Preventing And Treating Infections In Children With Asplenia Or Hyposplenia

Question 1

What are some examples of encapsulated organisms?

Answer 1

Streptococcus pneumonia
Hemophilus influenza type B 
Neisseria meningitidis
Salmonella species
E Coli

Less common
Pseudomonas
Klebsiella
Streptococci
Staphylococci

Question 2

In the first three months of life, which bugs are more common?

Answer 2

Coliform: E. Coli and klebsiella

Question 3

The highest frequency of infection is in what time post-splenectomy?

Answer 3

Within the first three years

Question 4

What is the mortality rate of sepsis in asplenia patients?

Answer 4

50 - 70%

Question 5

What type of pathogen could cause sepsis after a dog bite?

Answer 5

Capnocytophagia species

Question 6

Other than encapsulated organisms and dog bites, is there any other infection that is higher risk in patients without spleens? (2)

Answer 6

Severe malaria - travel advise and prevention is essential

Babesia (tick bites)

Question 7

Does prophylactic antibiotics provide complete protection?

Answer 7

No.

Education is essential

Question 8

What antibiotic would you give a patient with asplenia if they were bitten by a dog?

Answer 8

Amoxicillin-clavulinic acids

Question 9

List some special streptococcal immunization so for kids with no spleen?

Answer 9

• PCV13 (conjugate): kids at birth should receive four doses at 2,4,6, and 12-15 months. Needs to be given at least eight weeks apart. If kids are between 12-24 months, they should be given two doses. If they are over 24 months, they need one dose
• PPV23 (polysaccharide) should be given once 24 months, this needs to be given at least eight weeks after PCV13

Question 10

When do kids need a booster of PPV23?

Answer 10

At five years

Question 11

What do oh you do if an asplenic patient previously got only PPV23?

Answer 11

Give them PCV13 one year after receipt of PPV23

Question 12

What are the special recommendations for meningococcal vaccination?

Answer 12

All should receive the conjugate quadrivalent vaccine MCV4 and 4CmenB

Options for MCV4:
At birth Menveo 2 4 6 12 and 15 months
If 12 months, they should get two doses of Menveo eight weeks apart
If over 2 years, they can have any product: Menveo, menactra, nimenrix
Need to be re vaccinated every five years

Question 13

What are children who have no spleen at risk of?

Answer 13

Overwhelming bacterial sepsis with encapsulated organism

Question 14

Do kids with no spleen need any special protection against hemophilus?

Answer 14

No. They should just get their primary vaccinations at 2, 4 and 6 months with a booster at 18 months.

Question 15

If a kid has Hemophilus sepsis, do they still need the vaccine?

Answer 15

yes. Infection does not cause life long protection

Question 16

If the kid travels a lot, what do you need to think about?

Answer 16

They have a higher risk of salmonella, so giving them vaccine for S typhi

Question 17

If the kid is having an elective splenectomy, when should it be arranged with regards to optimising vaccines?

Answer 17

At least 2 weeks after vaccines

Question 18

If the splenectomy is emergent, when do you start giving special vaccines?

Answer 18

At least two weeks after splenectomy

Question 19

What prophylactic antibiotics do you give these kids and why?

Answer 19

1-3 months: Amox-clav to cover E Coli and Klebsiella

> 3: Pen VK or amoxicillin

Question 20

When do you discontinue antibiotic prophylaxis?

Answer 20

Controversial topic:
CPS: At five years and once they have had a minimum of 2 years post splenectomy
Some groups recommend life long prophylaxis (ideally)

NB nuclear if partial splenectomy or functional asplenia

Question 21

What antibiotic prophylaxis should kids get if they have anaphylaxis to penicillin?

Answer 21

Erythromycin - although higher rates of pneumococcal resistance

Question 22

If a kid without a spleen came in with a fever, what do you do?

Answer 22

Resus
BCx
Ceftriaxone
If penicillin-resistant strep pneumo - consider Vancomycin and ceftriaxone
If Penicillin Allergy: Vancomycin and cipro