Splenektomi sonrası sepsis

Dalak, vücutta bulunan lenfoid dokuların en geniş ölçüde toplandığı bir organ olduğu için splenektomi yapılmış hastalar önemli ölçüde risk taşırlar. Splenektomi sonrası ağır infeksiyon, mortalite oranı yüksek olan ağır fulminan bir hastalıktır. Splenektomi sonrası sepsis, dalak fonksiyonları bozulan veya splenektomi yapılan hastalarda 24 saat içinde gelişen ve klinik olarak kötüleşen bir tablo olarak tanımlanır. Dalağın fonksiyonunu bozan en sık nedenler arasında cerrahi, konjenital aspleni, radyoterapi, infarkt, infiltrasyon (amiloidoz gibi), granulomatoz hastalık (sarkoidoz gibi) veya kanser (hemanjiosarkom gibi primer, sekonder veya lenfoma) sayılabilir. Streptococcus pneumoniae, Haemophilus influenzae tip b ve Neisseria meningitidis splenektomi sonrası sepsiste en sık saptanan infeksiyon etkenleridir. Semptomlar genellikle nonspesifiktir, düşük dereceli ateş, ürperme, kas ağrısı, ishal, bazen bulantı ve farenjit olabilir. Özellikle splenektomili hastalarda gelişen her ateş atağı splenektomi sonrası sepsis gelişimi açısından bir uyarı olarak kabul edilmeli ve acil olarak değerlendirilmelidir.

Anahtar Kelimeler:

Epidemiyoloji, Ameliyat sonrası komplikasyonlar, Splenektomi, Streptococcus pneumoniae, Sepsis, Antibiyotik proflaksisi

Postsplenectomy sepsis

Splenectomized patients are under a significant infection risk, because the spleen is the largest accumulation of lymphoid tissue in the body. Postsplenectomy sepsis is a serious fulminant process that carries a high mortality rate. The terms postsplenectomy sepsis and overwhelming postsplenectomy infection are used to describe a clinical entity where an illness could evolve from good health to death within 24 hours, in the setting of a poorly functioning spleen. Some of the most common reasons for malfunctioning of the spleen include surgical, or congenital asplenia, irradiation, infarction, infiltration (eg. amyloidosis), granulomatous diseases (eg. sarcidosis), or cancer (primary, eg. hemangiosarcoma, secondary, or lymhoma). Streptococcus pneumoniae, Haemophilus influenzae tip b and Neisseria meningitidis are the most commonly reported pathogens causing postsplenectomy sepsis. The symptoms are usually very nonspecific: low-grade fever, chills, myalgias, diarrhea, sometimes nasue and pharyngitis. In every fever episode in patients who are splenectomized, it should be accepted as an awareness in terms of developing postsplenectomy sepsis and it should be urgently evalualated.

Keywords:

Epidemiology, Postoperative Complications, Splenectomy, Streptococcus pneumoniae, Sepsis, Antibiotic Prophylaxis,

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1. Abrahamsen AF, Borge L, Holte H: Infection after splenectomy for Hodgkin’s disease, Acta Oncol 1990;29(2):167-70.
2. Brigden ML: Detection, education and management of the asplenic or hyposplenic patient, Am Fam Physician 2001;63(3):499-506, 508.
3. Carpenter CT, Kaiser AB: Purpura fulminans in pneumococcal sepsis: case report and review, Scand J Infect Dis 1997;29(5):479-83.
4. Davidson RN, Wall RA: Prevention and management of infections in patients without a spleen, Clin Microbiol Infect 2001;7(12):657-60.
5. El-Alfy MS, El-Sayed MH: Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention? Hematol J 2004;5(1):77-80.
6. Falletta JM, Woods GM, Verter JI et al: Discontinuing penicillin prophylaxis in children with sickle cell anemia, Prophylactic Penicillin Study II, J Pediatr 1995;127(5):685-90.
7. Gaston MH, Verter JI, Woods G et al: Prophylaxis with oral penicillin in children with sickle cell anemia, A randomized trial, N Engl J Med 1986;314(25):1593-9.
8. Germing U, Fischer R, Bauser U, Schneider M, Aul C: Pneumococcal septicemia in functional asplenia: first manifestation of systemic autoimmune disease? Z Rheumatol 1999;58(1):31-4 (article in German).
9. Germing U, Perings C, Steiner S, Peters AJ, Heintzen MP, Aul C: Congenital asplenia detected in a 60 year old patient with septicemia, Eur J Med Res 1999;4(7):283-5.
10. Hinrichs JH, Dunkelberg WE: DF-2 septicemia after splenectomy: epidemiology and immunologic response, South Med J 1980;73(12):1638-40.
11. Hohenschild S: Babesiosis-a dangerous infection for splenectomized children and adults, Klin Padiatr 1999;211(3):137-40.
12. Kyaw MH, Holmes EM, Toolis F et al: Evaluation of severe infection and survival after splenectomy, Am J Med 2006;119(3):276-e1-7.
13. Lim J, Smith LG: Infection in asplenic in the critical care unit, “Cunha BA (ed): Infectious Diseases in Crit Care Medicine, 2nd ed.” kitabında s.497-506, Informa Healthcare, New York (2007).
14. Looareesuwan S, Suntharasamai P, Webster HK, Ho M: Malaria in splenectomized patients: report of four cases and review, Clin Infect Dis 1993;16(3):361-6.
15. Lutwick LI: Life threatening infections in the asplenic or hyposplenic individual, Curr Clin Top Infect Dis 2002;22:78-96.
16. Mahrer S, Raik E: Capnocytophaga canimorsus septicemia associated with cat scratch, Pathology 1992;24(3):194-6.
17. Markus HS, Toghill PJ: Impaired splenic function in elderly people, Age Ageing 1991;20(4):287-90.
18. Muller AF, Toghill PJ: Functional hyposplenism in alcoholic liver disease: a toxic effect of alcohol? Gut 1994;35(5):679-82.
19. Shapiro ED, Berg AT, Austrian R et al: The protective efficacy of polyvalent pneumococcal polysaccharide vaccine, N Engl J Med 1991;325(21):1453-60.
20. Spelman DW: Postsplenectomy overwhelming sepsis: reducing the risks, Med J Aust 1996;164(11):648.
21. Strickland A, Lloyd D: The spleen and indications of splenectomy, Surgery 2007;25(2):98-101.
22. Styrt B: Infection associated with asplenia: risks, mechanisms, and prevention, Am J Med 1990;88(5N):33N-42.
23. Sumaraju V, Smith LG, Smith SM: Infectious complications in asplenic hosts, Infect Dis Clin North Am 2001;15(2):551-65.