Overwhelming pneumococcal septicaemia in a patient with ulcerative colitis and splenic atrophy.

Abstract

In March 1981 the patient, her husband, and daughter developed mild diarrhoea, which they ascribed to 'food poisoning'. This caused little concern and husband and daughter rapidly recovered. The patient began to vomit and developed persistent headache. After 24 hours she suddenly collapsed. She was seen within half an hour by her general practitioner who noted that she was shocked and had a few purpuric spots. She was immediately transferred to hospital by which time

Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses

“…In particular, recent biological treatments, such as tumour necrosis factor-alpha (TNFα) antagonists, that alter immune response are thought to increase the risk of infection 17 18. Infection has been implicated as a contributory cause of death in people with rheumatoid arthritis,19 SLE20 and inflammatory bowel diseases,21 22 and case reports have found associations between SLE23 and ulcerative colitis24 and subsequent severe pneumococcal infection. We lack information on any treatment used for immune-mediated diseases and are unable to determine the extent to which treatment may affect pneumococcal disease occurrence in this population.…”

Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA

“…Immunomodulators and biological therapies further increase risks for infectious complications by dampening an overactive intestinal immune, many of which are preventable with vaccinations 9. Over the last several years, cases of fulminant hepatitis B,10 disseminated zoster11–13 and pneumococcal sepsis14 15 have been described in patients with Crohn's and ulcerative colitis being treated with various immunosuppressants. This issue is further compounded by the demonstrated underutilisation of vaccinations in the IBD population.…”

Vaccination of patients with inflammatory bowel disease: Practical recommendations

“…Intestinal barrier impairment and malnutrition are additional risk factors (4). Although the incidence of vaccine-preventable infections in patients with IBD is not well established, severe forms of pneumococcal infection (fulminant sepsis) (5)(6)(7), pneumonia by the varicella-zoster virus (8,9), hepatitis B virus reactivation in patients with latent infection (10, 11), and a high incidence of shingles have all been described (12,13). In addition, there is a high risk for cervical dysplasia and cancer (14,15), particularly in women with Crohn's disease, due to a greater prevalence of infection with the human papillomavirus.…”