OPSI stands for the English technical term “overwhelming post-splenectomy infection”. As the name implies, such an infection first develops as a result of a splenectomy – a surgical removal of the spleen. OPSI syndrome is a bacterial infection, but it is quite common after splenectomy surgery (occurring in about 1 to 5 percent of cases). In these cases, mortality as a result of 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. Reasons for surgical removal of the spleen are often injuries to it as a result of accidents, but internal diseases affecting the spleen may also indicate splenectomy. OPSI syndrome is a form of sepsis, an inflammatory reaction of the organism caused by fungi, bacteria or their toxins. Because sepsis can lead to organ failure or life-threatening infection of vital signs, it is a serious condition. OPSI syndrome occurs exclusively as a result of splenectomy or an inoperable spleen that can no longer perform its function. The most common bacterium that is primarily the cause of OPSI syndrome in children is pneumococcus. Infection with pneumococcus in OPSI syndrome can be especially dangerous for children and the elderly because their defenses are weaker.
Causes
The spleen’s role is to defend against infection, so although it is not essential for life, it is very important, especially for defense against pathogens. Certain bacteria attack the spleen, leading to sepsis, or OPSI syndrome. Sepsis (in Greek, sepo means “to make lazy”) is also colloquially known as blood poisoning. OPSI syndrome can occur a few days after splenectomy, but it can also occur years after surgical splenectomy.
Symptoms, complaints, and signs
The hallmarks of OPSI syndrome are those of blood poisoning (sepsis). It initially begins with fever and chills, accompanied by pain in the upper abdomen. If not treated immediately, a state of shock develops. This manifests itself in pale skin that feels cold. The affected person shows impaired consciousness and may talk in incoherent sentences. He is unable to express himself clearly. In addition, the person freezes and produces cold sweat. Usually, he or she is extremely anxious and restless. Breathing speeds up, blood pressure drops, and the heart races (tachycardia). A life-threatening condition develops. Without treatment, the patient may become completely unresponsive and eventually unconscious. As a result of the processes in the organism, blood clotting is disturbed 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 inadequately. They stop working and the complete circulation collapses. The result is multi-organ failure. At this stage, patients often look bloated due to fluid accumulation in the tissues. Petechiae, which are small pinpoint hemorrhages, appear on the skin. Once this state is reached, treatment is only possible in the rarest of cases. Due to the irreversible damage to the body, the patient falls into a coma and dies.
Diagnosis and course
Symptoms of OPSI syndrome most commonly include fever and pain in the upper abdomen and stomach area. In general, any symptoms that normally occur with the flu, such as aching limbs, may also be indications of OPSI syndrome. As organs are attacked, multi-organ failure can occur, with kidneys, liver and lungs, among others, stopping working. Chills can also occur as part of sepsis. In some cases, it can lead to coma. In the worst cases, an illness with OPSI syndrome can be fatal.
Complications
Usually, OPSI syndrome is already a complication. In the worst case, this syndrome can lead to the death of the affected person if it is not treated properly. For this reason, inflammation and infection after the removal of the spleen must be avoided at all costs. The affected person usually suffers from the usual symptoms of an infection.There is a high fever and further also circulatory shock if no treatment of OPSI syndrome occurs. Similarly, severe abdominal pain and further multi-organ failure may occur. However, this case occurs only if the OPSI syndrome is not treated. Further, affected individuals go into a coma or lose consciousness and eventually die. In most cases, OPSI syndrome is successfully treated with antibiotics. No particular complications occur if treatment is started early enough. The patient’s life expectancy is also not affected if the course of the disease is positive. In some cases, the affected person may be dependent on oxygen therapy. If organs have already been damaged, transplants will be necessary to keep the affected person alive.
When should you see a doctor?
OPSI syndrome is a serious condition that causes serious complications and therefore must be treated immediately by a doctor. If skin itching, bleeding, fever, and other typical symptoms of OPSI syndrome occur, a doctor must be consulted. Diarrhea and headaches are also typical signs that require clarification. Affected individuals should inform the appropriate physician. The syndrome occurs predominantly after surgical removal of the spleen, which is why the physician can quickly make a diagnosis. At the latest, when the well-being decreases considerably and the complaints do not subside, it is necessary to go to the doctor with it. Sufferers should talk to their family doctor or an internist. Ideally, the disease is treated by a specialist in infectious diseases. Close monitoring by the physician is also necessary during treatment. If side effects, interactions or other unusual complaints occur as a result of the medication, the doctor must be informed. In case of doubt, inpatient treatment in a hospital is necessary.
