Presse Med
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Comparative Study
[Antibiotic prophylaxis against bacterial infections in the hyposplenic and asplenic child].
RISK OF INFECTION IN SPLENECTOMIZED CHILDREN: Observations in cohorts of splenectomized patients have led to the conclusion that the risk of bacterial infection is highest among young children, particularly under the age of 2 years, within 2 years of splenectomy and in children with an associated disease.
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SIGNIFICANT INCIDENCE OF SPLENECTOMY: Asplenism concerns a significant number of subjects: in France 6,000 to 9,000 patients undergo splenectomy annually. More than half of these patients are adults.
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FROM ASPLENIA TO SEVERE INFECTION: The most serious consequence of asplenia due to absence of the spleen, its resection or its functional failure is the risk of severe infection. RAPIDLY PROGRESSIVE SEPTICEMIA: It is estimated that the risk of death due to septicemia is 200 times higher in splectomized patients than in patients with a spleen. Death occurs within several days or even hours in most of the patients due to overwhelming post-splenectomy infection (OPSI). ⋯ In adults, morbidity is 0.9% and mortality 0.8%. PREVENTION OF RECURRENCE: Furthermore, in an asplenic subject or in a patient with a chronic disease threatening the spleen, the development of infectious episodes is an expression of evolving immunodepression, calling for preventive measures against recurrence. Anti-pneumococcal vaccination and antibiotic prophylaxis using penicillin V considerably reduces the incidence of pneumococcal infection in splenectomized subjects.
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VARIOUS EFFECTS: Mycophenolate mofetil (MMF) is a specific inosine monophosphate dehydrogenase inhibitor implied in the de novo synthesis of purine bases; it selectively decreases lymphocyte proliferation and is used for the prevention of acute organ rejection. It also decreases the expression of certain adhesion molecules and slows down the functional renal progression in many experimental models of glomerular nephritis. THE GLOMERULAR PATHOLOGY: To date there has been very few studies on the efficacy of MMF in human glomerular diseases and these have been sporadic clinical observations or series of cases with around ten patients. In general, these reports were of cases in which conventional treatment had failed.