Hazard of severe infections in splenectomized infants and children

Abstract

A series of nineteen cases of severe and often fulminating infection, six terminating fatally, in children following splenectomy is presented. Except for two cases of traumatic rupture of the spleen, the major indication for splenectomy was based on the needs arising from an established blood disorder. The infections fell into several well defined categories: meningitis, acute benign pericarditis (in patients with Cooley's anemia), acute endocarditis and sepsis. In the cases in which bacterial diagnosis was possible pneumococcus was the most frequent offender and of the clinical types, meningitis was most common. Pneumococcic meningitis predominated in this and other reports. In the majority of cases the interval between splenectomy and infection was two years or less, with a range from one day to sixteen years. The age at splenectomy extended from thirteen months to seventeen years. There was no diminution in the concentration of gamma globulin in these patients. The cases described in this paper, together with current reports of a similar nature, suggest more than a random association between splenectomy and susceptibility to infection. An extensive experimental background implicates the spleen in fundamental processes relating to resistance to infection. The sample reported in this paper is avowedly small in comparison with the ever increasing number of splenectomies. Nevertheless, while the benefits accruing from splenectomy are substantial and well documented, the potential hazards demand that exact criteria be established in selecting patients for the operation. In the light of the experience cited in this paper, the young splenectomized patient requires close supervision for several years postoperatively so that immediate and energetic treatment may be instituted in the event of sudden and severe illness. Specific prophylaxis presents manifold problems which await further study