Sepsis, infective endocarditis (IE), and various intracellular organisms were associated in the pathogenesis of infection-induced splenic infarction, according to study results published in BMC Infectious Diseases.

In this retrospective study, the study authors investigated the relationship between splenic infarction and infection by analyzing medical records of patients diagnosed with splenic infarction and evidence of pathogenic infection, who visited Inha University Hospital in Incheon, Republic of Korea, between January 2008 and December 2018.

Of the 101 patients (mean age, 59.1±17.3 years) included in the study, 49.5% were women, 63 had systemic infections, and 38 had localized infections. Of the 63 patients with systemic infections, 10 patients had IE, 26 had bacteremia without IE, and 27 had miscellaneous systemic infection with Plasmodium vivax being the most commonly isolated pathogen (n=12), followed by Orientia tsutsugamushi (n=5).


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In the 38 patients with localized infections, causes of infections included respiratory tract infection (n=11), followed by intra-abdominal infection (n=9), skin and soft-tissue infection (n=8), hepatobiliary infection (n=8), and urinary tract infection (n=2).

The 3 main risk factors for splenic infarction in patients with infection were conditions that could directly affect the pancreatic vessels (26.7%), atherosclerotic disease (21.8%), and atrial fibrillation (12.9%).

In a subgroup analysis that assessed features associated with splenomegaly, most patients with splenomegaly had miscellaneous systemic infections (15 of 18, or 83.3%). Because intracellular organisms represented the causative pathogen in most cases with miscellaneous systemic infections, identifying the presence or absence of splenomegaly may be helpful in differentiating patients with intracellular organisms, noted the authors.

In addition, the study authors “found that the presence of intracellular organisms was associated with splenomegaly without infarction in other organs,” which can differentiate patients with miscellaneous systemic infections from other patients with splenic infarction.

Limitations of the study included the retrospective design, findings being from a single tertiary hospital, and the small number of patients with splenic infarction, which was insufficient to address all etiologies.

“Because various risk factors are associated with infections, we suggest considering both clinical and radiological findings from patients [with splenic infarction] when making a diagnosis,” the study authors concluded.

Reference

Im JH, Chung MH, Lee HJ, et al. Splenic infarction and infectious diseases in Korea. BMC Infect Dis. 2020;20(1):915. doi:10.1186/s12879-020-05645-9