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Ladu AI, Kadaura MU, Dauda M, Baba AS, Jeffery C, Farate A, Adekile A, Bates I, Dacombe R. Bacteraemia Among Patients with Sickle Cell Disease in Nigeria: Association with Spleen Size and Function. Mediterr J Hematol Infect Dis 2023; 15:e2023054. [PMID: 37705518 PMCID: PMC10497316 DOI: 10.4084/mjhid.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mairo U Kadaura
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mohammed Dauda
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Abubakar Sadiq Baba
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Abubakar Farate
- Department of Radiology, Faculty of Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Rufai T, Aninagyei E, Akuffo KO, Ayin CTM, Nortey P, Quansah R, Cudjoe FS, Tei-Maya E, Osei Duah Junior I, Danso-Appiah A. Malaria and typhoid fever among patients presenting with febrile illnesses in Ga West Municipality, Ghana. PLoS One 2023; 18:e0267528. [PMID: 37228010 DOI: 10.1371/journal.pone.0267528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Clinicians in areas where malaria and typhoid fever are co-endemic often treat infected patients irrationally, which may lead to the emergence of drug resistance and extra cost to patients. This study determined the proportion of febrile conditions attributable to either malaria and/or typhoid fever and the susceptibility patterns of Salmonella spp. isolates to commonly used antimicrobial agents in Ghana. METHODS One hundred and fifty-seven (157) febrile patients attending the Ga West Municipal Hospital, Ghana, from February to May 2017 were sampled. Blood samples were collected for cultivation of pathogenic bacteria and the susceptibility of the Salmonella isolates to antimicrobial agents was performed using the Kirby-Bauer disk diffusion method with antibiotic discs on Müller Hinton agar plates. For each sample, conventional Widal test for the detection of Salmonella spp was done as well as blood film preparation for detection of Plasmodium spp. Data on the socio-demographic and clinical characteristics of the study participants were collected using an android technology software kobo-collect by interview. RESULTS Of the total number of patients aged 2-37 years (median age = 6 years, IQR 3-11), 82 (52.2%) were females. The proportion of febrile patients with falciparum malaria was 57/157 (36.3%), while Salmonella typhi O and H antigens were detected in 23/157 (14.6%) of the samples. The detection rate of Salmonella spp in febrile patients was 10/157 (6.4%). Malaria and typhoid fever coinfection using Widal test and blood culture was 9 (5.7%) and 3 (1.9%), respectively. The isolates were highly susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and amikacin but resistant to ampicillin, tetracycline, co-trimoxazole, gentamicin, cefuroxime, chloramphenicol, and meropenem. CONCLUSION Plasmodium falciparum and Salmonella spp coinfections were only up to 1.9%, while malaria and typhoid fever, individually, were responsible for 36.3% and 6.4%, respectively. Treatment of febrile conditions must be based on laboratory findings in order not to expose patients to unnecessary side effects of antibiotics and reduce the emergence and spread of drug resistance against antibiotics.
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Affiliation(s)
- Tanko Rufai
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Teye-Muno Ayin
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Priscillia Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Reginald Quansah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Francis Samuel Cudjoe
- School of Biomedical and Allied Health Science, University of Ghana, Korle-Bu, Accra
| | - Ernest Tei-Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Purdue University Biological Sciences, West-Lafayette, Indiana, United States of America
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Délicat-Loembet LM, Baraïka MA, Bougoudogo F, Diallo DA. Bacterial Infection in the Sickle Cell Population: Development and Enabling Factors. Microorganisms 2023; 11:microorganisms11040859. [PMID: 37110283 PMCID: PMC10142700 DOI: 10.3390/microorganisms11040859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 03/30/2023] Open
Abstract
The high frequency of bacterial infections represents a major threat to public health. In developing countries, they are still responsible for significant morbidity and mortality in pediatric populations with sickle cell disease, particularly in children under 5 years of age. Indeed, they have an increased susceptibility to bacterial infections due to their immune deficiency. This susceptibility is even greater for pneumococcal and salmonella infections. In addition, the underdevelopment of some countries and socio-economic factors increases this condition. This review examines the common and specific factors leading to infections in people with sickle cell disease in different types of developed and undeveloped countries. The threat of bacterial infections, particularly those caused by S. pneumoniae and Salmonella, is of increasing concern due to the rise in bacterial resistance to antibiotics. In light of this disturbing data, new strategies to control and prevent these infections are needed. Solutions could be systematic penicillin therapy, vaccinations, and probabilistic antibiotic therapy protocols.
