[Overwhelming postsplenectomy infection].

Abstract

BACKGROUND: Splenectomy performed at any age and for any reason increases the risk for death due to overwhelming infection. AIM: To evaluate definition, etiology, incidence, risk factors and prophylaxis of overwhelming postsplenectomy infection, as well as the methods related to splenic tissue preservation when total splenectomy is necessary. METHOD: Bibliographic review. RESULTS: The etiological agents more frequently found are Streptococcus pneumoniae, Haemophilus influenza and type B, and Neisseria meningitidis. Other bacteria like Escherichia coli, Streptococcus b-hemolytic, Staphylococcus aureus and Pseudomonas sp represent a significant risk as well. In addition, a great variety of agents including other enteric Gram-negative microorganisms and non-bacteria pathogens can also be sporadically identified. The prophylaxis is based on three main aspects: patient's education, immune prophylaxis and chemical prophylaxis. However these are not enough to prevent the higher risk of developing sepsis. When total splenectomy is unavoidable, heterotopic splenic autotransplantation seems to be the only alternative for splenic tissue preservation. According to clinical and experimental studies, the splenic autotransplanted tissue present a similar structure to a normal spleen and preserve the splenic immune function. CONCLUSIONS: The high risk of overwhelming postsplenectomy infection, reduced the indication for total splenectomy, in trauma and several diseases. Prophylactic methods have been developed to minimize the effects of the sepsis. Several researches have been done to determine the immunocompetence of autogenous splenic grafts in response to bacteria invasion.