Several medical illnesses, not typically recognized as being associated with abnormal spleen function, may be complicated by fulminant pneumococcal sepsis. We report a case of fatal pneumococcal sepsis in a patient diagnosed with mixed connective tissue disease who likely had systemic lupus erythematosus and unsuspected splenic fibrosis. Medical illnesses associated with functional asplenia, hematological findings suggesting splenic dysfunction, and confirmatory tests of hyposplenism are discussed.
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PMID:Fatal pneumococcal septicemia in a patient with a connective tissue disease. 865 35

A peripheral blood film reflecting hyposplenism is an important finding. Not only does it indicate the risk to the patient of fulminant sepsis requiring preventative action but it may also direct further investigations towards an underlying medical condition. The occurrence of hyposplenism in systemic amyloidosis has been described. We present three cases which demonstrate this association and highlight the value of the peripheral blood film.
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PMID:The importance of the peripheral blood film in systemic amyloidosis. 893 94


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