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Jang T, Mo G, Stewart C, Egini O, Dutta D, Muthu J, Lim SH. Antibiotic use in adults during sickle cell vaso-occlusive crisis: Is it time for a controlled trial? Br J Haematol 2021; 193:1281-1283. [PMID: 33783844 DOI: 10.1111/bjh.17439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Tim Jang
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - George Mo
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Connor Stewart
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ogechukwu Egini
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - John Muthu
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Seah H Lim
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Ochocinski D, Dalal M, Black LV, Carr S, Lew J, Sullivan K, Kissoon N. Life-Threatening Infectious Complications in Sickle Cell Disease: A Concise Narrative Review. Front Pediatr 2020; 8:38. [PMID: 32154192 PMCID: PMC7044152 DOI: 10.3389/fped.2020.00038] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
Sickle cell disease (SCD) results in chronic hemolytic anemia, recurrent vascular occlusion, insidious vital organ deterioration, early mortality, and diminished quality of life. Life-threatening acute physiologic crises may occur on a background of progressive diminishing vital organ function. Sickle hemoglobin polymerizes in the deoxygenated state, resulting in erythrocyte membrane deformation, vascular occlusion, and hemolysis. Vascular occlusion and increased blood viscosity results in functional asplenia and immune deficiency in early childhood, resulting in life-long increased susceptibility to serious bacterial infections. Infection remains a main cause of overall mortality in patients with SCD in low- and middle-income countries due to increased exposure to pathogens, increased co-morbidities such as malnutrition, lower vaccination rates, and diminished access to definitive care, including antibiotics and blood. Thus, the greatest gains in preventing infection-associated mortality can be achieved by addressing these factors for SCD patients in austere environments. In contrast, in high-income countries, perinatal diagnosis of SCD, antimicrobial prophylaxis, vaccination, aggressive use of antibiotics for febrile episodes, and the availability of contemporary critical care resources have resulted in a significant reduction in deaths from infection; however, chronic organ injury is problematic. All clinicians, regardless of their discipline, who assume the care of SCD patients must understand the importance of infectious disease as a contributor to death and disability. In this concise narrative review, we summarize the data that describes the importance of infectious diseases as a contributor to death and disability in SCD and discuss pathophysiology, prevalent organisms, prevention, management of acute episodes of critical illness, and ongoing care.
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Affiliation(s)
- Dominik Ochocinski
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Mansi Dalal
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - L Vandy Black
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - Silvana Carr
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Judy Lew
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Kevin Sullivan
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States.,Congenital Heart Center, University of Florida, Gainesville, FL, United States
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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Banza MI, Mulefu JP, Lire LI, N'dwala YTB, Tshiamala IB, Cabala VDPK. [Digestives diseases associated to sickle cell anemia in Lubumbashi: epidemiological and clinical aspects]. Pan Afr Med J 2019; 33:253. [PMID: 31692839 PMCID: PMC6814946 DOI: 10.11604/pamj.2019.33.253.18017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/07/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction la drépanocytose est une maladie génétique de transmission autosomique liée à une anomalie de structure de l'hémoglobine qui aboutit à la formation de l'hémoglobine S. Le but de notre étude est de colliger les cas de pathologies digestives rencontrées chez les drépanocytaires de Lubumbashi et d'en ressortir les caractéristiques épidémiologiques et cliniques. Méthodes il s'agit d'une étude rétrospective, descriptive transversale réalisée au Centre de Recherche de la Drépanocytose de Lubumbashi. Elle a concerné les dossiers des patients suivi pour drépanocytose ayant présenté une pathologie digestive au cours de notre période de 3 ans (de janvier 2015 à décembre 2017). Le recueil des données s'est fait grâce à une fiche d'enquête comportant différents paramètres d'étude comprenant: l'âge, le sexe, le motif de consultation, le diagnostic, le type de crise vaso-occlusive, les examens paracliniques réalisés, le traitement à l'hydroxyurée. Résultats nous avons colligé 206 dossiers (N=206) des patients drépanocytaires ayant fait une pathologie digestive sur un total de 403 dossiers examinés, ce qui représente une fréquence de 51,11% des pathologies digestives chez les drépanocytaires. Les 2 sexes sont représentés avec une légère prédominance féminine (51,94%) et un sexe ratio H/F: 0,92. La tranche d'âge la plus représentée est celle comprise entre 1 et 6 ans (32,52%), la moyenne d'âge: 11,8ans; écart-type: 21,9; âges extrêmes: 13 mois et 38 ans. Le motif de consultation est dominé par la fièvre (60,67%), la douleur abdominale (44,66%) et les troubles digestifs (30,09%). Les crises vaso-occlusives abdominales sont retrouvées chez 65 patients (31,55%) parmi lesquels 36 patients ont présenté 1 seule crise, 24 en ont présenté 2 et 5 patients en ont présenté 3. Les pathologies intestinales étaient présentes chez 121 patients (69,41%) dominées par la parasitose intestinale (retrouvée chez 58 patients dont l'examen des selles a mis en évidence 4 parasites: le Yersinia enterocolitis, l'entamoeba histolytica, le Giardia intestinalis et le clostridium difficile); les pathologies gastriques retrouvées chez 105 patients (50,97%) reparties en ulcère gastro-duodénal (45 patients) et gastrite (60 patients); la pathologie vésiculo-biliaire présente chez 40 patients (19,41%) comprenant la lithiase vésiculaire sans cholécystite 32 patients, la cholécystite lithiasique 5 patients et 3 cas de lithiase de la