Overwhelming post-splenectomy infection

An overwhelming post-splenectomy infection (OPSI) is a rare but rapidly fatal infection occurring in individuals following removal of the spleen. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including Streptococcus pneumoniae.[1]

The risk of OPSI is 0.23–0.42 percent per year, with a lifetime risk of 5 percent.[2] Most infections occur in the first few years following splenectomy, but the risk of OPSI is lifelong.[1][3] OPSI is nearly uniformly fatal without treatment, and modern treatment has decreased the mortality to approximately 40–70 percent.[1][4] Individuals with OPSI are most commonly treated with antibiotics and supportive care.[2] Measures to prevent OPSI include vaccination and prophylactic antibiotics.[2][5][6]

Mechanism

The spleen contains many macrophages (part of the reticuloendothelial system), which are immune cells that phagocytose (eat) and destroy bacteria. In particular, these macrophages are activated when bacteria are bound by IgG antibodies (IgG1 or IgG3) or the complement component C3b. These types of antibodies and complement are immune substances called opsonizers, molecules that bind to the surface of bacteria to facilitate phagocytosis.

When the spleen is no longer present (asplenia), IgG and C3b are still bound to bacteria, but they cannot be removed from the blood circulation due to the loss of the splenic macrophages. Hence the bacteria are free to cause infection.

Patients without spleens often need immunizations against pathogens that normally require opsonization and phagocytosis by macrophages in the spleen. These include common human pathogens with bacterial capsules (Streptococcus pneumoniae, Salmonella typhi, Neisseria meningitidis, E. coli, Hemophilus influenzae, Streptococcus agalactiae, Klebsiella pneumoniae). Capsules made of polysaccharides (sugars) permit bacteria to evade phagocytosis by macrophages alone, since only proteins are directly recognized by macrophages in phagocytosis. So humoral immunity in forms of IgG and complement proteins is the human immune system's response against bacterial capsules.

References

  1. 1 2 3 Waghorn DJ (March 2001). "Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed". Journal of Clinical Pathology. 54 (3): 214–8. doi:10.1136/jcp.54.3.214. PMC 1731383Freely accessible. PMID 11253134.
  2. 1 2 3 Davidson RN, Wall RA (December 2001). "Prevention and management of infections in patients without a spleen". Clinical Microbiology and Infection. 7 (12): 657–60. doi:10.1046/j.1198-743x.2001.00355.x. PMID 11843905.
  3. ↑ Cullingford GL, Watkins DN, Watts AD, Mallon DF (June 1991). "Severe late postsplenectomy infection". The British Journal of Surgery. 78 (6): 716–21. doi:10.1002/bjs.1800780626. PMID 2070242.
  4. ↑ Schwartz PE, Sterioff S, Mucha P, Melton LJ, Offord KP (November 1982). "Postsplenectomy sepsis and mortality in adults". Journal of the American Medical Association. 248 (18): 2279–83. doi:10.1001/jama.248.18.2279. PMID 7131680.
  5. ↑ "Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Working Party of the British Committee for Standards in Haematology Clinical Haematology Task Force". BMJ. 312 (7028): 430–4. 1996. doi:10.1136/bmj.312.7028.430. PMC 2350106Freely accessible. PMID 8601117.
  6. ↑ Davies JM, et al. (2001-06-02). "The prevention and treatment of infection in patients with an absent or dysfunctional spleen - British Committee for Standards in Haematology Guideline up-date". BMJ. 312 (7028): 430–4. doi:10.1136/bmj.312.7028.430. PMC 2350106Freely accessible. PMID 8601117.
This article is issued from Wikipedia - version of the 10/27/2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.