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{{Overwhelming post-splenectomy infection}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
 
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{{SK}} OPSI
 
==[[Overwhelming post-splenectomy infection overview|Overview]]==
 
==[[Overwhelming post-splenectomy infection pathophysiology|Pathophysiology]]==


==Overview==
==[[Overwhelming post-splenectomy infection causes|Causes]]==
'''Overwhelming post-splenectomy infection''' or '''OPSI''' is a rapidly fatal [[septicaemia]] infection due to the absence of spleen protection against certain bacteria ([[asplenia]]).


Patients with absent (eg [[splenectomy]]) or non-functional [[spleen]]s can die of these uncommon infections in a few hours. The risk of contracting an OPSI for such patients is 0.23-0.42% per year, with a lifetime risk of 5%, and an associated mortality of 38-69%.<!--
==[[Overwhelming post-splenectomy infection differential diagnosis|Differentiating Overwhelming Post-splenectomy Infection from other Diseases]]==
  --><ref>{{cite journal |author=Davidson R, Wall R |title=Prevention and management of infections in patients without a spleen |journal=Clin Microbiol Infect |volume=7 |issue=12 |pages=657-60 |year=2001 |id=PMID 11843905}}</ref>
Prevention with [[vaccination]]s and [[antibiotic]]s can largely prevent OPSI - see [[asplenia]] for details.<!--
  --><ref name="BMJ1996">{{cite journal | author= | title=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 | journal=BMJ | year=1996 | pages=430-4 | volume=312 | issue=7028 | id=PMID 8601117 | url=http://bmj.bmjjournals.com/cgi/content/full/312/7028/430}}</ref><!--
  --><ref name="BMJ2001">{{cite journal | author=J M Davies et al | title=The Prevention And Treatment Of Infection In Patients With An Absent Or Dysfunctional Spleen - British Committee for Standards in Haematology Guideline up-date | journal=BMJ | year=2001-06-02 | url=http://bmj.bmjjournals.com/cgi/eletters/312/7028/430#12088}}</ref>


== Mechanism of Infection ==
==[[Overwhelming post-splenectomy infection epidemiology and demographics|Epidemiology and Demographics]]==


The spleen contains many macrophages (part of the reticuloendothelial system), immune cells which phagocytose (eat) and destroy bacteria.  In particular, these macrophages are activated when bacteria are bound by IgG antibodies (IgG1 or IgG3) or complement component C3b.  These types of antibodies and complement are immune substances called opsonizers, molecules which bind to the surface of bacteria to make them easier for macrophages to phagocytose and destroy the bacteria. 
==[[Overwhelming post-splenectomy infection risk factors|Risk Factors]]==


When the spleen is gone, IgG and complement component C3b are still bound to bacteria, but they cannot be removed from the blood circulation because the spleen, which contained the macrophages, is gone.  The bacteria therefore are free to cause infection.
==[[Overwhelming post-splenectomy infection natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


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 capsules (''Streptococcus pneumoniae, Salmonella typhi, Neisseria meningitidis, E. Coli, Hemophilus influenzae, Streptococcus Agalactiae, Klebsiella pneumoniae'').  Capsules (made of polysaccharides [sugars]) are an evolutionary development by bacteria to evade phagocytosis by macrophages alone, since only proteins are directly recognized by macrophages in phagocytosis.  Humoral immunity in the form of IgG and complement proteins is the answer of the human immune system to allow these pathogens marked for destruction.
==Diagnosis==
[[Overwhelming post-splenectomy infection history and symptoms|History and Symptoms]] | [[Overwhelming post-splenectomy infection physical examination|Physical Examination]] | [[Overwhelming post-splenectomy infection laboratory findings|Laboratory Findings]] | [[Overwhelming post-splenectomy infection chest x ray|Chest X Ray]] | [[Overwhelming post-splenectomy infection echocardiography or ultrasound|Ultrasound]] | [[Overwhelming post-splenectomy infection other imaging findings|Other Imaging Findings]] | [[Overwhelming post-splenectomy infection other diagnostic studies|Other Diagnostic Studies]]


==References==
==Treatment==
{{reflist|2}}
[[Overwhelming post-splenectomy infection medical therapy|Medical Therapy]] | [[Overwhelming post-splenectomy infection primary prevention|Primary Prevention]] | [[Overwhelming post-splenectomy infection cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Overwhelming post-splenectomy infection future or investigational therapies|Future or Investigational Therapies]]


{{SIB}}
==Case Studies==
[[Overwhelming post-splenectomy infection case study one|Case #1]]<br>
==Related Chapters==
* [[Splenectomy]]


[[Category:Disease]]
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Medical emergencies]]
 
[[Category:Infectious disease]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
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Latest revision as of 18:36, 18 September 2017

Overwhelming post-splenectomy infection Microchapters

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Overview

Pathophysiology

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Differentiating Overwhelming Post-splenectomy Infection from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Ultrasound

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Medical Therapy

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: OPSI

Overview

Pathophysiology

Causes

Differentiating Overwhelming Post-splenectomy Infection from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

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Medical Therapy | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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