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Acute illness in Nigerian children with sickle cell anaemia
1Department of Medicine, Lagos University Teaching Hospital, Nigeria.
Insights
In Nigerian children with sickle cell disease (SCD), bacterial infections like pneumonia and bacteremia are common, causing significant illness. Current preventive strategies used in Europe and America may not be suitable for this population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Sickle cell disease (SCD) is a prevalent genetic disorder in Nigeria, leading to significant childhood morbidity.
- Children with SCD are highly susceptible to infections, which are a major cause of acute illness and mortality.
- Understanding the specific infectious patterns in Nigerian children with SCD is crucial for effective management.
Purpose of the Study:
- To prospectively investigate the pattern of acute illness and infections in Nigerian children with homozygous sickle cell disease.
- To identify the common clinical presentations, types of crises, and infectious agents responsible for illness in this cohort.
- To evaluate the applicability of existing preventive measures for SCD-related infections in the Nigerian context.
Main Methods:
- Prospective study of 60 children with homozygous sickle cell disease presenting with acute illness at a pediatric emergency room in Lagos.
- Data collection included patient demographics, clinical symptoms, physical signs, and types of crises (painful, anemic, or combined).
- Microbiological investigations were performed to identify bacterial pathogens, with a focus on infections occurring during crises and overall.
Main Results:
- Fever, pain (limb/abdominal), and cough were the most frequent symptoms; pallor and hepatomegaly were common signs.
- Painful crises (50%), anemic crises (18%), and combined crises (20%) were observed. Infection was present in 76% of children in crisis.
- Bacterial infections, including pneumonia (35%) and bacteremia (32%), were prevalent, with Klebsiella spp., E. coli, and Staph. aureus being predominant isolates.
Conclusions:
- Bacterial infections are a primary cause of morbidity in young Nigerian children with sickle cell disease.
- The identified spectrum of bacterial pathogens suggests that current anti-pneumococcal preventive measures used in Western countries may not be effective in Nigeria.
- There is a need for locally relevant control and preventive strategies to reduce infection-related morbidity in Nigerian children with SCD.
Abstract:
The pattern of illness in 60 consecutive children with homozygous sickle cell disease who attended the Paediatric Emergency Room of a busy Lagos hospital with acute illness was studied prospectively. Their ages ranged from 3 months to 13 years with a peak in the 2nd year. There were twice as many boys as girls. The commonest symptoms were fever, limb or abdominal pain and cough, and the commonest signs were pallor and hepatomegaly. Painful crises occurred in 27, anaemic crises in 11, and a combination of these in 12 children. Infection was detected in 76% of subjects in crises. Infection was found in 82% of all the children and was mainly bacterial. The commonest infections were pneumonia (35%), bacteraemia (32%), tonsillitis/pharyngitis (17%) and osteomyelitis (8%). The predominant bacteria isolated were Klebsiella spp (38%), E. coli (23%), Staph. aureus (23%), Staph. albus (23%) and Pseudomonas spp (23%). Some children had multiple isolates. Bacterial infection was a major cause of morbidity in very young children and merits appropriate control and preventive measures in this age group. The spectrum of bacteria isolated makes it unlikely that the specific anti-pneumococcal measures widely advocated in Europe and America for young children with SCA would be appropriate in Nigeria.