-
American Family Physician Mar 2015Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic,... (Review)
Review
Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic, some patients present with the clinical syndrome of infectious mononucleosis (IM). The syndrome most commonly occurs between 15 and 24 years of age. It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. A heterophile antibody test is the best initial test for diagnosis of EBV infection, with 71% to 90% accuracy for diagnosing IM. However, the test has a 25% false-negative rate in the first week of illness. IM is unlikely if the lymphocyte count is less than 4,000 mm3. The presence of EBV-specific immunoglobulin M antibodies confirms infection, but the test is more costly and results take longer than the heterophile antibody test. Symptomatic relief is the mainstay of treatment. Glucocorticoids and antivirals do not reduce the length or severity of illness. Splenic rupture is an uncommon complication of IM. Because physical activity within the first three weeks of illness may increase the risk of splenic rupture, athletic participation is not recommended during this time. Children are at the highest risk of airway obstruction, which is the most common cause of hospitalization from IM. Patients with immunosuppression are more likely to have fulminant EBV infection.
Topics: Adolescent; Airway Obstruction; Antibodies, Viral; Disease Management; Herpesvirus 4, Human; Humans; Immunoglobulin M; Infectious Mononucleosis; Serologic Tests; Splenic Rupture; Young Adult
PubMed: 25822555
DOI: No ID Found -
BMC Family Practice May 2019General practitioners encounter the vast majority of patients with Epstein-Barr virus-related disease, i.e. infectious mononucleosis in children and adolescents. With... (Review)
Review
BACKGROUND
General practitioners encounter the vast majority of patients with Epstein-Barr virus-related disease, i.e. infectious mononucleosis in children and adolescents. With the expanding knowledge regarding the multifaceted role of Epstein-Barr virus in both benign and malignant disease we chose to focus this review on Epstein-Barr virus-related conditions with relevance to the general practitioners. A PubMed and Google Scholar literature search was performed using PubMed's MeSH terms of relevance to Epstein-Barr virus/infectious mononucleosis in regard to complications and associated conditions.
MAIN TEXT
In the present review, these included three early complications; hepatitis, splenic rupture and airway compromise, as well as possible late conditions; lymphoproliferative cancers, multiple sclerosis, rheumatoid arthritis, and chronic active Epstein-Barr virus infection. This review thus highlights recent advances in the understanding of Epstein-Barr virus pathogenesis, focusing on management, acute complications, referral indications and potentially associated conditions.
CONCLUSIONS
Hepatitis is a common and self-limiting early complication to infectious mononucleosis and should be monitored with liver tests in more symptomatic cases. Splenic rupture is rare. Most cases are seen within 3 weeks after diagnosis of infectious mononucleosis and may occur spontaneously. There is no consensus on the safe return to physical activities, and ultrasonic assessment of spleen size may provide the best estimate of risk. Airway compromise due to tonsil enlargement is encountered in a minority of patients and should be treated with systemic corticosteroids during hospitalization. Association between lymphoproliferative cancers, especially Hodgkin lymphoma and Burkitt lymphoma, and infectious mononucleosis are well-established. Epstein-Barr virus infection/infectious mononucleosis as a risk factor for multiple sclerosis has been documented and may be linked to genetic susceptibility. Chronic active Epstein-Barr virus infection is rare. However, a general practitioner should be aware of this as a differential diagnosis in patients with persisting symptoms of infectious mononucleosis for more than 3 months.
Topics: Airway Obstruction; Arthritis, Rheumatoid; Burkitt Lymphoma; Chronic Disease; Epstein-Barr Virus Infections; General Practice; Hematologic Neoplasms; Hepatitis, Viral, Human; Herpesvirus 4, Human; Hodgkin Disease; Humans; Infectious Mononucleosis; Lymphadenopathy; Multiple Sclerosis; Palatine Tonsil; Splenic Rupture
PubMed: 31088382
DOI: 10.1186/s12875-019-0954-3 -
American Family Physician Sep 2021Splenomegaly can be due to several mechanisms but is almost always a sign of a systemic condition. Patient habits, travel, and medical conditions can increase risk of...
Splenomegaly can be due to several mechanisms but is almost always a sign of a systemic condition. Patient habits, travel, and medical conditions can increase risk of splenomegaly and suggest etiology. Symptoms can suggest infectious, malignant, hepatic, or hematologic causes. Physical examination will typically reveal splenomegaly, but abdominal ultrasonography is recommended for confirmation. Physical examination should also assess for signs of systemic illness, liver disease, and anemia or other hematologic issues. The most common causes of splenomegaly in the United States are liver disease, malignancy, and infection. Except for apparent causes such as infectious mononucleosis, basic laboratory analysis and ultrasonography are the first-line steps in determining etiology. Malaria and schistosomiasis are common in tropical regions, where as many as 80% of people may have splenomegaly. Management of splenomegaly involves treating the underlying disease process. Splenectomies and spleen reduction therapies are sometimes performed. Any patient with limited splenic function requires increased vaccination and prophylactic antibiotics for procedures involving the respiratory tract. Acute infections, anemia, and splenic rupture are the most common complications of splenomegaly, and people with splenomegaly should refrain from participating in contact sports to decrease risk of rupture.