Treatment and therapy
Because organs are attacked in an OPSI syndrome, it is necessary for the patient to receive intensive medical care. Septic shock also requires intensive medical treatment. Every minute counts in therapy, so therapy should be initiated immediately. A treatment approach may require the use of antibiotics. If OPSI syndrome is suspected, antibiotics are usually administered first and foremost, as this is quick and combats a wide range of bacteria. After an antibiogram, which determines resistance to different pathogens, it is possible to switch to more specific antibiotics. Depending on the course of the disease, the patient may need to be ventilated and blood oxygen saturation monitored and regulated if necessary. Depending on which organs are attacked by the sepsis, organ replacement measures must be initiated. In addition to ventilation therapy, this may include renal replacement procedures and extracorporeal membrane oxygenation, in which all of the patient’s respiratory functions are taken over by a machine, bie the treatment of people with an OPSI syndrome.
Outlook and prognosis
OPSI syndrome is also known as postsplenectomy syndrome. It develops in one to five percent of affected individuals as a result of surgical splenectomy. OPSI syndrome is a severe bacterial infection. It results in a relatively high mortality rate postoperatively. Up to one 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 is the lack of work of the spleen. The spleen produces scavenger cells that could work against the bacterial infection. Since the spleen has now been removed, it can no longer do this work. The immune system lacks macrophages. The infection can therefore cause sepsis. This is often caused by pneumococcus in children. In addition, Haemophilus influenzae type B virus or Neisseria meningitidis can cause postoperative OPSI syndrome. Rather rarely, this is triggered by Ehrlichia species or Babesia. Why OPSI syndrome can develop as early as a few days after splenectomy, but also several years later, is a mystery. Only preventive vaccinations against the aforementioned pathogens provide some protection. Often, however, spleen removal is accidental or tumor-related.Therefore, those affected usually do not have time to get preventive vaccinations.
Prevention
As prevention of OPSI syndrome, the patient should be vaccinated against the pathogens that are most common before surgical removal of the spleen. So-called standby antibiotics or long-term treatment with antiobiotics are also options considered during splenectomy. For vaccination, the use of pneunomococcal vaccines is recommended. In addition, patients should be vaccinated against Haemophilus influenza type B and meningococcus. Vaccination should be given at least fourteen days before surgery to prevent contracting OPSI syndrome.
Follow-up care
In most cases, those affected by OPSI syndrome have few and even limited measures of aftercare available to them. However, affected individuals should seek diagnosis at a very early stage to prevent the occurrence of further complications and other medical conditions. As a rule, self-healing cannot occur, so that the patient is continuously dependent on medical examination and treatment. Therefore, a doctor should be contacted at the first signs of this infection. Most sufferers rely on surgical intervention to alleviate the symptoms. In this regard, the affected person should rest and take care of his body after the surgery. Efforts or stressful and physical activities should be refrained from in order not to stress the body unnecessarily. It is also necessary to take antibiotics. Those affected should take these regularly and in the correct dosage. The intake 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 this regard, the life expectancy of the affected person is significantly reduced in many cases due to the syndrome.
Here’s what you can do yourself
If symptoms of OPSI syndrome occur, the first thing to do is call 911. If shock occurs, first responders must provide first aid to the patient by placing him or her in a safe body position and performing resuscitative measures if necessary. After hospitalization, the condition should be cured for at least one to two weeks. Patients may consume sparing foods and engage in moderate exercise. Strenuous physical work, on the other hand, should be avoided. The diet should consist mainly of legumes, various types of nuts and red meat, as the high iron content strengthens the immune system and has a positive effect on general well-being. If there is no improvement in symptoms after a few days, another visit to the family doctor is recommended. Alternative remedies such as masterwort or burnet regulate the immune system and can be used, for example, in tea form or as an infusion. Patients should consult an alternative practitioner beforehand to avoid overdosing. Professional advice is also needed when using essential oils, which help against the typical fever symptoms in OPSI syndrome.