From the Guidelines
Cerebritis post splenectomy is a medical emergency that requires prompt antibiotic treatment and measures to prevent overwhelming post-splenectomy infection (OPSI). The treatment approach should prioritize covering encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, as these are the most common causes of OPSI 1.
Key Considerations
- Patients should receive immunization against these encapsulated bacteria at least 14 days after splenectomy, or before discharge if the risk of missing vaccination is high 1.
- Annual immunization against seasonal flu is recommended for all patients over 6 months of age to decrease the risk of secondary bacterial infection, including pneumococcal infection 1.
- Antibiotic therapy should be strongly considered in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
Treatment Approach
- The recommended emergency standby treatment in adults includes Amoxycillin, 3 g starting dose followed by 1 g every 8 h, or Levofloxacin 500 mg every 24 h or Moxifloxacin 400 mg every 24 h for beta-lactam allergic patients 1.
- In children, Amoxycillin 50 mg/Kg in three divided daily doses is recommended, with alternative options for beta-lactam allergic patients to be proposed by a specialist 1.
Prevention and Education
- Patients should be educated about seeking immediate medical attention for any fever or signs of infection, as cerebritis can be life-threatening without prompt intervention 1.
- Community physicians should be aware of the asplenic/hyposplenic condition to provide the most appropriate level of care 1.
- Patients should be given an antibiotic supply in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
From the Research
Cerebritis Post Splenectomy
- Cerebritis is a serious condition that can occur in individuals who have undergone splenectomy, although there is limited direct evidence linking the two conditions 2, 3.
- Splenectomy increases the risk of infections, particularly overwhelming post-splenectomy infection (OPSI), which can be caused by encapsulated bacteria such as Streptococcus pneumoniae 4, 5.
- OPSI is a medical emergency that requires prompt diagnosis and management with fluid resuscitation and empirical antimicrobials 4, 5.
- Cerebritis, on the other hand, is an infectious process that can be diagnosed using computerized tomography (CT) scans and can be treated with antibiotic therapy 2, 3.
- In some cases, cerebritis can be caused by methicillin-resistant Staphylococcus aureus (MRSA) and can be treated with linezolid, an oxazolidinone drug 3.
- The use of fixed-dose combinations of antibiotics, such as ceftriaxone-vancomycin, can be effective in treating various bacterial infections, including those that may occur in individuals who have undergone splenectomy 6.