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Overwhelming Post-Splenectomy Infection — SCE Infectious Diseases MCQ

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EasyInfection Prevention & ControlOverwhelming Post-Splenectomy InfectionSCE Infectious Diseases

A 60-year-old man with a history of splenectomy for trauma 20 years ago presents with acute onset fever, rigors, confusion, and a purpuric rash. He has not been taking prophylactic antibiotics. Blood pressure is 75/40 mmHg. Blood film shows encapsulated Gram-positive diplococci. What is the most likely diagnosis?

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Correct answer: E — Overwhelming post-splenectomy infection (OPSI) with Streptococcus pneumoniae

OPSI is a life-threatening emergency in asplenic patients. S. pneumoniae is the most common cause (~60%), followed by H. influenzae and N. meningitidis. OPSI has a fulminant course with mortality >50% if not treated rapidly. Encapsulated Gram-positive diplococci on blood film confirm pneumococcus. This patient was not on prophylactic Phenoxymethylpenicillin, which significantly reduces OPSI risk. Management includes aggressive resuscitation and broad-spectrum IV antibiotics (Ceftriaxone 2 g).

Reference: UKHSA 2024 – Green Book Ch 7: Asplenia; NICE 2024 – Asplenia management