Dokkyo Medical University Repository / 獨協医科大学リポジトリ
Not a member yet
2844 research outputs found
Sort by
The Importance of Infectious Disease Control after Pediatric Splenectomy According to Vaccine Schedule in Japan
Get PDF脾臓は重要な免疫機構を有するため脾機能が低下すると重症感染症をきたしやすい．特に脾臓摘出後の感染症は，脾摘後重症感染症（overwhelming postsplenectomy infection：OPSI）と呼ばれる．起因菌は莢膜を有する肺炎球菌やインフルエンザ菌b型，髄膜炎菌などが多い．致死率は50％に達し，発症24時間以内の死亡が多いため，急性期は迅速な対応を要する．脾摘後1〜2年以内が高リスクとされるが，OPSIのリスクは生涯続くため，患者教育，予防的抗菌薬投与，ワクチン接種，発熱時の対応など包括的な感染症対策が大切である．本稿ではOPSIについて概説するとともに，外傷性脾損傷後に脾臓全摘術を受けた小児例を提示し，術後早期より我々が行ったワクチンスケジュールを中心とするOPSI対策を提示する．The spleen is responsible for important immune mechanisms. Therefore, when splenic function is compromised, serious infections are more likely to occur. In particular, post-splenectomy infection is called overwhelming postsplenectomy infection （OPSI）. The most common causative organisms are Streptococcus pneumoniae, Haemophilus influenzae type b, and Meningococcus meningitidis which are capsular bacteria. The mortality rate is as high as 50 ％ , and death is common within 24 hours of onset, so the acute phase of the OPSI requires prompt treatment. Although the risk is considered high within 1-2 years after splenectomy, comprehensive infection control measures, including patient education, prophylactic antimicrobial drug administration, vaccination, and fever management, are important because the risk of OPSI continues throughout life. In this article, we provide an overview of OPSI, present a case of a child who underwent total splenectomy after traumatic splenic injury, and present our countermeasures against OPSI, focusing on a vaccine schedule that we implemented early in the postoperative period.journal articl
