Overwhelming Post-Splenectomy Infection: Narrative Review of the Literature

Abstract

Background: Almost 100 years have passed since the first evidence appeared of the immunologic function of the spleen against infections. The spleen now is recognized as the host for immune cells essential for antibody production and elimination of blood-borne pathogens, particularly encapsulated bacteria. Since the early 1900s, splenectomy has been a frequently performed surgical procedure with multiple indications. Unfortunately, removal of the spleen is associated with increased susceptibility to infection, which may be life-long, and death. Methods: Review of the pertinent English-language literature. Results: Splenectomized patients are predisposed to overwhelming fulminant infections caused by encapsulated bacteria that are refractory to the usual treatment, with a case-fatality rate of 40% to 54%. Recent studies demonstrate high morbidity. Conclusions: Because of this high mortality rate and the challenging treatment, prevention of infection by vaccination is a key feature of the management of splenectomized adult patients.