Preventing severe infection after splenectomy

doi:10.1136/bmj.331.7514.417

BMJ 2005;331:417-418 (20 August), doi:10.1136/bmj.331.7514.417

Editorial

Preventing severe infection after splenectomy

Patients should know the risks, be immunised, and take prophylacticantibiotics

The first 150 words of the full text of this article appear below.

Splenectomy may be followed by severe systemic infection becausesuch surgery removes the splenic macrophages that filter andphagocytose bacteria and other bloodborne pathogens. Overwhelmingpost-splenectomy infection (OPSI), as this complication is called,is uncommon but has high mortality.

Overwhelming post-splenectomy infection is usually caused bythe encapsulated bacteria Streptococcus pneumoniae, Haemophilusinfluenzae, and Neisseria meningitidis and more than half ofthose infected die.¹ Other pathogens in such infection may includebacteria such as Escherichia coli and Pseudomonas aeruginosa,² Capnocytophagiacanimorsus, group B streptococci, Enterococcus spp, Ehrlichiaspp, and protozoa such as the Plasmodium spp leading to malaria.

The first description of overwhelming post-splenectomy infectionwas published by King and Schumaker in 1952.³ The disease maybegin as a minor flu-like illness that rapidly escalates intoa fulminant infection.² It is most common in the first two yearsafter splenectomy but may occur decades later.⁴ Its . . . [Full text of this article]

Adrian Newland, professor

(a.c.newland@qmul.ac.uk)
Department of Haematology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London El IBB

Drew Provan, senior lecturer

Department of Haematology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London El IBB

Steven Myint, editor in chief

Journal of Infectious Disease, The Brae, Dunmow, Essex CM6 1HU

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Rapid Responses:

Read all Rapid Responses

What about old splenectomies?: Stephen Sciberras
bmj.com, 22 Aug 2005 [Full text]
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