Postsplenectomy Syndrome
Classification according to ICD-10 | |
---|---|
D73.0 | Asplenia after splenectomy |
A40.3 | Sepsis from Streptococcus pneumoniae |
A41.3 | Sepsis from Haemophilus influenzae |
A39.2 | Acute meningococcal sepsis |
ICD-10 online (WHO version 2019) |
The overwhelming post-splenectomy infection (OPSI syndrome, engl. O verwhelming p ost s plenectomy i nfection syndrome) is a particularly severe form of a bacterial infection after a surgical removal of the spleen ( splenectomy ).
frequency
The syndrome is relatively common at 1–5% and associated with a high mortality rate of 38 to 69%.
root cause
The cause is a specific, isolated disorder of the macrophages in the absence of a spleen, which leads to a limited ability to defend against infections with encapsulated bacteria . The loaded with antibodies bacterial capsules are no longer sufficient by these phagocytes, which are particularly in the spleen phagocytosis .
The most common bacterium that causes OPSI syndrome, especially in children, accounts for 50–90% of cases, is Streptococcus pneumoniae (pneumococci). Other pathogens are Haemophilus influenzae type B and Neisseria meningitidis . Ehrlichia species or protozoa of the genus Babesia are rare . The infection always takes the form of sepsis .
Clinical appearance
OPSI syndrome can occur a few days or several years after a splenectomy. The annual frequency of a splenectomized patient to develop OPSI syndrome is 0.23 to 0.42%; around 1–5% of patients will be affected at some point in their lives. Waterhouse-Friderichsen syndrome very often develops on the basis of the disease .
Infection prophylaxis
As a prophylaxis, vaccination against the most common encapsulated pathogens and always available ( stand-by antibiosis) or permanent treatment with antibiotics can be carried out.
swell
- T. Okabayashi, K. Hanazaki: Overwhelming postsplenectomy infection syndrome in adults - A clinically preventable disease. World J. Gastroenterology (2008) 14 (2), pp. 176-179 PMID 18186551
- RN Davidson, RA Wall: Prevention and management of infections in patients without a spleen . Clin Microbiol Infect. (2001) 7 (12), pp. 657-660 PMID 11843905
- M. Engelhardt and others: Prevention of infections and thromboses after splenectomy or loss of function of the spleen. In: German Medical Weekly. (2009); 134 (17), pp. 897-902. doi: 10.5167 / uzh-31524