voie biliaire principale; 1 seul cas de pancréatite aigue diagnostiquée. Les pathologies associées les plus retrouvées dans notre étude sont respiratoires avec 169 cas (82,03%), oto-rhino-laryngologiques avec 157 cas (76,21%), les crises vaso-occlusives osseuses (146 cas soit 70,87%), pathologies uro-génitales avec 64 cas (31,06%) et le paludisme chez 51 patients (24,75%). Les atteintes spléniques et hépatiques ont constitué chacun 47 cas (22,81%) et 18 cas (8,73%). L'échographie a était demandé chez 79 patients mais seulement 31 d'entre-eux l'ont réalisé, faute de moyen financier car il coute sur place 20 dollars américains. En cas de splénomégalie cliniquement évidente, le corps de Jolly a été demandé chez 23 patients mais seulement 2 patients l'ont réalisé vu qu'il coute 10 dollars américains. L'hémogramme de routine fait de l'hémoglobine, hématocrite, bilan inflammatoire et la goutte épaisse a été réalisée chez tous nos patients mais le bilan hépatique, les examens des selles, des urines sont préconisés en fonction de la plainte. Sur nos 206 patients, 60 seulement d'entre eux étaient sous traitement à l'hydroxyurée (29,16%). Conclusion les pathologies digestives sont fréquentes chez les drépanocytaires et représentent quasiment la moitié de l'effectif drépanocytaire. Malheureusement, la meilleure prise en charge reste butée à la pauvreté manifeste de la population limitants les examens paracliniques très utiles dans la pathologie digestive rencontrée chez le drépanocytaire.
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Affiliation(s)
- Manix Ilunga Banza
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Jules Panda Mulefu
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Lire Ipani Lire
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Yannick Tietie Ben N'dwala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Israel Badypwyla Tshiamala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Vincent de Paul Kaoma Cabala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Odey F, Okomo U, Oyo-Ita A. Vaccines for preventing invasive salmonella infections in people with sickle cell disease. Cochrane Database Syst Rev 2018; 12:CD006975. [PMID: 30521695 PMCID: PMC6517230 DOI: 10.1002/14651858.cd006975.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Salmonella infections are a common bacterial cause of invasive disease in people with sickle cell disease especially children, and are associated with high morbidity and mortality rates. Although available in some centres, people with sickle cell anaemia are not routinely immunized with salmonella vaccines. This is an update of a previously published Cochrane Review. OBJECTIVES To determine whether routine administration of salmonella vaccines to people with sickle cell disease reduces the morbidity and mortality associated with infection. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.We also conducted a search of the LILACS database and the World Health Organization International Clinical Trials Registry Platform (www.who.int/trialsearch) and ClinicalTrials.gov (www.clinicaltrials.gov).Date of most recent searches: 17 October 2018. SELECTION CRITERIA We planned to select all randomized controlled trials that compared the use of either the inactivated vaccine or an oral attenuated vaccine with a placebo among people with sickle cell disease. Equally, studies that compared the efficacy of one vaccine type over another were to be selected for the review. DATA COLLECTION AND ANALYSIS No trials of salmonella vaccines in people with sickle cell disease were found. MAIN RESULTS There is an absence of randomized controlled trial evidence relating to the scope of this review. AUTHORS' CONCLUSIONS It is expected that salmonella vaccines may be useful in people with sickle cell disease, especially in resource-poor settings where the majority of those who suffer from the condition are found. Unfortunately, there are no randomized controlled trials on the efficacy and safety of the different types of salmonella vaccines in people with sickle cell disease. We conclude that there is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of the different types of salmonella vaccines as a means of improving survival and decreasing mortality from salmonella infections in people with sickle cell disease. However, we believe that there are unlikely to be any trials published in this area, therefore, this review will no longer be regularly updated.
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Affiliation(s)
- Friday Odey
- Department of Paediatrics, University of Calabar Teaching Hospital, PMB 1115, Calabar, Cross River State, Nigeria, 540261
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Sirigaddi K, Aban I, Jantz A, Pernell BM, Hilliard LM, Bhatia S, Lebensburger JD. Outcomes of febrile events in pediatric patients with sickle cell anemia. Pediatr Blood Cancer 2018; 65:e27379. [PMID: 30070043 PMCID: PMC6150798 DOI: 10.1002/pbc.27379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited evidence exists to create institutional admission criteria guidelines for febrile sickle cell patients. In addition, evidence is lacking to understand readmission rates for febrile sickle cell patients discharged from the emergency department (ED) or hospital. PROCEDURES We conducted a 16-year retrospective study of bacteremia outcomes for febrile sickle cell patients. Risk variables analyzed included fever (either ≥ 39.5°C or ≥40°C), abnormal white blood cell (WBC) (>30,000 or <5,000/mcL), tachycardia and hypotension, or "ill appearing." Fourteen-day readmission rates were analyzed to determine outcomes for febrile sickle cell patients discharged from the ED or discharged within 72 h. RESULTS Bacteremia was identified in 17 (2.6%) of 653 febrile events that are presented to the ED. "Ill-appearing" patients had an 8.5-fold increased odds of being diagnosed with bacteremia. Models using WBC count, "ill appearing," and hypotension have the highest sensitivity and specificity (AUC > 0.75). Among 427 patients discharged from the ED or within 72 h of hospitalization, only 10 (2.3%) were readmitted for a new sickle cell complication. CONCLUSIONS Institutions can develop admission criteria based on WBC count, hypotension, and "ill appearance." Persistently febrile, well-appearing patient can be discharged at 48 h with minimal risk for new complications.
