OPSI syndrome

OPSI stands for the English technical term "overwhelming post-spelectomy infection" (translated as "overwhelming post-splenectomy infection"). As the name suggests, such an infection only arises as a result of a splenectomy - surgical removal of the spleen. The OPSI syndrome is a bacterial infection that is quite common after spleen surgery (about 1 to 5 percent of cases). In these cases, the mortality rate as a result of the infection in OPSI syndrome is 40 to 60 percent.

What is OPSI Syndrome?

The spleen is located in the abdominal cavity near the stomach and is involved in the blood circulation of the organs. The reason for surgical removal of the spleen is often injuries as a result of accidents, but internal diseases that affect the spleen can also indicate splenectonmia.

The OPSI syndrome is a form of sepsis, an inflammatory reaction of the organism, which is caused by fungi, bacteria or their toxins. Since sepsis can lead to organ failure or a life-threatening infection of the vital functions, it is a serious illness. The OPSI syndrome arises exclusively as a result of a splenectomy or a dysfunctional spleen that can no longer perform its task.

The most common bacterium that is the main cause of OPSI syndrome in children is pneumococci. Infection with pneumococci in OPSI syndrome can be particularly dangerous for children and the elderly because their immune system is weaker.

causes

The spleen has its task in defense against infection, so that although it is not essential for life, it is very important in particular for defense against pathogens. Certain bacteria attack the spleen and lead to sepsis, the OPSI syndrome.

Sepsis (in Greek sepo means something like "make lazy") is colloquially referred to as blood poisoning. OPSI syndrome can occur a few days after a splenectomy, but OPSI syndrome can also occur years after surgical removal of the spleen.

Symptoms, ailments & signs

The hallmarks of OPSI syndrome are blood poisoning (sepsis). It starts with a fever and chills, accompanied by pain in the upper abdomen. If not treated immediately, a state of shock develops. This manifests itself in a pale skin that is cold to the touch.

The affected person shows impaired consciousness and may be speaking in disjointed sentences. He is unable to express himself clearly. In addition, the person freezes and produces cold sweats. Mostly she is extremely anxious and restless. Breathing speeds up, blood pressure drops, and the heart is racing (tachycardia). A life-threatening condition arises.

Without treatment, the patient can become completely listless and eventually pass out. Blood clotting is disturbed by the processes in the organism and internal bleeding occurs. Since the blood circulation no longer functions correctly, the organs are not supplied with blood and oxygen at all or only insufficiently.

They stop working and the whole cycle breaks down. The result is a multiple organ failure. At this stage, patients often look puffy due to the build up of fluid in the tissues. Petechiae, which are small punctiform hemorrhages, develop on the skin. Once this state has been reached, treatment is only possible in the rarest of cases. Due to the irreversible damage in the body, the patient falls into a coma and dies.

Diagnosis & course

The symptoms of a OPSI syndrome The most common cases are fever and pain in the upper abdomen and epigastric region. In general, any symptoms that normally occur with the flu, such as aching limbs, can also indicate OPSI syndrome. Since the organs are attacked, multi-organ failure can occur, in which, among other things, Kidneys, liver and lungs stop working. Chills can also occur as part of sepsis. In some cases it can lead to a coma. In the worst case, an illness with the OPSI syndrome can be fatal.

Complications

As a rule, OPSI syndrome is already a complication. In the worst case, this syndrome can lead to the death of the person affected if it is not treated properly. For this reason, inflammation and infection must definitely be avoided after removal of the spleen. Those affected usually suffer from the usual symptoms of infection.

If the OPSI syndrome is not treated, the patient develops a high fever and continues to suffer from circulatory shock. It can also lead to severe abdominal pain and multiple organ failure. However, this only occurs if the OPSI syndrome is not treated. People continue to fall into a coma or lose consciousness and eventually die.

In most cases, the OPSI syndrome is successfully treated with the help of antibiotics. There are no particular complications if treatment starts early enough. The patient's life expectancy is also not affected if the disease progresses positively. In some cases, the person may need oxygen therapy. If organs have already been damaged, transplants are necessary to keep the affected person alive.

When should you go to the doctor?

OPSI syndrome is a serious condition that has serious complications and must therefore be treated immediately by a doctor. If skin itching, bleeding, fever and other typical symptoms of OPSI syndrome occur, a doctor should be consulted. Diarrhea and headaches are also typical signs that require clarification. Affected persons should inform the responsible doctor. The syndrome occurs predominantly after the spleen has been surgically removed, which is why the doctor can quickly make a diagnosis.

