Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed

Abstract

Aims-Patients without spleens are at increased risk of overwhelming infection. Recently, greater eVorts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis. In practice, such preventive measures might not be followed or may fail. A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed. Methods-Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma. Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained. Results-Seventy seven cases were reported. The age range varied from 3 months (congenital asplenia) to 87 years. In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years. Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate. Streptococcus pneumoniae caused approximately 90% episodes. Only 31% individuals had received pneumococcal vaccination before OPSI. Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures. Few patients had been adequately advised on antibiotic prophylaxis or other measures. Conclusions-Currently accepted best practice for managing asplenic patients is not being followed. Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised. The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance. More is needed to ensure optimal management for this cohort of the population. (J Clin Pathol 2001;54:214-218)

A survey of vaccine coverage and antibiotic prophylaxis in splenectomised patients in Scotland

“…Passive surveillance data in the UK, based on 77 cases of postsplenectomy infection between 1994 and 1998, showed that S pneumoniae and N meningitidis accounted for 87% and 3% of cases, respectively. 7 The remaining 10% of cases were caused by Listeria monocytogenes, E coli, Klebsiella sp, Salmonella typhimurium, and others.…”

Investigation of The Protective Effects of Beta-D-Glucan Against Invasive Encapsulated Streptococcus pneumoniae Sepsis in Splenectomized Rats

“…Cerrahi olarak dalağı alınan bireylerde fatal enfeksiyon gelişi-mi önemli bir sağlık sorunu olarak ortaya çıkabilir 14 . Makrofajlar, bakterileri hem direkt olarak hem de opsonizasyon ile fagosite edebilir 15 .…”

“…Bakterilerin opsonize edilmesinde, kapsül antijenlerine karşı, dalağın beyaz pulpa marjinal zon B hücreleri tarafından sentezlenen IgM antikorlarının rolü vardır. İnsanlardaki bu durum, fare ve sıçanlarda da benzerdir 4,14,15 . Bu çalışmada, splenektomi grubunda serum IgM düzeylerinin kontrol grubuna göre yarı yarıya düşmesi bu bilgilerle örtüşmektedir.…”

Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

“…In persons lacking a spleen, these infections can trigger the syndrome of Overwhelming postsple nectomy infection (OPSI), associated with up to 69 % mortality [60]. Based on various prospective studies, the risk of IMD in asplenic individuals ranged from < 1-8 cases/100 person years; depending on definition and study setting.…”

“…In the few studies investigating the pathogen distribution in infections of asplenic patients, meningococci were rare, reports ranging from 0-3.7 % of infections [56][57][58][59][60][61]. In the 4 available cohort studies reporting details of the pathogen distribution [56][57][58][59], only 4 out of a total of 1117 severe infections were caused by meningococci (0.36 %).…”