Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Immunosuppressive Agents/adverse effects , Meningococcal Infections/physiopathology , Neisseria meningitidis, Serogroup W-135/immunology , Opportunistic Infections/physiopathology , Thrombotic Microangiopathies/complications , Waterhouse-Friderichsen Syndrome/etiology , Acute Kidney Injury/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/immunology , Acute Kidney Injury/therapy , Adult , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Ciprofloxacin/therapeutic use , Combined Modality Therapy , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/therapy , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Intensive Care Units , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/physiopathology , Male , Meningococcal Infections/complications , Meningococcal Infections/drug therapy , Meningococcal Infections/microbiology , Neisseria meningitidis, Serogroup W-135/drug effects , Neisseria meningitidis, Serogroup W-135/isolation & purification , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/etiology , Severe Acute Respiratory Syndrome/immunology , Severe Acute Respiratory Syndrome/therapy , Shock, Septic/complications , Shock, Septic/etiology , Shock, Septic/immunology , Shock, Septic/therapy , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/immunology , Thrombotic Microangiopathies/prevention & control , Treatment Outcome , Waterhouse-Friderichsen Syndrome/immunology , Waterhouse-Friderichsen Syndrome/microbiology , Waterhouse-Friderichsen Syndrome/prevention & control , Young AdultABSTRACT
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.