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脾切除术后凶险性感染致严重脓毒症1例报道
Report of a case of overwhelming post-splenectomy infection caused by severe sepsis
 [PDF]

王丽锋,马骏,陈怡
WANG Li-feng
, MA Jun, CHEN Yi

- , 2015, DOI: 10.3969/j.issn.1674-8115.2015.12.033
Abstract: 目的 探讨以严重脓毒症为主要表现的脾切除术后凶险性感染(OPSI)的临床特点。方法 报道分析1例OPSI致严重脓毒症患者的临床资料,探讨其临床特点。结果 患者,男,35岁,脾切除术后2年,因头痛、呕吐就诊仁济南院急诊科,检查结果显示为严重脓毒症,诊断为OPSI。给予患者抗感染及对症支持治疗,1周后症状趋于稳定,预后良好。结论 OPSI的发病率低,但病死率高,临床医师须对该病充分认识,做到早诊断、早治疗,以免延误病情。
: Objective To explore the clinical characteristics of overwhelming post-splenectomy infection (OPSI) with main manifestation of severe sepsis. Methods Clinical data of a patient with severe sepsis caused by OPSI was reported and analyzed and the clinical characteristics were investigated. Results A 35-year-old male patient who underwent splenectomy two years before was admitted by the Department of Emergency of Renji Hospital South Campus due to headache and emesis. Examination results showed severe sepsis and the patient was diagnosed with OPSI and underwent anti-infectious treatment and symptomatic supportive treatment. After one week, the symptoms tended to be stable and the prognosis was good. Conclusion The incidence of OPSI is low but the mortality is high. Clinicians should be fully aware of this disease, so as to make early diagnose and treatment and avoid delay
Overwhelming Postsplenectomy Infection for Splenectomized HCV Patients
Naoki Hashimoto
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1101711
Abstract: Pegylated-interferon (IFN) plus ribavirin remains the most effective therapeutic regimen for patients with chronic hepatitis C interferon. Thrombocytopenia is a common side effect of this treatment, often leading to discontinuation of a potentially curative therapy. Splenectomy was a clinically effective treatment for hepatitis C virus-associated thrombocytopenia. Splenectomy in patients with hepatitis C cirrhosis is now safer prelude to antiviral treatment. Overwhelming post splenectomy infection (OPSI) syndrome is a rare condition, but is associated with high mortality. However, recognition and clinical management of OPSI is not well established. We reviewed the literature characterizing the clinicopathological features of OPSI and assessed the most effective and feasible administration of the condition. Prevention strategies such as vaccination and education are also potentially important parts of the strategy for splenectomized HCV patients.
The value of prophylactic vaccinations and antibiotic treatment in post-splenectomy patients: a review
Lammers AJ
Transplant Research and Risk Management , 2012, DOI: http://dx.doi.org/10.2147/TRRM.S25198
Abstract: lue of prophylactic vaccinations and antibiotic treatment in post-splenectomy patients: a review Review (1403) Total Article Views Authors: Lammers AJ Published Date June 2012 Volume 2012:4 Pages 19 - 24 DOI: http://dx.doi.org/10.2147/TRRM.S25198 Received: 13 April 2012 Accepted: 21 May 2012 Published: 28 June 2012 AJ Jolanda Lammers Department of Infectious diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands Abstract: Although spleen preservation surgery and non-operative management are first-line treatment options, total splenectomy is frequently performed. Splenectomy is performed for a number of indications including idiopathic thrombocytopenic purpura, high-energetic trauma, and hematological malignancy. Following splenectomy, patients are at risk for overwhelming post-splenectomy infection (OPSI), a syndrome that presents with mild symptoms at onset but irreversible multi-organ-failure occurs within hours to days. Since the spleen plays an important role in the immune response to polysaccharide antigens, encapsulated bacteria such as pneumococci are the most frequently described causative organisms of OPSI. Although the incidence of OPSI is low, the associated mortality is reported to be as high as 80%. Because of the overwhelming and frequently irreversible nature of this syndrome, prophylactic measures to prevent OPSI have been recommended. These recommendations include vaccination, use of antibiotics, and continuous patient education. After splenectomy, patients should receive immunizations against the encapsulated bacteria S. pneumoniae, H. influenza, and N. meningitidis. Antibiotic therapy should include prophylaxis as well as “on-demand” antibiotics when infection is suspected. Importantly, patients should receive ongoing education regarding the risks associated with asplenia and precautions to take when infection occurs and when traveling.
