Post-splenectomy Sepsis: A Review of the Literature (original) (raw)
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Sepsis after splenectomy: prophylaxis and treatment
JOURNAL OF SURGICAL AND CLINICAL RESEARCH, 2014
Infection is very important for the patient underwent splenectomy follow up, not only for the prevalence, but the lethality of disease. The following review is to summarize practical informations about the extent of knowledge of etiology, diagnosis, treatment and prophylaxis. The treatment starts early and appropriate prophylaxis are decisive for the prognosis of asplenia, being the focus of this study. To carry out this work a review of relevant literature of the last decade was taken. As a result, we emphasized extensively about the treatment and prophylaxis of the disease, but the large number of fatal outcomes, found until today, indicates that studies on early diagnosis and early treatment as well as prophylaxis, need to be improved. A infecção tem grande importância no acompanhamento do paciente submetido a esplenectomia, não só pela prevalência, mas pela letalidade da doença. A presente revisão busca sintetizar informações de forma prática, no âmbito do conhecimento da etiologia, diagnóstico, tratamento e profilaxia. O tratamento iniciado precocemente e a profilaxia correta são decisivas para o prognóstico dos asplênicos, sendo o foco desse estudo. Para realização desse trabalho foi feita revisão de literatura relevante da última década. A pesquisa bibliográfica evidenciou que há esquemas de condutas Sepsis after splenectomy: prophylaxis and treatment Araújo-Filho I, et al J Surg Cl Res -Vol. 5 (1) 2014:56-64 57 médicas amplamente já utilizados a cerca do tratamento e profilaxia da doença. Um grande número de desfechos fatais, encontrados até os dias atuais, nos indica que estudos sobre diagnóstico e início do tratamento precoce, assim como a profilaxia, merecem ser aperfeiçoados.
Overwhelming Post Splenectomy Infection (OPSI) in Adult – Need for Awareness and Recognition
2015
Overwhelming Post Splenectomy infection (OPSI) is a rare but fulminant disease with high mortality. The symptoms are usually non-specific in the initial stages mimicking flu and the source of infection usually remains cryptic. In spite of aggressive management, death rapidly occurs and is usually due to overwhelming sepsis. The commonest organism implicated is Streptococcus pneumoniae and the risk for OPSI after splenectomy is present throughout the lifetime of an individual. We report a case of a young woman who had undergone splenectomy nine years back. She rapidly deteriorated and died after a non-specific infection of three days duration. This case report is being presented to highlight that awareness and recognition of this important entity among physicians along with appropriate vaccination and education of patients' at risk may help reduce the high mortality associated with this serious disease.
European journal of medical research, 2010
Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score >16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II)). From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients....
Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases
Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections.
Postsplenectomy sepsis: Historical background and current concepts
World Journal of Surgery, 1985
Although most common in infancy and early childhood, susceptibility to postsplenectomy infection is not limited by age or underlying pathological condition. Postsplenectomy sepsis is a fulminant, rapid process which often begins with vague symptoms. Death may follow in hours unless appropriate fluid resuscitation and antibiotic therapy is promptly instituted. Experimental evidence suggests that splenectomy results in a loss of both mechanical and humoral protective factors. Elective splenectomy should be postponed until after age 4 years. Preoperative immunization with pneumococcal vaccine and prophylactic antibiotics may play a role in preventing postsplenectomy sepsis. In instances of trauma, all or part of the spleen should be preserved when possible. Postsplenectomy sepsis is a lifelong risk. Patient and parent education and long-term follow-up are essential. Recognizing the Population at Risk Patients undergoing splenectomy for any reason are more susceptible to overwhelming bacterial infection. Postsplenectomy sepsis is defined as fulminant bacteremia, meningitis, or pneumonia that occurs weeks to years after splenectomy [1]. Morris and Bullock suggested as early as 1919 that splenectomy would increase susceptibility to infection [2]. In 1952, King and Shumacker [3] of Indiana University first documented this association between splenectomy and overwhelming fulminant sepsis in 5 infants undergoing splenec
Effect of splenectomy on Gram-negative bacterial clearance in the presence and absence of sepsis
British Journal of Surgery, 1988
Severe sepsis leads to depression of the reticulo-endothelial system (RES) with delayed bloodstream clearance of particulate matter and bacteria. Splenectomy results in increased susceptibility to infection with encapsulated organisms but its effect on the resistance to postoperative Gram-negative infection has been little studied. We have investigated the effect of splenectomy on RES function by measurement of plasma fibronectin concentrations and bacterial clearance in the presence and absence of sepsis. In experiment 1, rabbits underwent splenectomy (n=8) or laparotomy only (n=8) 4 weeks before a second laparotomy. In experiment 2, animals had either splenectomy (n=8) or laparotomy only (n=8) followed 4 weeks later by devascularization of the appendix (sepsis). Plasma fibronectin concentrations and the blood clearance and organ distribution of an intravenous injection of 75Se-labelled viable Escherichia coli (2–3 × 108 colony forming units (c.f.u.)) were measured 24 h after the s...
Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections. Citation: Leone G., Pizzigallo E. Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases.
Surgical removal of the spleen, splenectomy, is a procedure that has significantly decreased in frequency as our understanding of the infectious complications of the asplenic state increased. The full spectrum and details of splenic function, however, have yet to be fully outlined. As a result, our comprehension of the long-term consequences of splenectomy remains incomplete. We review the evidence relating to the effects of splenectomy on infection, malignancy, thrombosis, and transplantation. Perhaps the best-defined and most widely understood complication of splenectomy is the asplenic patient's susceptibility to infection. In response to this concern, novel techniques have emerged to attempt to preserve splenic function in those patients for whom surgical therapy of the spleen is necessary. The efficacy of these techniques in preserving splenic function and staving off the complications associated with splenectomy is also reviewed in this article.