post splenectomy infections

1. Commom Infections in Post-
Splenectomy Patients
Presented by:
Anish Dhakal
6th
June, 2019

2. SPLEEN
• Largest lymphoid organ in body
• Filtering 10–15% of the body's blood volume per
minute.
• Major site of early immunoglobulin M
production, which is important in the acute
clearance of pathogens from the bloodstream.
• When its function is absent or reduced, the ability
to fight off infection is impaired, particularly from
encapsulated bacterial organisms.

4. Indications for Splenectomy
• Hemolytic anemia
• Idiopathic thrombocytopenic purpura.
• Bleeds following physical trauma or
spontaneous rupture
• Hypersplenism
• For diagnosing certain lymphomas
• The spread of gastric cancer to splenic tissue

5. Overwhelming post-splenectomy
infection (OPSI)
• Is a rare but rapidly fatal infection occurring in
individuals following removal of the spleen.
• The infections are typically characterized by
either meningitis or sepsis, and are caused
by encapsulated organisms.
• Most infections occur in the first few years
following splenectomy, but the risk of OPSI is
lifelong.
• Once an infection occurs, the mortality rates are
high, ranging from 38% to 69%, and fulminant
infections frequently develop in patients who are
relatively young.

6. • Encapsulated organisms are the most virulent
pathogens to patients with decreased or absent
splenic function
– Streptococcus pneumoniae -90%
– Haemophilus influenza type B
– Neisseria meningitidis
– Escherichia coli
– Klebsiella pneumoniae
– Salmonella typhi
Etiology:

7. • Coexisting medical conditions, such as
malignancy or immunosuppressive disorders,
may predispose asplenic patients to infection,
further increasing their risk for OPSI.

8. Clinical presentation of OPSI
• Often begins with mild, nonspecific symptoms
• Patients usually have a fever and may complain
of headache, chills, malaise, and various GI
symptoms
• However, this prodrome is usually very brief
and progresses rapidly to symptoms of septic
shock, including hypotension, oliguria,
hypoglycemia, and disseminated intravascular
coagulopathy

9. Cont..
• Patients may develop concomitant meningitis or
pneumonia, or they may experience convulsions
or cardiovascular collapse.
• Death can occur within 24 to 48 hours of illness
onset.
• Mortality is high despite aggressive antibiotic
therapy and intensive medical care
• Patients who survive often have serious long-term
sequelae, such as deafness; osteomyelitis; or
extensive tissue necrosis, which may potentially
require amputation when extremities are involved.

10. Investigation
• CBC: Long term effect minimal. Initially
leukocytosis and thrombocytosis
• Blood, urine, and sputum should be cultured on
hospital admission.
• PBS: Howell-Jolly bodies present in erythrocytes
of patients without a spleen
• Lumbar puncture is an important tool in
diagnosing possible meningitis, especially in
small children.
• Chest radiographs are indicated anytime
pneumonia is suspected

11. Management
• Initiation of treatment should never be
postponed until the results of these tests are
available because bacterial proliferation occurs
at an accelerated pace.
• Empiric oral antibiotics may be started by the
patient at home, or antibiotics can be given IM
or IV at the primary care provider’s .
• The antibiotic of choice for treating OPSI has
traditionally been IV penicillin.

12. Cont..
• Ceftriaxone 100 mg/kg IV or IM, maximum 2
g per dose.
• IV vancomycin 60 mg/kg/d in divided doses
every 6 hours, maximum 4 g per day.
• Regimens may be adjusted as the results of
sensitivity testing become available.

13. PREVENTION OF OPSI
• Vaccine with pneumococcal, Haemophilus
influenzae type B. meningococcal group C and
influenza vaccination at least 2-3 wks before
elective splenectomy.
• Unimmunized patients should receive the vaccine
shortly after surgery but may be less effective.
• Pneumococcal re- immunisation should be given
at least 5 years and influenza annually and must
be documented.

14. Cont…
• Life- long prophylactic penicilline V 500 mg twice
daily is recommended. In penicillin- allergic consider
macrolide.
• Patient should be educated regarding the risk of
infection and methods of prophylaxis.
• Animal bites should be promptly treated to prevent
serious soft tissue infection and septicaemia.
• Should also be encouraged to wear an identification
bracelet or carry a wallet card notifying others of their
condition in emergency situations.

15. Referances
• Harrison‘s Principles of Internal Medicine, 20th
edition
• Sandra L. Moffett, PA-C.Overwhelming postsplenectomy
infection: Managing patients at risk. Journal of
American Physician Assistants 2009; 22(7)
• Morgan Tl, Tomich EB. Overwhelming Post-splenectomy
Infection (OPSI). J Emerg Med. 2012;43(4):758-763.
• Takehiro Okabayashi, Kazuhiro Hanazaki.
Overwhelming postsplenectomy infection syndrome in
adults - A clinically preventable disease. WorldJournal of
gastroenterology 2008 Jan 14; 14(2): 176–179.
• Davidson’s Principles of Medicine, 23rd
edition