Abstract
Background
Overwhelming post-splenectomy infection (OPSI) is a serious disease that can progress
from a mild flu-like illness to fulminant sepsis in a short time period. Although
relatively rare, it has a high mortality rate with delayed or inadequate treatment,
and therefore, it is important for Emergency Physicians to be familiar with it. Patients
who are asplenic or hyposplenic are at an increased risk for infection and death from
encapsulated organisms and other dangerous pathogens.
Objectives
There is an abundance of literature discussing OPSI from the perspective of hematologists
and infectious disease specialists, but an Emergency Medicine perspective is necessary
to truly understand the acute nature of the disease. The objective of this article
is to present a careful examination of the literature with a focus on early diagnosis
and management to provide Emergency Physicians with the ability to positively affect
outcomes of this deadly disease.
Case Report
We present the case of a well-appearing 5-month-old girl with congenital asplenia
who presented to the Emergency Department with fever, and rapidly progressed to septic
shock as a result of OPSI. Aggressive resuscitation was initiated, including empiric
antibiotics, and after a prolonged hospital course in the pediatric intensive care
unit, the child recovered.
Conclusion
Rapid identification of patients at risk for OPSI, followed by administration of intravenous
antibiotics, usually vancomycin and ceftriaxone, combined with early goal-directed
therapy, are the keys to successful treatment. If initiated early in the patient's
course, the 70% mortality rate can be reduced to the 10–40% range.
Keywords
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Article info
Publication history
Published online: June 25, 2012
Accepted:
October 11,
2011
Received in revised form:
June 17,
2011
Received:
March 23,
2011
Identification
Copyright
Published by Elsevier Inc.