Topics: Anemia; Disease Management; Humans; Splenic Rupture; Splenomegaly; Ultrasonography
PubMed: 34523897
DOI: No ID Found -
Clinical Medicine (London, England) Mar 2019
Topics: Dabigatran; Humans; Rupture, Spontaneous; Splenic Rupture
PubMed: 30872308
DOI: 10.7861/clinmedicine.19-2-188 -
Ugeskrift For Laeger Mar 2024Atraumatic splenic rupture (AMR) is a life-threatening condition with a wide range of aetiologies, and it may present with a vague symptomatology. Therefore, AMR can be... (Review)
Review
Atraumatic splenic rupture (AMR) is a life-threatening condition with a wide range of aetiologies, and it may present with a vague symptomatology. Therefore, AMR can be diagnostically challenging. In this review, we wish to focus on the fact that guidelines only exist for traumatic splenic rupture although they may be applicable for AMR too. In addition, a stringent ABCDE approach for clinical examination may early and reliable diagnose the patients and guide further imaging examination and treatment.
Topics: Humans; Physical Examination; Rupture, Spontaneous; Splenic Rupture
PubMed: 38533862
DOI: 10.61409/V05230328 -
Journal of Surgical Case Reports Mar 2017Splenic rupture is a rare but serious complication from cocaine abuse. Given the ubiquitous prevalence of abuse and the potential for death from intraperitoneal...
Splenic rupture is a rare but serious complication from cocaine abuse. Given the ubiquitous prevalence of abuse and the potential for death from intraperitoneal bleeding, the prompt diagnosis and treatment of cocaine-induced disease including splenic rupture is essential. The management for splenic rupture from traumatic and atraumatic etiology has shifted from emergent laparotomy and splenectomy to non-operative approach with transcatheter splenic artery embolization. We report a 39-year-old male with a significant substance abuse history who presented with atraumatic splenic rupture. He was managed nonoperatively with adjunctive transcatheter splenic artery embolization. His post-procedure course was complicated by an intra-abdominal abscess requiring drainage via interventional radiology guided pigtail catheter placement and intravenous antibiotics. This case report is intended to raise awareness of the potentiating effects of cocaine use in this patient population and highlight questions raised during this patient's management.
PubMed: 28458860
DOI: 10.1093/jscr/rjx054 -
JAMA Surgery Dec 2020Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization only if necessary (SURV) for patients at high risk of spleen rupture remains controversial.
OBJECTIVE
To determine whether the 1-month spleen salvage rate is better after pSAE or SURV.
DESIGN, SETTING, AND PARTICIPANTS
In this randomized clinical trial conducted between February 6, 2014, and September 1, 2017, at 16 institutions in France, 133 patients with splenic trauma at high risk of rupture were randomized to undergo pSAE or SURV. All analyses were performed on a per-protocol basis, as well as an intention-to-treat analysis for specific events.
INTERVENTIONS
Prophylactic SAE, preferably using an arterial approach via the femoral artery, or SURV.
MAIN OUTCOMES AND MEASURES
The primary end point was an intact spleen or a spleen with at least 50% vascularized parenchyma detected on an arterial computed tomography scan at 1 month after trauma, assessed by senior radiologists masked to the treatment group. Secondary end points included splenectomy and pseudoaneurysm, secondary SAE after inclusion, complications, length of hospital stay, quality-of-life score, and length of time off work or studies during the 6-month follow-up.
RESULTS
A total of 140 patients were randomized, and 133 (105 men [78.9%]; median age, 30 years [interquartile range, 23-47 years]) were retained in the study. For the primary end point, data from 117 patients (57 who underwent pSAE and 60 who underwent SURV) could be analyzed. The number of patients with at least a 50% viable spleen detected on a computed tomography scan at month 1 was not significantly different between the pSAE and SURV groups (56 of 57 [98.2%] vs 56 of 60 [93.3%]; difference, 4.9%; 95% CI, -2.4% to 12.1%; P = .37). By the day 5 visit, there were significantly fewer splenic pseudoaneurysms among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 8 of 65 [12.3%]; difference, -10.8%; 95% CI, -19.3% to -2.1%; P = .03), significantly fewer secondary embolizations among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 19 of 65 [29.2%]; difference, -27.7%; 95% CI, -41.0% to -15.9%; P < .001), and no difference in the overall complication rate between the pSAE and SURV groups (19 of 65 [29.2%] vs 27 of 65 [41.5%]; difference, -12.3%; 95% CI, -28.3% to 4.4%; P = .14). Between the day 5 and month 1 visits, the overall complication rate was not significantly different between the pSAE and SURV groups (11 of 59 [18.6%] vs 12 of 63 [19.0%]; difference, -0.4%; 95% CI, -14.4% to 13.6%; P = .96). The median length of hospitalization was significantly shorter for patients in the pSAE group than for those in the SURV group (9 days [interquartile range, 6-14 days] vs 13 days [interquartile range, 9-17 days]; P = .002).
