Splenectomy and sepsis: The role of the spleen in the immune-mediated bacterial clearance

Over the past few years, many observations of overwhelming post splenectomy bacterial infections have been reported. Streptococcus pneumoniae is the a etiologic agent in about 80% of cases, but also gram-negative bacteria are involved in the development of fatal infections in splenectomized patients. Functionally, the spleen plays a fundamental role in bacterial clearance e ither by antibody response or macrophage bactericidal capacity. At the same time, there is evidence that the spleen also contributes to bacterial endo toxin detoxification. Finally, the mechanisms responsible for gram-positive and gram-negative sepsis in the splenectomized host and possible therapeut ical approaches able to neutralize bacterial products endowed with noxious effects are discussed.