The value of prophylactic vaccinations and antibiotic treatment in post-splenectomy patients: a review
Lammers AJ
Transplant Research and Risk Management , 2012,
Abstract: AJ Jolanda LammersDepartment of Infectious diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The NetherlandsAbstract: Although spleen preservation surgery and non-operative management are first-line treatment options, total splenectomy is frequently performed. Splenectomy is performed for a number of indications including idiopathic thrombocytopenic purpura, high-energetic trauma, and hematological malignancy. Following splenectomy, patients are at risk for overwhelming post-splenectomy infection (OPSI), a syndrome that presents with mild symptoms at onset but irreversible multi-organ-failure occurs within hours to days. Since the spleen plays an important role in the immune response to polysaccharide antigens, encapsulated bacteria such as pneumococci are the most frequently described causative organisms of OPSI. Although the incidence of OPSI is low, the associated mortality is reported to be as high as 80%. Because of the overwhelming and frequently irreversible nature of this syndrome, prophylactic measures to prevent OPSI have been recommended. These recommendations include vaccination, use of antibiotics, and continuous patient education. After splenectomy, patients should receive immunizations against the encapsulated bacteria S. pneumoniae, H. influenza, and N. meningitidis. Antibiotic therapy should include prophylaxis as well as “on-demand” antibiotics when infection is suspected. Importantly, patients should receive ongoing education regarding the risks associated with asplenia and precautions to take when infection occurs and when traveling.Keywords: S. pneumoniae, sepsis, splenectomy, vaccination
Determinants of splenectomy in splenic injuries following blunt abdominal trauma
AA Akinkuolie, OO Lawal, OA Arowolo
South African Journal of Surgery , 2010,
Abstract: Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Patients and methods. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. Results. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. Discussion. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Conclusion. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.
Splenectomy Associated Changes in IgM Memory B Cells in an Adult Spleen Registry Cohort  [PDF]
Paul U. Cameron,Penelope Jones,Malgorzata Gorniak,Kate Dunster,Eldho Paul,Sharon Lewin,Ian Woolley,Denis Spelman
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0023164
Abstract: Asplenic patients have a lifelong risk of overwhelming post-splenectomy infection and have been reported to have low numbers of peripheral blood IgM memory B cells. The clinical value of quantitation of memory B cells as an indicator of splenic abnormality or risk of infection has been unclear. To assess changes in B cell sub-populations after splenectomy we studied patients recruited to a spleen registry (n = 591). A subset of 209 adult asplenic or hyposplenic subjects, and normal controls (n = 140) were tested for IgM memory B cells. We also determined a) changes in IgM memory B cells with time after splenectomy using the cross-sectional data from patients on the registry and b) the kinetics of changes in haematological markers associated with splenectomy(n = 45). Total B cells in splenectomy patients did not differ from controls, but memory B cells, IgM memory B cells and switched B cells were significantly (p<0.001) reduced. The reduction was similar for different indications for splenectomy. Changes of asplenia in routine blood films including presence of Howell-Jolly bodies (HJB), occurred early (median 25 days) and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. There was a more gradual decrease in IgM memory B cells reaching a stable level within 6 months after splenectomy. IgM memory B cells as proportion of B cells was the best discriminator between splenectomized patients and normal controls and at the optimal cut-off of 4.53, showed a true positive rate of 95% and false positive rate of 20%. In a survey of 152 registry patients stratified by IgM memory B cells around this cut-off there was no association with minor infections and no registry patients experienced OPSI during the study. Despite significant changes after splenectomy, conventional measures of IgM memory cells have limited clinical utility in this population.
Overwhelming postsplenectomy infection syndrome in adults - A clinically preventable disease  [cached]
Takehiro Okabayashi, Kazuhiro Hanazaki
World Journal of Gastroenterology , 2008,
Abstract: Overwhelming postsplenectomy infection (OPSI) syndrome is a rare condition, but is associated with high mortality. However, recognition and clinical management of OPSI is not well established. The prevalence of splenectomy increased recently because it was a clinically effective treatment for hepatitis C virus-associated thrombocytopenia before the introduction of the interferon/ribavirin combination therapy. We reviewed the literature characterizing the clinicopathological features of OPSI and assessed the most effective and feasible administration of the condition. A Medline search was performed using the keywords 'overwhelming', 'postsplenectomy infection', 'postsplenectomy sepsis', 'chronic liver disease', and/or 'splenectomy'. Additional articles were obtained from references within the papers identified by the Medline search. Durations between splenectomy and onset of OPSI ranged from less than 1 wk to more than 20 years. Autopsy showed that many patients with OPSI also had Waterhouse-Friderichsen syndrome. Although the mortality rate from OPSI has been reduced by appropriate vaccination and education, the precise pathogenesis and a suitable therapeutic strategy remain to be elucidated. Protein energy malnutrition (PEM) is commonly observed in cirrhotic patients. Since the immune response in patients with PEM is compromised, a more careful management for OPSI should therefore be applied for cirrhotic patients after splenectomy. In addition, strict long-term follow up of OPSI patients including informed consent will lead to a better prognosis.
