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Overwhelming Postsplenectomy Infection
Aka: Overwhelming Postsplenectomy Infection, Postsplenectomy Sepsis
- See Also
- Asplenic
- Epidemiology
- Risk in Asplenic or Hyposplenic patients
- Hospitalization for infection in 33% within 10 years
- Highest risk in first 2 years after splenectomy
- Causes
- Most common
- Streptococcus Pneumoniae (57%)
- HaemophilusInfluenzae (6%)
- Neisseria Meningitidis (3.7%)
- Salmonella (esp. in Sickle Cell Anemia)
- Other causes
- Capnocytophaga canimorsus (dog exposure)
- Group B Streptococcus
- Bartonella Bacilliformis
- Eikenella corrodens
- Region specific (tick-borne illness)
- Babesia (Babesiosis)
- Ehrlichia
- Risk Factors in Asplenic or Hyposplenic patients
- Splenectomy within last 2 years (highest risk)
- Hodgkin's Disease
- Hypogammaglobulinemia
- Chemotherapy
- Radiation Therapy
- Bone Marrow Transplantation
- Symptoms
- Source of infection may be difficult to identify
- Short, often mild Influenza-like prodrome
- Fever
- Malaise
- Myalgias
- Headache
- Vomiting
- Diarrhea
- Abdominal Pain
- Signs
- Septic Shock
- Disseminated Intravascular Coagulation
- May be rapidly fatal within 48 hours
- Labs (do not delay antibiotics)
- Chemistry panel (Chem7 or SMA7)
- Complete Blood Count with platelets and differential
- White Blood Cell Count will be abnormal (too high or too low)
- Toxic granulation
- Thrombocytopenia
- Peripheral Blood Smear with buffy coat preparation
- Observe for Bacteria
- Blood Culture
- Imaging
- Chest XRay
- Management: Antibiotics
- Empirically cover Penicillin-resistant pneumococcus and HaemophilusInfluenzae
- First Line Antibiotics (usually used in combination with Vancomycin)
- Cefotaxime (Claforan)
- Adults: 2 g IV q8 hours
- Children: 25 to 50 mg/kg IV q6 hours
- Ceftriaxone (Rocephin)
- Adults: 2 g IV q12 to 24 hours
- Children: 50 mg/kg IV q12 hours
- Levofloxacin (Use as alternative only if Anaphylaxis to Penicillin or Cephalosporins)
- Adults: 750 mg IV q24 hours
- Added Antibiotics in Special Circumstances
- Penicillin Resistant Pneumococcus suspected (add in most cases)
- Vancomycin
- Adults: 1 to 1.5 g IV q12 hours
- Children: 30 mg/kg IV q12 hours
- Gastrointestinal or Urinary Source
- Gentamicin
- Adults: 5 to 7 mg/kg IV q24 hours
- Children: 2.5 mg/kg IV q8 hours
- Ciprofloxacin (adults only) 400 mg IV q12 hours
- Prognosis
- Mortality
- Immediate treatment: 10% mortality
- Delayed treatment: 50-80% mortality
- Prevention
- See Asplenic
- References
- Brigden (2001) Am Fam Physician 63(3):499-506 [PubMed]
- Brigden (1999) Crit Care Med 27:836-42 [PubMed]
- Hansen (2001) Pediatr Dev Pathol 4(2):105-21 [PubMed]
- Lynch (1996) Infect Dis Clin North Am 10:693-707 [PubMed]