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Affiliation(s)
| | - Inmaculada Aban
- University of Alabama at Birmingham, Department of Biostatistics
| | - Amelia Jantz
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Brandi M. Pernell
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Lee M. Hilliard
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Smita Bhatia
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
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Ochaya O, Hume H, Bugeza S, Bwanga F, Byanyima R, Kisembo H, Tumwine JK. ACS in children with sickle cell anaemia in Uganda: prevalence, presentation and aetiology. Br J Haematol 2018; 183:289-297. [PMID: 30125958 DOI: 10.1111/bjh.15543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/01/2018] [Indexed: 11/28/2022]
Abstract
ACS (ACS) is a serious complication of sickle cell anaemia (SCA). We set out to describe the burden, presentation and organisms associated with ACS amongst children with SCA attending Mulago Hospital, Kampala, Uganda. In a cross-sectional study, 256 children with SCA and fever attending Mulago Hospital were recruited. Chest X-rays, blood cultures, complete blood count and sputum induction were performed. Sputum samples were investigated by Ziehl-Nielsen staining, culture and DNA polymerase chain reaction (PCR) for Chlamydia pneumoniae. Of the 256 children, 22·7% had ACS. Clinical and laboratory findings were not significantly different between children with ACS and those without, besides cough and abnormal signs on auscultation. Among the 83 sputum cultures Streptococcus pneumoniae (12%) and Moraxella spp (8%), were the commonest. Of the 59 sputa examined with DNA PCR, 59·3% were positive for Chlamydia pneumoniae. Mycobacterium tuberculosis was isolated in 6/83 sputa. These results show that one in 5 SCA febrile children had ACS. There were no clinical and laboratory characteristics of ACS, but cough and abnormalities on auscultation were associated with ACS. The high prevalence of Chlamydia pneumoniae in children with ACS in this setting warrants the addition of macrolides to treatment, and M. tuberculosis should be differential in sub-Saharan children with ACS.
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Affiliation(s)
- Odong Ochaya
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences (CHS), Makerere University, Kampala, Uganda
| | - Heather Hume
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences (CHS), Makerere University, Kampala, Uganda
| | - Sam Bugeza
- Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosemary Byanyima
- Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harriet Kisembo
- Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences (CHS), Makerere University, Kampala, Uganda
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Grannum D, Lashley PM. The morbidity pattern of children with sickle cell disorders admitted to the Queen Elizabeth Hospital, Barbados (2009-2013). Trop Doct 2017; 48:11-16. [PMID: 29099347 DOI: 10.1177/0049475517740309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A retrospective study was conducted by examining all the medical files of all the children with sickle cell anaemia (Hb SS) admitted from 1 January 2009 to 31 December 2013. A total of 220 admission notes (59 patients aged 5 months-16 years) were analysed. Of these, 53.2% were boys; 85.8% of the patients had Hb SS. The most common reason for admission was vaso-occlusive crisis. Blood transfusions were used in 39.7% of admissions There were no deaths during the study period. We note the number of sickle cell-related admissions and morbidity has increased, along with an increase in the number of blood transfusions. The mortality rate for children with sickle cell in Barbados is low compared to other territories in the Caribbean and worldwide. The need for better comprehensive management protocols and universal screening should decrease the morbidity patterns seen in this study.
