Clinical Reviews| Volume 43, ISSUE 4, P758-763, October 2012

Overwhelming Post-Splenectomy Infection (OPSI): A Case Report and Review of the Literature



      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.


      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.


      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.


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        • Lynch A.M.
        • Kapila R.
        Overwhelming postsplenectomy infection.
        Infect Dis Clin North Am. 1996; 10: 693-707
        • Brigden M.L.
        Overwhelming postsplenectomy infection still a problem.
        West J Med. 1992; 157: 440-443
        • Sawmiller C.J.
        • Dudrick S.J.
        • Hamzi M.
        Postsplenectomy Capnocytophaga canimorsus sepsis presenting as an acute abdomen.
        Arch Surg. 1998; 133: 1362-1365
        • Rivella S.
        Ineffective erythropoiesis and thalassemias.
        Curr Opin Hematol. 2009; 16: 187-194
        • Holdsworth R.J.
        • Irving A.D.
        • Cuschieri A.
        Postsplenectomy sepsis and its mortality rate: actual versus perceived risks.
        Br J Surg. 1991; 78: 1031-1038
        • Rosner F.
        • Zarrabi M.H.
        • Benach J.L.
        • et al.
        Babesiosis in splenectomized adults. Review of 22 reported cases.
        Am J Med. 1984; 76: 696-701
        • Krause P.J.
        • Gewurz B.E.
        • Hill D.
        • et al.
        Persistent and relapsing babesiosis in immunocompromised patients.
        Clin Infect Dis. 2008; 46: 370-376
        • Waghorn D.J.
        Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed.
        J Clin Pathol. 2001; 54: 214-218
        • Davidson R.N.
        • Wall R.A.
        Prevention and management of infections in patients without a spleen.
        Clin Microbiol Infect. 2001; 7: 657-660
        • Di Cataldo A.
        • Puleo S.
        • Li Destri G.
        • et al.
        Splenic trauma and overwhelming postsplenectomy infection.
        Br J Surg. 1987; 74: 343-345
        • Gopal V.
        • Bisno A.L.
        Fulminant pneumococcal infections in ‘normal’ asplenic hosts.
        Arch Intern Med. 1977; 137: 1526-1530
        • Thomsen R.W.
        • Schoonen W.M.
        • Farkas D.K.
        • et al.
        Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study.
        Ann Intern Med. 2009; 151: 546-555
        • Lawrence T.
        • Puel A.
        • Reichenbach J.
        • et al.
        Autosomal-dominant primary immunodeficiencies.
        Curr Opin Hematol. 2005; 12: 22-30
        • Okabayashi T.
        • Hanazaki K.
        Overwhelming postsplenectomy infection syndrome in adults—a clinically preventable disease.
        World J Gastroenterol. 2008; 14: 176-179
        • Konradsen H.B.
        • Pedersen F.K.
        • Henrichsen J.
        Pneumococcal revaccination of splenectomized children.
        Pediatr Infect Dis J. 1990; 9: 258-263
        • Stryker R.M.
        • Orton D.W.
        Overwhelming postsplenectomy infection.
        Ann Emerg Med. 1988; 17: 161-164
        • El-Alfy M.S.
        • El-Sayed M.H.
        Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention?.
        Hematol J. 2004; 5: 77-80