Cases of Opsi syndrome still candidate for medical ICU
Aygencel, Gulbin;Dizbay, Murat;Turkoglu, Melda Aybar;Tunccan, Ozlem Guzel;
Brazilian Journal of Infectious Diseases , 2008, DOI: 10.1590/S1413-86702008000600024
Abstract: splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (opsi) syndrome. it seems to be more common in children, but occurs at all ages. the risk is greatest in the early months and years after operation, but never disappears entirely. the course is rapid, the clinical symptoms are serious, and the prognosis is very poor. in this paper, three cases of opsi syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. with the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients.
Overwhelming postsplenectomy infection due to Mycoplasma pneumoniae in an asplenic cirrhotic patient: Case report
Feng Xu, Chao-Liu Dai, Xing-Mao Wu, Peng Chu
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-162
Abstract: We report a case of OPSI in a 41-year-old woman with hypersplenism associated with hepatitis B cirrhosis. We detected a significant Mycoplasma pneumoniae agglutination titer, but no evidence of infection with Chlamydia pneumoniae, Legionnella spp., or any other bacterial or fungal pathogens. She eventually died despite aggressive therapy.M. pneumoniae could be an underestimated cause of OPSI, and should be suspected in fulminant infectious cases in asplenic patients.Overwhelming postsplenectomy infection (OPSI) is a rare condition and extremely dangerous in asplenic individuals. The most common pathogen associated with OPSI is Streptococcus pneumoniae [1]. There have not been any published case reports on OPSI, in which Mycoplasma pneumoniae was implicated. We report here on an adult patient who had undergone splenectomy for hypersplenism associated with hepatitis B cirrhosis and eventually developed OPSI possibly caused by M. pneumoniae.On November 14, 2010, a 41-year-old woman was admitted to our hospital with complaints of high fever and chills of 10-hour duration. Three weeks prior she had undergone a splenectomy for pancytopenia associated with splenomegaly caused by hepatitis B cirrhosis-related portal hypertension without esophageal varices (Figure 1). Her postoperative course was uneventful, and she was discharged 14 days after her operation. Due to her non-compliance, she was not administered the immunoprophylaxis vaccination. Immediately before her onset of fever, she had taken a sponge bath. Acetaminophen did not relieve the fever, and she was admitted to the local hospital 3 hours later when her temperature was 40.5°C. Her physicians only treated the fever and did not administer antibiotics. Three hours later she became disoriented, astatic, and incontinent of urine. At this time she was admitted to our hospital. On initial physical examination, her temperature was 38.2°C; blood pressure, 52/26 mm Hg; pulse rate, 130 beats/min; and respiratory rate, 24 b
Aderência e atividade microbicida de monócitos em portadores de esquistossomose mans?nica na forma hepatoesplênica cirúrgica
Brandt, Carlos Teixeira;Leite, Carlos Roberto Carvalho;Manh?es-de-Castro, Raul;Brandt Filho, Carlos;Castro, Célia Maria Machado Barbosa de;
Acta Cirurgica Brasileira , 2003, DOI: 10.1590/S0102-86502003000200011
Abstract: surgical treatment in children suffering from schistosomissis mansoni includes splenectomy; ligature of left gastric vein and auto-implantation of spleen morsels into the greater omentum. the efficacy of this procedure may be responsible for the disappearance of overwhelming post-splenectomy infection (opsi), in this kind of patients. this condition may be assigned to the lowering of igm, circulating lymphocytes, properdin and to the absence of tutfsin, which may lead to the deficiency of mono-macrophage activity cells, responsible for bacteria adherence, phagocytosis and its destruction. purpose: to analyze the functional features of the monocytes from young patients, who underwent splenectomy, ligature of left gastric vein and auto-implantation of morsels of spleen tissue on the major omentum. these patients were cared for at - university hospital - "servi?o de cirurgia geral da crian?a, hospital das clínicas, ufpe", from 1991 to 2000. methods: it was analyzed the rates of monocytes in vitro adherence to the solid surface and the generation of o2- radical by the monocytes, stimulated with acetate miristate of phorbol (pma) and pma + tuftsin, in 3 groups. the 1st group (ai), constituted by 18 patients with schistosomiasis mansoni in the hepatosplenic form and treated with splenectomy, ligature of left gastric vein and auto-implantation of fragments of spleen tissue on the major omentum; the 2nd group (esp), formed by 09 patients with schistosomiasis mansoni in the hepatosplenic form who underwent azigo-portal disconnection with splenectomy and the 3rd one (ct) constituted by 12 voluntary teenagers from the same geographic area and with the same socio-economical conditions. results: there was no significant difference in the monocyte adherence rate among the 3 groups. with regard to the generation of o2- release, the monocytes of patients from ai group had a super oxide generation similar to that of individuals from ct group, and higher than the patients from esp gr
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