OPSI stands for the English technical term “overwhelming post-splelectomy infection”. As the name suggests, such an infection only occurs as a result of a splenectomy – surgical removal of the spleen. OPSI syndrome is a bacterial infection, but it is quite common (about 1 to 5 percent of cases) after spleen surgery. In these cases, the mortality rate 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. The reason for surgical removal of the spleen is often injury to it as a result of accidents, but internal diseases affecting the spleen can also indicate splenectomy. See aviationopedia for Laryngitis Explanations.
The 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 a life-threatening infection of vital functions, it is a serious condition. The OPSI syndrome arises exclusively as a result of a splenectomy or a dysfunctional spleen that can no longer fulfill its task.
The most common bacterium that is the primary cause of OPSI syndrome in children is pneumococci. Infection with pneumococci in OPSI syndrome can be particularly dangerous for children and the elderly, since their immune system is weaker.
The spleen has its task in the defense against infection, so that although it is not vital, it is very important for the defense against pathogens. Certain bacteria attack the spleen and lead to sepsis, OPSI syndrome.
Sepsis (in Greek sepo means something like “make lazy”) is colloquially referred to as blood poisoning. OPSI syndrome can occur a few days after a splenectomy, but OPSI syndrome can also occur years after surgical removal of the spleen.
Symptoms, Ailments & Signs
The hallmarks of the OPSI syndrome are those of blood poisoning (sepsis). It initially begins with fever and chills, accompanied by upper abdominal pain. If not treated immediately, shock will develop . This manifests itself in pale skin that is cold to the touch.
The sufferer shows impaired consciousness and may speak in incoherent sentences. He is unable to express himself clearly. In addition, the person freezes and produces cold sweats. Most of the time she is extremely anxious and restless. Breathing accelerates, blood pressure drops and the heart races (tachycardia). A life-threatening condition arises.
Without treatment, the patient can become completely listless and eventually unconscious as the disease progresses. Due to the processes in the organism, blood coagulation is disturbed and internal bleeding occurs. Since the blood circulation no longer works properly, the organs are not supplied with blood and oxygen at all or only insufficiently.
They stop their work and the whole cycle collapses. The result is multi-organ failure. At this stage, patients often appear bloated from fluid buildup in the tissues. Petechiae appear on the skin, which are small punctate hemorrhages. Once this state has been reached, treatment is only possible in the rarest of cases. Due to the irreversible damage in the body, the patient falls into a coma and dies.
Diagnosis & History
The most common symptoms of OPSI syndrome are fever and pain in the upper abdomen and in the stomach area. In general, all symptoms that normally occur with the flu, such as body aches, can also be indications of OPSI syndrome. Since the organs are attacked, multi-organ failure can occur in which the kidneys, liver and lungs, among other things, stop working. Chills can also occur as part of sepsis. In some cases it can lead to a coma. In the worst case, an illness with the OPSI syndrome can be fatal.
As a rule, 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. Those affected usually suffer from the usual symptoms of an infection.
There is a high fever and also a circulatory shock if the OPSI syndrome is not treated. Severe abdominal pain and multi-organ failure can also occur. However, this case only occurs if the OPSI syndrome is not treated. Furthermore, those affected fall into a coma or lose consciousness and eventually die.
In most cases, the OPSI syndrome is successfully treated with antibiotics. There are no particular complications if treatment is started early enough. The life expectancy of the patient is also not affected if the disease progresses positively. In some cases, the sufferer may need oxygen therapy. If organs have already been damaged, transplants are necessary to keep the affected person alive.
When should you go to the doctor?
OPSI syndrome is a serious condition that has serious complications and must be treated promptly 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 persons should inform the responsible doctor. The syndrome occurs mainly after surgical removal of the spleen, which is why the doctor can quickly make a diagnosis.
At the latest when the well-being decreases significantly and the symptoms do not go away, you have to go to the doctor. Patients should speak to their family doctor or an internist. Ideally, the disease is treated by a specialist in infectious diseases. Close monitoring by the doctor is also necessary during treatment. If side effects or interactions as well as other unusual symptoms occur as a result of the administration of the medication, the doctor must be informed. In case of doubt, inpatient treatment in the hospital is necessary.
