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• W2022681775 abstract "In their report, E J Watkins and colleagues (Jan 6, p 38)1Watkins EJ Brooksby P Schweiger MS Enright SM Septicaemia in pig-farm worker.Lancet. 2001; 357: 38Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar do not make clear the difficulty of recognising the implications of splenectomy at the time of recruitment to employment. Farmers, like many employers, frequently make only cursory enquiries, or none at all, about previous health issues. Moreover, an operation such as splenectomy is unlikely to attract concern, and will probably be equated with appendicectomy in a fit-looking person. Thus, the onus of protection is on the individual who has undergone splenectomy. This matter is important because the inconsistency of maintenance of preventive measures in such patients has been recognised.2Waghorn DJ Mayon-White RT A study of 42 episodes of overwhelming post-splenectomy infection: is current guidance for asplenic individuals being followed?.J Infect. 1997; 35: 289-294Summary Full Text PDF PubMed Scopus (102) Google Scholar Much depends on the adequacy of advice given by the surgeon who removes the spleen. Guidelines on advice are currently undergoing revision.3Working Party for the British Committee for Standards in Haematology Clinical Haematology Task Force. Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. London: British Committee for Standards in Haematology. Clinical Haematology (in press).Google Scholar In a search of abstracts on MEDLINE from 1966 (around the date when human infection was first recognised) onwards, I found three further reports of Streptococcus suis infection in splenectomy patiensts.4Communicable Disease Reports CDR 81/145, CDR 81/113. Public Health Laboratory Service, London1981/82Google Scholar, 5Francois B Gissot V Ploy MC Vignon P Recurrent septic shock due to Streptococcus suis.J Clin Microbiol. 1998; 36: 2395PubMed Google Scholar Three of these four patients have died. Via the Public Health Laboratory Service, I am aware of one (as yet unpublished) further such infection in the UK in 1999 that resulted in death. This total provides a crude estimated case fatality rate for S suis infection after splenectomy of 80%. Thus, Watkins and colleagues’ argument for avoidance of activities with a high exposure risk, especially pig farming, butchering, and abattoir work, seems justified. A central registry of splenectomy cases (there in none at present) that included details of occupation could improve follow-up supervision and re-education of these patients, as well as our ability to identify other occupations that might be dangerous to them." @default.
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• W2022681775 date "2001-04-01" @default.
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• W2022681775 title "Streptococcus infection and splenectomy" @default.
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• W2022681775 doi "https://doi.org/10.1016/s0140-6736(00)04280-x" @default.
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