Diagnóstico post mortem de septicemia neumocócica en una mujer joven con hiposplenia / Post-mortem diagnosis of pneumococcal septicaemia in young woman with hyposplenia

RESUMEN

La enfermedad neumocócica es una importante causa de morbimortalidad. La descripción de casos de identificación post mortem de Streptococcus pneumoniae (SP) es infrecuente. Presentamos un caso de fallecimiento por sepsis fulminante secundaria a SP en una mujer joven con factores de riesgo. Se trata de un fallecimiento comunicado por urgencias hospitalarias como una parada cardiaca extrahospitalaria de posible origen abdominal. La autopsia judicial reveló hallazgos compatibles con un cuadro de sepsis fulminante, por lo que se comunicó a vigilancia epidemiológica de salud pública. Se realizaron estudios microbiológicos post mortem, que permitieron aislar SP en el cultivo de líquido pleural, posteriormente la PCR en sangre identificó SP y se caracterizó el serotipo (22F). A pesar de que la hipoesplenia era conocida desde la adolescencia y ser una indicación de vacunación, la paciente no estaba vacunada frente al SP por ninguna de las 2 vacunas actualmente recomendadas en España

ABSTRACT

Pneumococcal infections are a significant cause of morbidity and mortality. Post-mortem identification of Streptococcus pneumoniae (SP) is uncommon. A case of death due to fulminant pneumococcal septicaemia in a young woman with hyposplenia is presented. The death was notified by the hospital emergency department as an out-of-hospital cardiac arrest of possible abdominal aetiology. Forensic autopsy found changes suggestive of fulminant septicaemia and the public health epidemiology service was informed. Post-mortem microbiology studies were carried out, in which SP was isolated in the pleural fluid culture, and later PCR in blood identified SP, as well as determining and the serotype (22F). Although hyposplenia was known since adolescence, and was an indication of vaccination, the patient was not vaccinated against SP by any of the two currently recommended vaccines in Spain