From the Guidelines
The most common causes of pneumonia in patients post-splenectomy are encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis, which can lead to overwhelming post-splenectomy infection (OPSI) and severe pneumonia. These pathogens are especially dangerous for asplenic patients because the spleen plays a crucial role in filtering and removing encapsulated bacteria from the bloodstream [ 1 ]. Without a spleen, patients have reduced ability to clear these organisms, leading to severe infections. Streptococcus pneumoniae is the most prevalent pathogen, responsible for approximately 50% of cases [ 1 ]. Other significant pathogens include Haemophilus influenzae type B and Neisseria meningitidis.
Prevention and Management
To prevent pneumonia and other infections in post-splenectomy patients, the following measures are recommended:
- Vaccination against encapsulated bacteria, including pneumococcal, Haemophilus influenzae type b, and meningococcal vaccines, should be administered at least 2 weeks before splenectomy or as soon as possible after surgery [ 1 ].
- Annual influenza vaccination is also recommended for all patients over 6 months of age [ 1 ].
- Patients should be educated about the lifelong risk of infection and the need to seek immediate medical attention when febrile.
- Antibiotic prophylaxis may be necessary in some patients, especially in the first few years after splenectomy or in high-risk patients [ 1 ].
- In cases of sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, patients should be treated with antibiotics, such as amoxicillin or levofloxacin, as soon as possible [ 1 ].
Key Considerations
- The risk of OPSI and associated death is highest in the first year after splenectomy, but remains elevated for more than 10 years and probably for life [ 1 ].
- Asplenic/hyposplenic patients, especially children under 5 years old, have a greater overall risk of OPSI and increased death compared to adults [ 1 ].
- Community physicians should be aware of the asplenic/hyposplenic condition to provide the most appropriate level of care [ 1 ].
From the Research
Most Common Causes of Pneumonia in Patients Post-Splenectomy
The most common causes of pneumonia in patients post-splenectomy are infections caused by encapsulated bacteria, including:
- Streptococcus pneumoniae 2, 3, 4, 5, 6
- Haemophilus influenzae type b (Hib) 2, 3, 5, 6
- Neisseria meningitidis 2, 3, 5, 6
Prevention Measures
To prevent these infections, several measures are recommended, including:
- Vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis 2, 3, 5, 6
- Antibiotic prophylaxis, such as phenoxymethyl-penicillin, for at least 2 years post-splenectomy 3, 6
- Education on prevention measures and infectious risk 3, 6
- Carrying a medical alert and an up-to-date vaccination card 3, 6
Risk Factors
Patients post-splenectomy are at increased risk of developing overwhelming postsplenectomy infection (OPSI), which has a mortality rate of up to 50% 3, 6. The risk of OPSI is higher in patients who do not receive recommended vaccinations and antibiotic prophylaxis 2, 5.