Overwhelming Post-Splenectomy Infection: Narrative Review of the Literature

Abstract

Because of this high mortality rate and the challenging treatment, prevention of infection by vaccination is a key feature of the management of splenectomized adult patients.

Post-splenectomy Sepsis: A Review of the Literature

“…Less common organisms include Gram-negative bacteria such as Pseudomonas aeruginosa, Capnocytophaga canimorsus, Bartonella spp., and Babesia spp. [30]. Pneumococcal infection is by far the most common with an associated mortality rate of up to 60% [20,24].…”

The evolving indications for splenectomy

“…Splenectomy leaves the patient vulnerable to overwhelming infection by encapsulated bacteria (eg Streptococcus pneumoniae, Haemophylus influenza, Neisseria meningitidis) and patients must have vaccinations and take lifelong antibiotic prophylaxis to prevent this. Even so, there is a 5% lifetime risk of a serious infection (Davidson & Wall, ) and the subsequent risk of mortality during one of these episodes is higher than expected in those with a spleen, at 40–54%(Taniguchi et al , ). The medical management of autoimmune cytopenias is also immumosuppressive, with the newer agents having the potential for even more infective complications than rituximab.…”

Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

“…An increased risk of IMD was accordingly reported for persons with immune deficiencies, among these, particularly those with complement deficiencies [8,9], but also others, such as persons with asplenia [8], persons infected with HIV [10,54,55] or persons with unreplaced hypogammaglobulinemia [11]. In addition, laboratory staff at risk for contact with N. meningitis aerosols are at increased risk of IMD [4,5] and IMD incidence is increased in household contacts of IMD patients in the ensuing year despite post-exposure chemotherapy [2].…”

“…The risk of invasive infections such as sepsis and meningitis is increased after splenectomy, especially through gram-negative pathogens, Staphylococcus aureus and pneumococci [8,[55][56][57][58][59]. In persons lacking a spleen, these infections can trigger the syndrome of Overwhelming postsple nectomy infection (OPSI), associated with up to 69 % mortality [60].…”