Recurrent,Fatal Hemophilus Influenzae Sepsis in a Splenectomized Child on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Abstract

This child, who was on CAPD, had two episodes of Hemophilus influenzae sepsis, the second of which proved fatal. Predisposing factors were prior splenectomy, recent immunosuppression and cytomegalovirus infection. Peritonitis was not present. Nephrologists must consider various risk factors when caring for the increasing number of young children on CAPD, particularly those who are splenectomized.

In some renal transplant recipients splenectomy has been advocated in an effort to improve graft survival (I). The procedure entails both perioperative risk and long-term complications, most notably bacterial sepsis. The risk of overwhelming, post splenectomy infection (OPSI) is higher in young children (2) and may be further increased in patients with end-stage renal disease.

We report a fatal case of recurrent Hemophilus influenzae (H. flu) septicemia in a splenectomized child receiving continuous ambulatory peritoneal dialysis (CAPD). In the absence of an available, effective vaccine to prevent hemophilus infections in children, our experience with this child suggests that prophylactic antibiotics should be given to reduce the risk of OPSI in susceptible individuals.