Encapsulants organic

Patients with fever greater than 38.5°C (101.3°F) should be evaluated, and appropriate antibiotics should include coverage for encapsulated organisms, especially pneumococcal organisms. 

Because patient with SCD have impaired splenic function, they are less adequately protected against encapsulated organisms such as S. pneumoniae, Hemophilus influenzae, and Salmonella. The use of pneumococcal vaccine in SCD patients has decreased the rates of morbidity and mortality dramatically. However, there are still groups of SCD children who continue to have high rates of invasive pneumococcal infections.17 Two pneumococcal vaccines are available. The 7-valent conjugate... 

Any fever greater than 38.5°C in a SCD patient should be evaluated immediately (see Table 65-2), and the patient should have a blood culture drawn and be started on antibiotics that provide empirical coverage for encapsulated organisms.27 Patients who should be hospitalized include ... 

Broad intravenous antibiotic coverage for the encapsulated organisms can include ceftriaxone or cefotaxime. For patients with true cephalosporin allergy, clindamycin may be used. If staphylococcal infection is suspected owing to previous history or the patient appears acutely ill, vancomycin should be initiated. Macrolide antibiotics, such as erythromycin and azithromycin, may be initiated if Mycoplasma pneumonia is suspected. While the patient is receiving broad-spectrum antibiotics, their regular use of penicillin for prophylaxis can be suspended. Fever should be controlled with acetaminophen or ibuprofen. Because of the risk of dehydration during infection with fever, increased fluid may be needed.6,27... 

Fever of 38.5°C (101.3°F) or higher should be evaluated promptly. A low threshold for empiric antibiotic therapy with coverage against encapsulated organisms is recommended (e.g., ceftriaxone for outpatients and cefotaxime for inpatients). 

The kidneys are paired encapsulated organs, each weighing approximately 150 g, and typically 11x6x3 cm with a smooth outer surface. A longitudinal cut reveals two distinct layers the dark reddish coloured outer cortex which makes up about 70% of the tissue mass and the paler coloured inner medulla. 

Factors in addition to sickling may be responsible for the pathogenesis of a number of the clinical manifestations associated with SCD. Obstruction of blood flow to the spleen by sickle cells can result in functional asplenia, defined as the loss of splenic function with an intact spleen. These patients may also have deficient opsonization. Impaired splenic function increases susceptibility to infection by encapsulated organisms, particularly pneumococcal disease. Coagulation abnormalities in SCD may be the result of continuous activation of the hemostatic system or disorganization of the membrane layer. " ... 

Clinical features SCD carries a high risk for overwhelming sepsis due to functional asplenia and failure to make antibodies against encapsulated organisms patients should be evaluated for temperature greater than 38.5°C. A low threshold for empiric therapy is recommended. 

Functional asplenia and failure to make antibodies against encapsulated organisms contribute to the high risk of overwhelming sepsis... 

Patients with SCD have impaired splenic function, which increases their susceptibility to infection by encapsulated organisms, particularly pneumococci. Prior to the routine use of penicillin prophylaxis and the development of pneumococcal vaccines, invasive pneumococcal disease was 20- to 100-fold more common in children with SCD than in healthy children. Even with these interventions, some groups of children with SCD continue to have a high rate of invasive pneumococcal infections. - ... 

Patients with SCD should be evaluated as soon as possible for any fever greater than 38.5°C. Evaluation should be initiated as outlined in Table 101-2. Criteria for hospitalization include an infant less than 1 year old, history of previous bacteremia or sepsis, temperature greater than 40°C, WBC greater than 30,000/mm or less than 5000/ mm and/or platelets less than 100,000/mm, and evidence of other acute complications or toxic appearance. Outpatient management can be considered in older nontoxic children with reliable family caregivers. Antibiotic choice should provide adequate coverage for encapsulated organisms. 

Results in increased incidence of infections (encapsulated organisms)... 

Molecular Encapsulation Organic Reactions in Constrained Systems Edited by Udo H. Drinker and Jean-Luc Mieusset 2010 John Wiley Sons, Ltd... 

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