CONCLUSIONS AND RELEVANCE
Among patients with splenic trauma at high risk of rupture, the 1-month spleen salvage rate was not statistically different between patients undergoing pSAE compared with those receiving SURV. In view of the high proportion of patients in the SURV group needing SAE, both strategies appear defendable.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02021396.
Topics: Adult; Aneurysm, False; Embolization, Therapeutic; Female; Humans; Length of Stay; Male; Middle Aged; Prospective Studies; Return to Work; Spleen; Splenectomy; Splenic Artery; Splenic Rupture; Time Factors; Tomography, X-Ray Computed; Watchful Waiting; Wounds, Nonpenetrating; Young Adult
PubMed: 32936242
DOI: 10.1001/jamasurg.2020.3672 -
Ugeskrift For Laeger Mar 2019
Topics: Humans; Infectious Mononucleosis; Splenic Rupture
PubMed: 30869068
DOI: No ID Found -
The Journal of International Medical... Feb 2022Although rare, late-diagnosed atraumatic splenic rupture (ASR) may result in mortality. We investigated the occurrence of ASR cases at our centre over the previous six...
OBJECTIVE
Although rare, late-diagnosed atraumatic splenic rupture (ASR) may result in mortality. We investigated the occurrence of ASR cases at our centre over the previous six years.
METHODS
This was a retrospective, cross-sectional study that included all patients who underwent emergency splenectomy due to ASR between January 01, 2015, and January 01, 2021.
RESULTS
Of the 203 patients who underwent splenectomy, 15 met our criteria for ASR. Median age was 55 years (34-90), and 10 (67%) patients were male. Most common pre-existing diseases were diabetes mellitus (6, 40%) and heart valve disease (5, 33%). Ten (67%) patients had splenic rupture due to splenic infarction and abscess. There were two (13%) cases with diffuse large B cell lymphoma (DLBCL) and two (13%) cases with lung cancer and spleen metastasis. Median length of hospital stay was 6 days (2-24) and three (20%) patients died in hospital.
CONCLUSIONS
Male sex, previous splenic infarctions, haematological malignancies, lung cancer spleen metastases, underlying cardiovascular disease and diabetes mellitus may increase the risk for ASR. Further prospective controlled studies are needed to confirm our results.
Topics: Cross-Sectional Studies; Humans; Male; Middle Aged; Retrospective Studies; Rupture, Spontaneous; Splenic Rupture; Treatment Outcome
PubMed: 35209723
DOI: 10.1177/03000605221080875 -
Annals of the Royal College of Surgeons... Mar 2019The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with...
INTRODUCTION
The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with potential reasons for the increasing rarity of the procedure.
METHODS
A retrospective cohort study was carried out of all patients undergoing splenectomy (as identified by a single trust pathology department on receipt of splenic samples) between 1 January 2000 and 1 May 2017. Case notes and computer systems were interrogated for data on operating surgeon, patient demographics, diagnosis, surgical approach (laparoscopic/open/converted to open), critical care admission and 30-day mortality.
RESULTS
During the study period, 170 consecutive splenectomies were undertaken by 24 different operating surgeons. There were on average 5.8 planned and 4.2 unplanned splenectomies per year. The 30-day mortality rate for all splenectomies was 8.8%, with an elective 30-day mortality rate of 2.0%. Only 3 of the current consultant surgeons had undertaken more than 6 cases over the 17-year study period. Some senior consultants had not performed any splenectomies (either planned or unplanned) during the 17-year study period.
CONCLUSIONS
Splenectomy is required ever more rarely and experience as a district general hospital consultant is limited. Possible reasons for this include improvements in medical management of haematological diseases, the increasing use of conservative and radiological management for traumatic splenic injury, and a reduction in trauma cases and diversion of such cases to major trauma centres. Trainees and consultants must seek experience during specialty training or via cadaveric training in order to demonstrate competence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Elective Surgical Procedures; Emergency Treatment; Female; Hospital Mortality; Hospitals, General; Humans; Laparoscopy; Male; Middle Aged; Retrospective Studies; Spleen; Splenectomy; Splenic Rupture; Surgeons; Young Adult
PubMed: 30602286
DOI: 10.1308/rcsann.2018.0215