THE TRAVELLER WITH AN ABSENT OR DYSFUNCTIONAL SPLEEN - Hilary Simons Rose Tucker This is an abbreviated slide set to comply with copyright.

THE TRAVELLER WITH AN ABSENT
  OR DYSFUNCTIONAL SPLEEN

This is an abbreviated slide set to comply with copyright.
        Please do not use as your primary resource

                    Hilary Simons
                     Rose Tucker

LEARNING OUTCOMES
At the end of this session, participants should be able to:

•   explain the importance of identifying the cause of an
    absent or dysfunctional spleen
•   identify the main challenges faced by travellers with
    an absent or dysfunctional spleen
•   determine the key areas of risk management for these
    travellers

BUT…WHAT DOES THE SPLEEN DO?

•   Acts as a filter for red blood cells: breaks
    down damaged / malformed blood cells
•   Removes microorganisms
•   Involved in antibody production

ABSENT or DYSFUNCTIONAL SPLEEN

OPSI

•   Overwhelming Post Splenectomy Infection:
    • encapsulated bacteria
      • Streptococcus pneumoniae (most commonly)
      • Haemophilus influenza type b (Hib)
      • Neisseria meningitidis

PREVENTING INFECTION

•   Routine vaccination - fully vaccinated
    according to national schedule (PHE, 2020)
In addition
  • Pneumococcal
  • MenACWY
  • MenB
  • Influenza
  • Long term antibiotics for some

Immunisation against infectious
disease Ch 7. 2020

PREVENTING INFECTION: TRAVEL SPECIFIC

Vaccination; inactivated? Live vaccines?
Non vaccine preventable; Food and water hygiene
Alternative/standby antibiotics?

OTHER INFECTIONS

• Parasitic:
 • babesiosis
 • malaria

• Bacterial:
 •   Capnocytophaga canimorsus (present in
     mouths of dogs/cats)

BABESIOSIS BABESIA MICROTI

https://travelhealthpro.org.uk/factsheet/38/insect-and-tick-bite-avoidance

MALARIA FALCIPARUM
Avoid travel to malarious areas.
Avoid infection
•    rigorous mosi bite
     precautions
•    strict adherence to
     chemoprophylaxis (even in
     BA only areas).
Chiodini PL, Patel D, Whitty CJM and Lalloo DG. Guidelines for
malaria prevention in travellers from the United Kingdom,
2019. London: Public Health England; August 2019

Travellers with an absent or poorly functioning
 Adam,should
spleen   splenectomy    after diagnosis
                 be dissuaded             of ITP
                                 from travel     two area
                                              to any
 yearsrisk
with    ago.
           of No meds.but where travel is essential
              malaria,
awareness, rigorous bite avoidance and antimalarials
 Backpacking
should          around
         be advised.     Costa
                      ACMP 2019 Rica for eight weeks
 July and August

Faye 32, is planning a year long road trip –
from Connecticut, USA, down to the tip of
South America. Mostly camping and in
hostels.
She had her spleen removed 15 years ago

                  OPSI
                Parasites
                Dog bite
              Close contact
                Accident

A 6 year old boy, travelling to Kisumu and
Mombasa, Kenya with his family for 3 weeks,
leaving in 2 months time. He has sickle cell disease.

 Not only a
dysfunctional
   spleen

Jim 38, attends for his yellow fever vaccine. he is
travelling to Uganda in 6 weeks time, staying for 2
months, working on a veterinary research project.

He had a splenectomy 3 years ago due to a crush
injury caused by a bull!

  Crohn’s disease – recently switched from long term
  methotrexate 15mg weekly to infliximab.

ALERT CARD and PATIENT
              INFORMATION
                                                     Ensure prompt
                                                    recognition and
                                                      treatment of
                                                        infection

https://www.gov.uk/government/publications/splenectomy-leaflet-and-card

SUMMARY
•   At risk from invasive bacteria
    • Remember routine and travel specific
      vaccinations
    • Food and water hygiene

•   At risk from parasites
    • Insect and tick bite avoidance and precautions

•   Explore underlying medical history
    • Insurance and alert card
    • Liaise with supervising clinician
    • Seek specialist advice

RESOURCES

•   Chiodini PL, Patel D, Whitty CJM and Lalloo DG. Guidelines for
    malaria prevention in travellers from the United Kingdom, 2019.
    London: Public Health England; August 2019
•   Davies JM et al. Review of guidelines for the prevention and
    treatment of infection in patients with an absent or dysfunctional
    spleen: Brit J Haem 2011; 155, 308-31
•   Immunisation against infectious disease. Ch 7 updated 2020

Rosemarytucker@nhs.net

Hilary.simons@lstmed.ac.uk