An overwhelming post-splenectomy infection (OPSI) is a rare but rapidly fatal infection occurring in individuals following removal (or permanent dysfunction) of the spleen. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including Streptococcus pneumoniae. It is a medical emergency and requires immediate treatment. Death has been reported to occur within 12 hours. are species of Babesia, which are tick-borne parasites that cause babesiosis.
Signs and symptoms
OPSI may initially present with mild viral symptoms such as fever or coughing, however later in infection symptoms may include shakes, shivers, chills, diarrhea, vomiting, malaise, myalgia, headache and abdominal pain.
The disease progresses rapidly from the above mentioned symptoms to coma to refractory septic shock and finally death in as little as 24 hours.
Patient education
Knowledge of the risks of asplenia correlates with a greatly reduced risk of OPSI, thus patient education is vital to preventing OPSI and may be the most important factor for preventing OPSI. More and more people are increasingly getting their healthcare information from the internet and the lack of reliable, readable and comprehensive information on the risks of asplenia and splenectomy poses a preventable risk factor for asplenic individuals.
The Green Book (immunisation guidance, UK) in chapter 7 covers immunisation of people with underlying medical conditions that affect immunity which includes asplenic patients.
As there are a range of different pneumococcal vaccines, the patient should be offered the most up to date ones (typically 23 valent polysaccharide vaccine and 13 valent conjugate vaccine), if they have not had them already as part of standard schedule. Repeat doses are recommended in patients without a spleen.
The CDC recommends against live vaccines and has specific advice for travellers, which includes malaria avoidance for asplenic individuals.
Prognosis
OPSI is almost always fatal without treatment, but modern treatment has decreased the mortality to approximately 40–70 percent. Individuals with OPSI are most commonly treated with antibiotics and supportive care.
The risk is greatest for children and elderly (70+ years old), but it can happen at any age. Greater risk is associated with splenectomy for hematological conditions such as sickle cell anemia, thalassemia and tumours when compared to splenectomy due to trauma.