Postsplenectomy Syndrome

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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