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Affiliation(s)
- D Grannum
- Department of Child Health, Queen Elizabeth Hospital, St Michael, Barbados
| | - Paula M Lashley
- Department of Child Health, Queen Elizabeth Hospital, St Michael, Barbados
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Douamba S, Nagalo K, Tamini L, Traoré I, Kam M, Kouéta F, Yé D. [Major sickle cell syndromes and infections associated with this condition in children in Burkina Faso]. Pan Afr Med J 2017; 26:7. [PMID: 28450986 PMCID: PMC5398225 DOI: 10.11604/pamj.2017.26.7.9971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Le but de cette étude était d’étudier les infections chez les enfants présentant un syndrome drépanocytaire majeur. Méthodes Étude hospitalière monocentrique, rétrospective descriptive sur dix années menée à Ouagadougou, Burkina Faso. Étaient inclus tous les enfants porteurs d'un syndrome drépanocytaire majeur (homozygote SS et double hétérozygote SC, SDPunjab, Sβ thalassémique, SOArab et SE) hospitalisés pour une infection bactérienne confirmée à la microbiologie. Résultats Cent trente trois patients répondaient à nos critères d’inclusion. Le phénotype SS représentait 63,2% des cas et le SC 36,8%. La fréquence des infections était de 21,8%. Celles-ci touchaient dans 45,9% des cas les enfants âgés de 0 à 5 ans. Les signes les plus fréquents étaient les douleurs ostéoarticulaires (42,1%), la toux (25,7%), les douleurs abdominales (23,3%), la pâleur (43,6%). Les broncho-pneumopathies (31,6%), le paludisme (16,5%), les ostéomyélites (12,8%) et les septicémies (10,5%) étaient les principaux diagnostics trouvés. Les agents pathogènes isolés étaient Streptococcus pneumoniae (35,5%) et Salmonella sp (33,3%). Les céphalosporines de 3e génération étaient les antibiotiques les plus fréquemment prescrits. Le taux brut de mortalité était de 7,5%. Conclusion Les infections bactériennes et le paludisme dominent le tableau des infections chez l'enfant drépanocytaire majeur au Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle. Les auteurs recommandent la mise en place d’un programme national de prise en charge de la drépanocytose, ce qui permettrait de prévenir voire réduire la survenue des infections chez les enfants drépanocytaires.
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Affiliation(s)
- Sonia Douamba
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Kisito Nagalo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Laure Tamini
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Madibèlè Kam
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Fla Kouéta
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Diarra Yé
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
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12
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Makani J, Mgaya J, Balandya E, Msami K, Soka D, Cox SE, Komba AN, Rwezaula S, Meda E, Muturi D, Kitundu J, Fegan G, Kirkham FJ, Newton CR, Snow RW, Lowe B. Bacteraemia in sickle cell anaemia is associated with low haemoglobin: a report of 890 admissions to a tertiary hospital in Tanzania. Br J Haematol 2015; 171:273-276. [PMID: 26084722 PMCID: PMC4744759 DOI: 10.1111/bjh.13553] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
Abstract
Bacteraemia is a leading cause of morbidity in sickle cell anaemia (SCA), but information from studies in Africa is limited. We evaluated 890 admissions from 648 SCA patients at a tertiary hospital in Tanzania. Bacteraemia was present in 43 admissions (4·8%); isolates included Staphylococcus aureus (12/43; 28%), non‐Typhi Salmonella (9/43; 21%), Streptococcus pneumoniae (3/43; 7%) and Salmonella Typhi (2/43; 5%). Compared to SCA patients without bacteraemia, SCA patients with bacteraemia had significantly lower haemoglobin [71 g/l vs. 62 g/l, odds ratio 0·72 (95% confidence interval 0·56–0·91), P < 0·01]. Further exploration is needed of the relationship between anaemia and bacterial infections in SCA in Africa.
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Affiliation(s)
- Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK
| | - Josephine Mgaya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Khadija Msami
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,London School of Hygiene & Tropical Medicine, London, UK
| | - Albert N Komba
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Stella Rwezaula
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elineema Meda
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - David Muturi
- Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Jesse Kitundu
- Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Gregory Fegan
- University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | | | - Charles R Newton
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Robert W Snow
- University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Brett Lowe
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
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13
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Odey F, Okomo U, Oyo-Ita A. Vaccines for preventing invasive salmonella infections in people with sickle cell disease. Cochrane Database Syst Rev 2015:CD006975. [PMID: 26043710 DOI: 10.1002/14651858.cd006975.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Salmonella infections are a common bacterial cause of invasive disease in people with sickle cell disease especially children, and are associated with high morbidity and mortality rates. Although available in some centres, people with sickle cell anaemia are not routinely immunized with salmonella vaccines. This is an update of a previously published Cochrane Review. OBJECTIVES To determine whether routine administration of salmonella vaccines to people with sickle cell disease reduces the morbidity and mortality associated with infection. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.We also conducted a search of the LILACS database.Date of most recent searches: 05 May 2015. SELECTION CRITERIA We planned to select all randomized controlled trials that compared the use of either the inactivated vaccine or an oral attenuated vaccine with a placebo among people with sickle cell disease. Equally, studies that compared the efficacy of one vaccine type over another were to be selected for the review. DATA COLLECTION AND ANALYSIS No trials of salmonella vaccines in people with sickle cell disease were found. MAIN RESULTS There is an absence of randomized controlled trial evidence relating to the scope of this review. AUTHORS' CONCLUSIONS It is expected that salmonella vaccines may be useful in people with sickle cell disease, especially in resource-poor settings where the majority of those who suffer from the condition are found. Unfortunately, there are no randomized controlled trials on the efficacy and safety of the different types of salmonella vaccines in people with sickle cell disease. We conclude that there is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of the different types of salmonella vaccines as a means of improving survival and decreasing mortality from salmonella infections in people with sickle cell disease.