Treatment & Therapy
Since the organs are attacked in OPSI syndrome, it is necessary for the patient to be treated in intensive care. Septic shock also requires intensive care treatment.
Every minute counts during therapy, so therapy should be initiated immediately. One treatment approach may require the use of antibiotics . If OPSI syndrome is suspected, antibiotics are usually administered first, as this is quick and fights a wide range of bacteria. After an antibiogram, in which the resistance to different pathogens is determined, it is possible to switch to more specific antibiotics.
Depending on the course of the disease, the patient must be ventilated and the oxygen saturation in the blood must be 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 can also include renal replacement procedures and extracorporeal membrane oxygenation, in which all respiratory functions of the patient are taken over by a machine, when treating people with OPSI syndrome.
Outlook & Forecast
OPSI syndrome is also known as postsplenectomy syndrome. It occurs in one to five percent of those affected as a result of surgical removal of the spleen (splenectomy). OPSI syndrome is a serious bacterial infection. This results in a relatively high postoperative mortality rate. Up to a 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 lies in the lack of work of the spleen. This produces scavenger cells that could work against the bacterial infection. But now that the spleen has been removed, it can no longer do this work. The immune system lacks macrophages. The infection can therefore cause sepsis. In children, this is often caused by pneumococci.
In addition, Haemophilus influenzae type B virus or Neisseria meningitidis can trigger postoperative OPSI syndrome. This is rarely triggered by Ehrlichia species or Babesia. Why the OPSI syndrome can develop just a few days after the spleen removal, but also several years later, is a mystery.
Only preventive vaccinations against the pathogens mentioned provide a certain degree of protection. However, the spleen is often removed as a result of an accident or tumor. Therefore, those affected usually do not have time to get vaccinated as a preventive measure.
To prevent OPSI syndrome, the patient should be vaccinated against the most common pathogens before surgical removal of the spleen. So-called stand-by antibiotics or long-term treatment with antibiotics are also options that are considered in the case of a splenectomy. When vaccinated, the use of pneunomococcal vaccines is recommended.
In addition, patients should be vaccinated against Haemophilus influenza type B and meningococci. The vaccination should be carried out at least fourteen days before the operation in order to prevent OPSI syndrome.
In most cases, those affected by the OPSI syndrome have only a few and only limited aftercare measures available. Those affected should try to get a diagnosis very early on in order to prevent the occurrence of further complications and other symptoms. As a rule, self-healing cannot occur, so that the patient is constantly dependent on medical examination and treatment.
Therefore, a doctor should be contacted at the first sign of this infection. Most of those affected require surgery to relieve the symptoms. The person concerned should rest after the procedure and take care of their body. Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body.
It is also necessary to take antibiotics. Those affected should take them regularly and in the right dosage. The consumption of alcohol should be avoided. After the operation, regular checks and examinations are very useful to detect damage to other organs due to OPSI syndrome. In many cases, the life expectancy of those affected is significantly reduced by the syndrome.
You can do that yourself
When symptoms of OPSI syndrome occur, the first thing you should do is call an ambulance. In the event of shock, first responders must provide first aid by positioning the patient in a safe position and applying CPR if necessary.
After the hospital stay, the condition should be cured for at least one to two weeks. Patients are allowed to eat bland foods and do moderate exercise. Strenuous physical work, on the other hand, should be avoided. The diet should consist primarily of legumes, various types of nuts and red meat, because the high iron content strengthens the immune system and has a positive effect on general well-being.
If the symptoms do not improve after a few days, we recommend that you visit your family doctor again. Alternative remedies such as masterwort or burnet regulate the immune system and can be used in tea form or as an infusion. Patients should consult a naturopath beforehand to avoid overdosing. Professional advice is also required when using essential oils, which help to combat the typical fever symptoms of OPSI syndrome.