Invasive group B streptococcal infection in a patient with post splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

BACKGROUND:Splenectomy in patients with liver cirrhosis(LC)is expected to become more common owing to its efficacy on portal hemodynamics.In this report we describe an alarming case of group B streptococcus(GBS)infection after splenectomy in a patient with LC.METHODS:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure.The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission.Pulmonary examination revealed significant wheezing during inspiration and expiration,but no crackles and stridor.Chest radiography and CT showed no infiltrates.A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made.Four days after admission,GBS infection was confirmed by blood culture and penicillin G was administered.Antibiotics were given intravenously for a total of 12 days.RESULTS:The patient was discharged on the 12th day after admission.CONCLUSIONS:Although efficacy of splenectomy in patients with LC has been reported,immune status should be evaluated for a longer period.Patients who have undergone splenectomy are highly susceptible to bacteria;moreover,LC itself is an independent risk factor for mortality in patients with sepsis.Since prophylaxis against GBS has not been established,immediate action should be taken.Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC,particularly the expected increase of splenectomy performed in LC patients.

Role of lipocalin 2 in intraventricular haemoglobin-induced brain injury

Objective:Our recent studies have shown that blood components,including haemoglobin and iron,contribute to hydrocephalus development and brain injury after intraventricular haemorrhage(IVH).The current study investigated the role of lipocalin 2(LCN2),a protein involved in iron handling,in the ventricular dilation and neuroinflammation caused by brain injury in a mouse model of IVH.Design:Female wild-type(WT)C57BL/6 mice and LCN2-deficient(LCN2^(−/−))mice had an intraventricular injection of haemoglobin,and control mice received an equivalent amount of saline.MRI was performed presurgery and postsurgery to measure ventricular volume and the brains were used for either immunohistochemistry or western blot.Results:Ventricular dilation was observed in WT mice at 24 h after haemoglobin(25 mg/mL,20µL)injection(12.5±2.4 vs 8.6±1.5 mm^(3) in the control,p<0.01).Western blotting showed that LCN2 was significantly upregulated in the periventricular area(p<0.01).LCN2 was mainly expressed in astrocytes,whereas the LCN2 receptor was detected in astrocytes,microglia/macrophages and neurons.Haemoglobin-induced ventricle dilation and glia activation were less in LCN2^(−/−)mice(p<0.01).Injection of high-dose haemoglobin(50 mg/mL)resulted in lower mortality in LCN2^(−/−)mice(27%vs 86%in WT;p<0.05).Conclusions:Intraventricular haemoglobin caused LCN2 upregulation and ventricular dilation.Haemoglobin resulted in lower mortality and less ventricular dilation in LCN2^(−/−)mice.These results suggest that LCN2 has a role in haemoglobin-induced brain injury and may be a therapeutic target for IVH.