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Affiliation(s)
- Friday Odey
- Department of Paediatrics, University of Calabar Teaching Hospital, PMB 1115, Calabar, Cross River State, Nigeria, 540261
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14
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Al Salman J, Al Agha RA, Al Taitoon S, Al Arrayed A. Fever in sickle cell disease patients in the Kingdom of Bahrain. J Infect Public Health 2014; 7:333-8. [PMID: 24841634 DOI: 10.1016/j.jiph.2014.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/30/2022] Open
Abstract
Sickle cell disease (SCD) is a hereditary blood disorder characterized by abnormal red blood cell shape (sickling). The incidence of the disease in the Kingdom of Bahrain is approximately 2.1%. Patients with SCD are prone to multiple health complications, some of which are fatal. A retrospective study was conducted at the Salmaniya Medical Complex in the Kingdom of Bahrain from June, 2012 to December, 2012 to assess the incidence of fever among the SCD in-patients at that institution. The study also assessed the antibiotics administered, type of organisms isolated and patient outcome. The results showed that a total of 59 patients developed fever and 33 of those with fever had a positive culture result (55.93%). The most common isolate was gram-positive bacteria, most commonly Staphylococcus epidermidis (42.86%), and ceftriaxone was the most commonly prescribed antimicrobial. In conclusion, there was a low rate of hospital acquired infection and special attention needs to be paid to the infection control measures for SCD patients. For most of the SCD fever cases, there was no clear cause of the fever even after extensive diagnostic evaluations; thus, those fevers may have been of a non-infectious etiology in this population. Fortunately, none of the patients had any of the common preventable infections as a result of the high vaccination coverage and strong vaccination program in place in the Kingdom of Bahrain.
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Affiliation(s)
- Jameela Al Salman
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain.
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15
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Makani J, Ofori-Acquah SF, Nnodu O, Wonkam A, Ohene-Frempong K. Sickle cell disease: new opportunities and challenges in Africa. ScientificWorldJournal 2013; 2013:193252. [PMID: 25143960 PMCID: PMC3988892 DOI: 10.1155/2013/193252] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/09/2013] [Indexed: 12/26/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most common genetic causes of illness and death in the world. This is a review of SCD in Africa, which bears the highest burden of disease. The first section provides an introduction to the molecular basis of SCD and the pathophysiological mechanism of selected clinical events. The second section discusses the epidemiology of the disease (prevalence, morbidity, and mortality), at global level and within Africa. The third section discusses the laboratory diagnosis and management of SCD, emphasizing strategies that been have proven to be effective in areas with limited resources. Throughout the review, specific activities that require evidence to guide healthcare in Africa, as well as strategic areas for further research, will be highlighted.
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Affiliation(s)
- J. Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S. F. Ofori-Acquah
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- School of Allied Health Sciences, College of Health Sciences, University of Ghana, Ghana
| | - O. Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - A. Wonkam
- Division of Human Genetics, Faculty of Heath Sciences, University of Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
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16
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Eke AC, Akarolo-Anthony SN, Enumah AP. Cranberries for treating asymptomatic bacteriuria during pregnancy. Hippokratia 2012. [DOI: 10.1002/14651858.cd009793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ahizechukwu C Eke
- Washington University School of Medicine; Department of Obstetrics and Gynecology; Maternity Building - 660 South Euclid St Louis Missouri USA 63110
| | - Sally N Akarolo-Anthony
- Harvard School of Public Health; Department of Nutrition; 677 Huntington Avenue Boston Massachusetts USA MA 02115
| | - Adaeze P Enumah
- Federal Medical Center; Department of Family Medicine; Orlu Road Owerri Imo State Nigeria 440001
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17
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Drépanocytose et salmonelloses invasives ostéo-articulaires. Arch Pediatr 2012; 19:267-70. [DOI: 10.1016/j.arcped.2011.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/10/2011] [Accepted: 12/16/2011] [Indexed: 11/23/2022]
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18
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Richards LH, Howard J, Klein JL. Community-acquired Salmonella bacteraemia in patients with sickle-cell disease 1969-2008: a single centre study. ACTA ACUST UNITED AC 2010; 43:89-94. [PMID: 20964487 DOI: 10.3109/00365548.2010.526958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We document the aetiology of community-acquired bacteraemia in sickle-cell disease (SCD) patients and present clinical aspects of 11 cases of Salmonella bacteraemia. Prospective computerized records of all significant bacteraemic episodes presenting to our institution from 1969 to 2008 were analysed. Additional clinical information was drawn from hospital medical records. Six thousand three hundred and sixty-nine community-acquired bacteraemic episodes were documented, with 66 occurring in SCD patients. Salmonella species were the third most frequently isolated organism in SCD patients; 18% of bacteraemias in SCD patients were caused by Salmonella species vs 3% in non-SCD patients (p < 0.0001). Moreover, the proportion of community-acquired Salmonella bacteraemic episodes caused by non-Typhi species was significantly higher in SCD compared to other patients (p = 0.0015). Focal infection was identified in 7 of the 11 cases of Salmonella bacteraemia in SCD patients, with bone and joint accounting for 6 of these. Infection may have been acquired during travel to the tropics in 4 patients. Our study supports the view that SCD patients are particularly susceptible to Salmonella infection. These infections frequently require multiple surgical interventions and prolonged hospital stays. SCD patients should be advised to pay particular attention to food hygiene while travelling to the tropics.