At the latest, when the well-being decreases significantly and the symptoms do not decrease, it must be taken to the doctor. The sick should speak to the family doctor or an internist. Ideally, the disease will be treated by a specialist in infectious diseases. Close monitoring by the doctor is also necessary during treatment. The doctor must be informed if side effects or interactions or other unusual complaints occur as a result of the medication. In case of doubt, inpatient treatment in the hospital is necessary.

Treatment & Therapy

There with one OPSI syndrome the organs are attacked, it is necessary that the patient receives intensive care. The septic shock also requires intensive medical treatment.

Every minute counts in therapy, so therapy should be started immediately. One approach to treatment may require the use of antibiotics. If the OPSI syndrome is suspected, antibiotics are usually given first, as this happens quickly and fights a wide range of bacteria. After an antibiogram, in which the resistance to different pathogens is determined, you can switch to more specific antibiotics.

Depending on the course of the disease, the patient must be ventilated and the oxygen saturation in the blood monitored and, if necessary, regulated. Depending on which organs are attacked by the sepsis, organ-replacing measures must be initiated. In addition to ventilation therapy, this can also include kidney replacement procedures and extracorporeal membrane oxygenation, in which all respiratory functions of the patient are taken over by one machine, or the treatment of people with OPSI syndrome.

Outlook & forecast

OPSI syndrome is also known as post splenectomy syndrome. It occurs in one to five percent of those affected as a result of surgical removal of the spleen (splenectomy). OPSI syndrome is a serious bacterial infection. This leads to a relatively high mortality rate postoperatively. Up to a third or more than half of all people affected by OPSI syndrome die from it. The prognosis is not particularly favorable.

The reason for this fatal development lies in the lack of work of the spleen. This namely produces phagocytes that could work against the bacterial infection. Since the spleen has now been removed, it can no longer carry out this work. The immune system lacks macrophages. The infection can therefore cause sepsis. This is often caused by pneumococci in children.

In addition, the Haemophilus influenzae type B virus or Neisseria meningitidis can cause postoperative OPSI syndrome. This is rarely caused by Ehrlichia species or Babesia. Why the OPSI syndrome can develop just a few days after removal of the spleen, but also several years afterwards, is a mystery.

Only preventive vaccinations against the pathogens mentioned provide a certain level of protection. However, the spleen is often removed as a result of an accident or tumor. Therefore, those affected usually do not have time to get preventive vaccinations.

prevention

As a prevention of OPSI syndrome the patient should be vaccinated against the most common pathogens prior to surgical removal of the spleen. So-called stand-by antibiosis or permanent treatment with antibiotics are also options that should be considered during a splenectomy. The use of pneumococcal vaccines is recommended for vaccination.

In addition, patients should be vaccinated against Haemophilus influenza type B and meningococci. The vaccination should be carried out at least fourteen days before the operation to prevent developing OPSI syndrome.

Aftercare

In most cases, those affected by OPSI syndrome have only a few and only limited follow-up measures available. Those affected should try to make a diagnosis very early in order to prevent further complications and other complaints from occurring. As a rule, self-healing cannot occur, so that the patient is constantly dependent on medical examination and treatment.

Therefore, a doctor should be contacted at the first sign of this infection. Most sufferers need surgery to relieve the symptoms. The affected person should rest after the procedure and take care of his body. Exertion or stressful physical activities should be avoided in order not to unnecessarily burden the body.

It is also necessary to take antibiotics. Those affected should take them regularly and in the correct dosage. The consumption of alcohol should be avoided. After the operation, regular checks and examinations are very useful in order to detect damage to the other organs due to the OPSI syndrome. In many cases, the life expectancy of the person affected is significantly reduced by the syndrome.

You can do that yourself

If symptoms of OPSI syndrome occur, the first thing to do is to call an emergency doctor. In the event of a state of shock, first aiders must provide first aid to the patient by placing him in a safe position and, if necessary, undertaking resuscitation measures.

After the hospital stay, the condition should be cured for at least one to two weeks. Patients are allowed to eat bland foods and do moderate exercise. In contrast, strenuous physical work should be avoided.The diet should mainly consist of pulses, various types of nuts and red meat, because the high iron content strengthens the immune system and has a positive effect on general well-being.

If there is no improvement in the symptoms after a few days, it is advisable to visit the family doctor again. Alternative remedies such as masterwort or Bibernelle regulate the immune system and can be used in tea form or as an infusion. Patients should consult a health practitioner beforehand to avoid overdosing. Expert advice is also required when using essential oils that help in OPSI syndrome against the typical symptoms of fever.