Preventing severe infection after splenectomy

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7514.417 (Published 18 August 2005)
Cite this as: BMJ 2005;331:417

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  1. Adrian Newland, professor (a.c.newland@qmul.ac.uk),
  2. Drew Provan, senior lecturer,
  3. Steven Myint, editor in chief
  1. Department of Haematology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London El IBB
  2. Department of Haematology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London El IBB
  3. Journal of Infectious Disease, The Brae, Dunmow, Essex CM6 1HU

    Patients should know the risks, be immunised, and take prophylactic antibiotics

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

    Overwhelming post-splenectomy infection is usually caused by the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis and more than half of those infected die.1 Other pathogens in such infection may include bacteria such as Escherichia coli and Pseudomonas aeruginosa,2 Capnocytophagia canimorsus, group B streptococci, Enterococcus spp, Ehrlichia spp, and protozoa such as the Plasmodium spp leading to malaria.

    The first description of overwhelming post-splenectomy infection was published by King and Schumaker in 1952.3 The disease may begin as a minor flu-like illness that rapidly escalates into a fulminant infection.2 It is most common in the first two years after splenectomy but may occur decades later.4 Its true incidence is not …

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