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Affiliation(s)
- Lucinda H Richards
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
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19
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20
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Odey F, Okomo U, Oyo-Ita A. Vaccines for preventing invasive salmonella infections in people with sickle cell disease. Cochrane Database Syst Rev 2009:CD006975. [PMID: 19821392 DOI: 10.1002/14651858.cd006975.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Salmonella infections are a common bacterial cause of invasive disease in people with sickle cell disease especially children, and are associated with high morbidity and mortality rates. Although available in some centres, people with sickle cell anaemia are not routinely immunized with salmonella vaccines. OBJECTIVES To determine whether routine administration of salmonella vaccines to people with sickle cell disease reduces the morbidity and mortality associated with infection. SEARCH STRATEGY We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.We also conducted a search of the LILACS database.Date of most recent search of the Group's Haemoglobinopathies Trials Register: 17 June 2009. SELECTION CRITERIA We planned to select all randomized controlled trials that compared the use of either the inactivated vaccine or an oral attenuated vaccine with a placebo among people with sickle cell disease. Equally, studies that compared the efficacy of one vaccine type over another were to be selected for the review. DATA COLLECTION AND ANALYSIS No trials of salmonella vaccines in people with sickle cell disease were found. MAIN RESULTS There is an absence of randomized controlled trial evidence relating to the scope of this review. AUTHORS' CONCLUSIONS It is expected that salmonella vaccines may be useful in people with sickle cell disease, especially in resource-poor settings where the majority of those who suffer from the condition are found. Unfortunately, there are no randomized controlled trials on the efficacy and safety of the different types of salmonella vaccines in people with sickle cell disease. We conclude that there is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of the different types of salmonella vaccines as a means of improving survival and decreasing mortality from salmonella infections in people with sickle cell disease.
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Affiliation(s)
- Friday Odey
- Department of Paediatrics, University of Calabar Teaching Hospital, PMB 1115, Calabar, Cross River State, Nigeria
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21
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Seeyave D, Desai N, Miller S, Rao SP, Piecuch S. Fatal delayed transfusion reaction in a sickle cell anemia patient with Serratia marcescens sepsis. J Natl Med Assoc 2006; 98:1697-9. [PMID: 17052065 PMCID: PMC2569743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Patients with sickle cell anemia may require repeated red cell transfusion, putting them at risk for minor blood group alloimmunization and the development of delayed hemolytic transfusion reactions. Although Streptococcus pneumoniae is the most common cause of life-threatening infection in patients with sickle cell anemia, those who have been recently hospitalized are at risk for infection with resistant hospital-associated organisms, and blood transfusion may put the patient at risk of infection with transfusion-associated organisms such as Serratia marcescens and Yersinic enterocolitica. We recently cared for an adolescent with sickle cell anemia who presented to the emergency department with a severe, delayed hemolytic transfusion reaction and Serratia marcescens infection. The patient had been discharged from the hospital five days previously, and had been transfused and treated with antibiotics while hospitalized. In addition to demonstrating the potential severity of delayed hemolytic transfusion reactions, our case illustrates the importance of providing relatively broad-spectrum antibiotic coverage to patients with sickle cell anemia and possible infection who have recently been hospitalized.
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Affiliation(s)
- Desiree Seeyave
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
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22
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Chulamokha L, Scholand SJ, Riggio JM, Ballas SK, Horn D, DeSimone JA. Bloodstream infections in hospitalized adults with sickle cell disease: a retrospective analysis. Am J Hematol 2006; 81:723-8. [PMID: 16795063 DOI: 10.1002/ajh.20692] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bloodstream infections (BSI) are a common cause of morbidity and mortality in people with sickle cell disease (SCD). In children with SCD, BSI are most often caused by encapsulated organisms. There is a surprising paucity of medical literature that is focused on evaluating SCD adults with BSI. We reviewed the charts of adults with SCD and BSI who were admitted to our hospital between April 1999 and August 2003. During this period a total of 1,692 hospital admissions for 193 adults with SCD were identified and 28% of these patients had at least 1 episode of positive blood cultures, with 69 episodes (17%) considered true BSI. Nosocomial BSI occurred in 34 episodes (49%). Among community BSI, in contrast to BSI in children with SCD, Streptococcus pneumoniae was rarely encountered. A high incidence of staphylococcal BSI in adults with SCD was noted. Twenty-eight percent of all BSI were caused by Staphylococcus aureus, and 15 of 22 isolates (68%) of these were methicillin-resistant. Gram-negative organisms, anaerobes, and yeast were found in 21 (27%), 3 (4%), and 4 isolates (5%) of BSI, respectively. Since over 80% of BSI were considered catheter-related, the higher incidence of gram-positive bacterial infections was likely due to the presence of indwelling central venous catheters. Empiric therapy for adults with SCD suspected of having BSI, especially in the presence of indwelling central venous catheters, should include antimicrobial therapy targeted at gram-positive bacteria (especially MRSA) and gram-negative bacteria. Also, if patients are critically ill, consideration should be made to include antifungal agents. Additional research into the adult SCD population appears necessary to further define this problem.
