The bottom line

June 2010

Clinical

Postsplenectomy infection

Strategies for prevention in general practice

Volume 39, No.6, June 2010 Pages 383-386

Penelope Jones

Ian Woolley

Karin Leder

Denis Spelman

Paul Cameron

Allen Cheng

Background

The spleen plays a crucial role in human defence against infection. Patients who are asplenic or hyposplenic are at increased risk of severe sepsis due to specific organisms. Overwhelming postsplenectomy infection (OPSI) has a mortality rate of up to 50%.

Objective/s

This article describes the causes of OPSI and provides strategies to reduce it.

Discussion

Streptococcus pneumoniae is responsible for over 50% of cases of OPSI. Strategies to prevent OPSI include education; vaccination against S. pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis and influenza (annually); and daily antibiotics for at least 2 years postsplenectomy and emergency antibiotics in case of infection. Asplenic patients should carry a medical alert and an up-to-date vaccination card. Asplenic patients require specific advice around travel and animal handling as they are at increased risk of severe malaria, and OPSI (due to Capnocytophaga canimorsus) may result from dog, cat or other animal bites. The Victorian Spleen Registry was established to improve adherence to best practice preventive guidelines and thereby reduce the incidence of OPSI.

The spleen is the largest lymphatic organ in the body and plays an important role in fighting infection. It works to remove micro-organisms and their products circulating within the bloodstream, and to produce antibodies to enhance the immune response. The asplenic or hyposplenic state can be confirmed by the detection of Howell-Jolly bodies on a blood film or by the demonstration of decreased IgM memory B cells in the blood.

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Correspondence afp@racgp.org.au

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