What can represent as a medical emergency in an aspleenic patient -
Sudden and unexpected nontraumatic death in individuals with asplenia or hyposplenia is usually due to fulminant bacterial sepsis, most often involving Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae. C canimorsus is a gram-negative bacillus commonly associated with exposure to dogs or cats through saliva, scratches, or bites. Even a seemingly small, benign-appearing wound, as seen in this case, can be a poal of entry for this organism. Patients infected with this organism can progress to fulminant sepsis with multiorgan failure with disseminated intravascular coagulation, anuria, and hypotension. In an asplenic patient, fever can be an early sign of sepsis, which can have a rapid and fulminant course. Asplenic patients are paicularly susceptible to infection by encapsulated organisms such as S pneumoniae, H influenzae, N meningitidis, and C canimorsus due to impaired immunity. If an asplenic patient has been exposed to a dog bite, scratch, or saliva, one should suspect C canimorsus. Asplenic patients who present with fever should be treated immediately with intravenous vancomycin and ceftriaxone without delay for laboratory tests or imaging. To help prevent fulminant sepsis, asplenic patients should receive vaccines (pneumococcal, meningococcal, and H influenzae type b) as well as a prescription for antibiotics (levofloxacin) to be used if they develop fever and cannot see a physician within 2 hours Ref Harrison 20th edition pg 897
Cat bite
Dog bite
Fish bite
Human bite
Infection