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Affiliation(s)
- Lalita Chulamokha
- Division of Infectious Diseases and Environmental Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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23
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Cumming V, Ali S, Forrester T, Roye-Green K, Reid M. Asymptomatic bacteriuria in sickle cell disease: a cross-sectional study. BMC Infect Dis 2006; 6:46. [PMID: 16539735 PMCID: PMC1434754 DOI: 10.1186/1471-2334-6-46] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 03/15/2006] [Indexed: 11/20/2022] Open
Abstract
Background It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD. Methods This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean ± sd) of participants was 26.6 ± 2.5 years. The main outcome measures were the culture of ≥ 105 colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). Results Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95%CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. Conclusion ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD.
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Affiliation(s)
- Vanessa Cumming
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Susanna Ali
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Terrence Forrester
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Karen Roye-Green
- Department of Microbiology, University Hospital of the West Indies, Mona, Kingston 7, Jamaica
| | - Marvin Reid
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona Campus, Kingston 7, Jamaica
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24
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García Arias MB, Cantalejo López MA, Cela de Julián ME, Bravo Clouzet R, Galarón García P, Beléndez Bieler C. Enfermedad de células falciformes: registro de la Sociedad Española de Hematología Pediátrica. An Pediatr (Barc) 2006; 64:78-84. [PMID: 16539921 DOI: 10.1016/s1695-4033(06)70013-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD), a genetic anemia, is currently an emerging health problem in Spain. Since 2000, The Spanish Society of Pediatric Hematology has maintained a registry of these patients. The data corresponding to 2004 are presented herein. PATIENTS AND METHODS Information was sent by different national hospitals. Pediatric patients with SCD followed-up during 2003 were registered in the first quarter of 2004. Data on epidemiology, diagnosis, treatment and outcome in each patient were gathered. RESULTS A total of 138 patients in 24 national hospitals were registered. Of these, 99 were still under follow-up. There was no significant difference in sex. The mean age was 8.2 years. Seventy-eight percent of the patients were homozygous. Forty-four percent were born in Africa but 76% had abnormal genes originating in Africa. Neurophysiologic disorders were detected in 36% of the patients. Symptomatic treatment was given in 65%, hydroxyurea in 27%, hypertransfusional therapy in 3%, and chelation therapy, indicated for ferric overload, was provided in 4%. None of the patients underwent stem cell transplantation. Acute complications requiring hospitalization occurred in 21%, and chronic complications were observed in 27%. The most frequent chronic complications were delayed height and weight gain and liver and biliary tract disorders. Two patients died. CONCLUSIONS This study confirms a highly significant increase in the prevalence of pediatric patients with SCD in the last 4 years, requiring greater resources to be devoted to the diagnosis and follow-up of this disease.
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25
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Bégué P, Castello-Herbreteau B. [Severe infections in children with sickle cell disease: clinical aspects and prevention]. Arch Pediatr 2001; 8 Suppl 4:732s-741s. [PMID: 11582920 DOI: 10.1016/s0929-693x(01)80189-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sickle-cell disease (SCD) is associated with frequent and often severe infections as a result of immune function impairment and functional asplenia. Also, infection can trigger a vasoocclusive crisis. Pneumonococcal bacteremia and meningitis due to S. pneumoniae are often lethal and justify the penicillin prophylaxis, which has provided a dramatic decrease in early mortality bacterial pneumonia is common in patients younger than four years, with most cases being due to S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae. Acute chest syndrome is both a difficult differential diagnosis and a common concomitant of bacterial pneumonia, because they are often intricated. Osteomyelitis is generally due to Salmonella, most often S. enteritidis. Multiple foci are common and treatment is difficult, with some patients developing chronic osteomyelitis with sequestration. Osteomyelitis is less frequent in developed countries and must been differentiated with bone infarction by use of bone scintigraphy. Parvovirus B19 infection causes acute erythroblastopenias. Malaria does not result in cerebral malaria, but can lead to severe anaemia or vasoocclusive crisis, and should therefore be effectively prevented. Antimicrobials are generally selected for efficacy against pneumococci (septicemia, meningitis), Salmonella (osteomyelitis, meningitis), and M. pneumoniae (pneumonia). Prophylactic therapy is of paramount importance and relies on long-term or lifelong penicillin therapy started at three months of age and no closely-spaced immunizations, most notably against peumococci, hepatitis B virus, S. typhi and H. influenzae. Resistant pneumococcal strains have not been reported to cause prophylactic treatment failures. New conjugated pneumococcal vaccines are effective in protecting very young infants and should therefore be used in sickle cell patients.
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Affiliation(s)
- P Bégué
- Service de pédiatrie générale, pathologie infectieuse et drépanocytose, hôpital Armand-Trousseau, 24, avenue du Dr Arnold-Netter, 75012 Paris, France.
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