A 27-year-old man calls the office to ask for advice about fever. He has had a mild cough for the last 2 days and developed fever and chills today, with a home temperature of 38.7 C (101.7 F). Several of his coworkers have been sick recently. The patient's past medical history is significant for a motorcycle accident requiring splenectomy at age 22. All his vaccinations, including influenza and pneumococcal vaccines, are up to date. He was given a prescription for amoxicillin-clavulanate 6 months ago "just in case."
Which of the following is the best advice for the patient?

Question

A 27-year-old man calls the office to ask for advice about fever.  He has had a mild cough for the last 2 days and developed fever and chills today, with a home temperature of 38.7 C (101.7 F).  Several of his coworkers have been sick recently.  The patient's past medical history is significant for a motorcycle accident requiring splenectomy at age 22.  All his vaccinations, including influenza and pneumococcal vaccines, are up to date.  He was given a prescription for amoxicillin-clavulanate 6 months ago "just in case."
Which of the following is the best advice for the patient?

Quizplus · Accepted Answer

Asplenic patients are at increased risk of infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Overwhelming infection in asplenic patients is rare but rapidly fatal if not recognized and treated aggressively at an early stage. On presentation, the patient may have mild symptoms and not appear toxic, but the infection can progress within hours to fulminant disease with severe shock, sepsis, and disseminated intravascular coagulation. Consequently, any febrile illness in an asplenic patient should prompt aggressive antibiotic therapy, even if the patient appears relatively stable (Choices B and C). Acceptable empiric oral regimens include amoxicillin-clavulanate, cefuroxime, or extended-spectrum fluoroquinolones (eg, levofloxacin). (Choices A and D) Treatment should continue for at least 72 hours while urgent diagnostic evaluation (eg, blood cultures, radiographs) is performed. Patients with signs of severe illness should receive empiric broad-spectrum coverage such as combination vancomycin and ceftriaxone. Educational objective: Asplenic patients are at increased risk of infection from encapsulated organisms and overwhelming infection. Any febrile illness in an asplenic patient should prompt aggressive antibiotic therapy and urgent diagnostic evaluation. __________ References: Clinical practice. Care of the asplenic patient. (http://www.ncbi.nlm.nih.gov/pubmed/25054718) Overwhelming post-splenectomy infection (OPSI): a case report and review of the literature. (http://www.ncbi.nlm.nih.gov/pubmed/22726665) Detection, education and management of the asplenic or hyposplenic patient. (http://www.ncbi.nlm.nih.gov/pubmed/11272299)

A 27-Year-Old Man Calls the Office to Ask for Advice