This document discusses common infections in patients after spleen removal (splenectomy). It notes that the spleen filters blood and produces antibodies, so its removal increases risk of infection by encapsulated bacteria like pneumococcus. It describes overwhelming post-splenectomy infection (OPSI) as a rapidly fatal infection occurring after splenectomy, typically causing meningitis or sepsis. It provides details on causes, symptoms, management with antibiotics, and importance of vaccination to prevent OPSI. Lifelong antibiotic prophylaxis is recommended for asplenic patients.

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