Prevention and management of overwhelming postsplenectomy infection - An update

Objectives: To review the diagnosis and management of overwhelming postsple nectomy infection and to discuss various preventative measures. Data Sources: Data used to prepare this article were drawn from published a rticles and work in progress. Study Selection: Articles were selected for relevance to the subject after location by a MEDLINE key word search. Data Extraction: The literature was reviewed to summarize the etiology and pathophysiology of postsplenectomy sepsis. Preventative strategies were out lined with a particular emphasis on education, immunoprophylaxis, and chemo prophylaxis. Data Synthesis: Although physicians have become increasingly aware of overw helming postsplenectomy infection in children, many remain unaware of the r isk to asplenic or hyposplenic adults who may have no underlying medical pr oblems. Recent studies have shown that many patients who have had splenecto mies have had neither appropriate vaccinations nor teaching that would expl ain the lifelong nature of their risk. The increasing incidence of penicill in-resistant pneumococci represents a major area of therapeutic and prophyl actic concern. The identification of Howell-Jolly bodies on a peripheral bl ood smear should alert physicians to the need for follow-up to document pos sible hyposplenism. Attention has focused on a three-pronged attack to this problem, including education, immunoprophylaxis, and chemoprophylaxis. Conclusions: Overwhelming postsplenectomy infection should be largely preve ntable if appropriate precautions are taken. Physicians need to know of the spectrum of diseases associated with hyposplenism and how patients noted t o have Howell-Jolly bodies should be investigated. They should also be awar e of appropriate guidelines for management of patients with asplenia or hyp osplenism.