Postsplenectomy sepsis clinical features, management and prevention

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Postsplenectomy sepsisclinical features,
management and prevention

• Report by Ri???/VS???

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Introduction

• PSS(Postsplenectomy sepsis)
• Fulminant sepsis syndrome
• usually due to S.pneumoniae
• Pateint with impaired spleen function or s/p
  splenectomy both have risk

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Role of spleen

• The largest lymphoid organ
• Filter senescent, rigid RBCs
• Ingesting circulating bacteria
• Production of antibodies

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Common causes of theraputic splenectomy

• Hemolytic anemia
• Thrombocytopenia
• Malignancy
• Hypersplenism
• Splenic trauma

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Common causes of impaired spleen function

• Hemoglobinopathy
• Hemolysis
• Congenital asplenia
• Collagen vascular diseases
• Allogenic bone marrow transplantation

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Incidence

• Children 1/175 patient years
• Adults 1/400500 patient years
• Highest risk at first few years
• 1/3 at first year
• 1/2 at first 2 years
• However, 1/3 after first 5 years
• Can happen even 20 years after splenectomy

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Common pathogens

• Encapsulated pathogen
• Streptococcus pneumoniae(5060 )
• No particular serotype is more common
• Haemophilus influezae(2030 )
• Neisseria spp.(1020 )
• Other uncommon pathogens
• Capnocytophaga canimorsus
• Common flora in oral cavity of dogs and cats
• Bordetella holmesii

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Clinical manifestations

• Fever
• Any fever must be viewed as possible PSS
• Bacteremia
• Coagulopathy
• Purpura, petechiae
• Meningitis
• Headache, neck stiffness, seizure
• Respiratory symptoms
• Cough, dyspnea, respiratory failure
• GI symptoms
• Nausea, vomiting, diarrhea, GI bleeding
• Shock

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LAB

• CBC
• Blood smear
• DIC profile
• Lumbar puncture
• CXR
• Blood culture

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Management

• Braod-spectrum antibiotics
• Based on expert opinion
• Must cover
• penicillin-resistant pneucoccus
• beta-lactamase producing H.influenzae
• General suggestion
• Ceftriaxone Vancomycin
• Levofloxacin Vancomycin
• Life-support measures
• H/D or CVVH for ARF
• Ventilator
• Inotropic agents
• Fluid

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Prevention

• Avoid unnecessary splenectomy
• Immunization
• Timing
• 14 days before splenectomy
• 14 days after splenectomy (not immediately)
• Pneumococcal vaccine
• PPV-23 for adults
• PCPV-7 for children and some adults
• Haemophilus B vaccine
• Meningococcal vaccine
• Re-immunization
• Other vaccines influenza vaccine

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Prevention

• Antibiotic prophylaxis
• Daily penicillin
• Reduce incidence by half
• Reduce mortality by 80 percents
• Life-long or 35years?
• Post PSS patients
• Abx for fever
• On hand
• Empirical Augmentin, Cefuroxine,
  fluoroquinolones
• When fever, Take the drug and go to doctor
  without delay
• Abx for dental procedures
• Not recommended for no obvious advantage

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Summary

• Be aware
• Any fever may be possible PSS
• Treatment in time
• Empirical abx
• Supportive care
• Pervention
• Vaccine
• Daily and On hand abx