ACS in children with sickle cell anaemia in Uganda: prevalence, presentation and aetiology

Area of Science:

• Pediatrics
• Infectious Diseases
• Hematology

Background:

• Acute Chest Syndrome (ACS) is a severe complication of sickle cell anaemia (SCA).
• Understanding the burden and causative organisms of ACS in SCA patients is crucial for effective management.
• Mulago Hospital in Kampala, Uganda, serves a significant population of children with SCA.

Purpose of the Study:

• To determine the prevalence, clinical presentation, and associated organisms of ACS in children with SCA.
• To identify clinical and laboratory factors associated with ACS in this population.
• To inform treatment guidelines for ACS in SCA patients in sub-Saharan Africa.

Main Methods:

• A cross-sectional study involving 256 children with SCA and fever was conducted.
• Diagnostic methods included chest X-rays, blood cultures, complete blood count, and sputum induction.
• Sputum samples were analyzed using Ziehl-Nielsen staining, culture, and DNA polymerase chain reaction (PCR) for Chlamydia pneumoniae.

Main Results:

• 22.7% of children with SCA and fever were diagnosed with ACS.
• Cough and abnormal auscultation findings were significantly associated with ACS.
• Key organisms identified included Streptococcus pneumoniae, Moraxella spp., Chlamydia pneumoniae (59.3% of PCR tests), and Mycobacterium tuberculosis (6/83 sputa).

Conclusions:

• ACS is a common and serious complication in febrile children with SCA in Uganda.
• Clinical presentation alone is not a reliable indicator for diagnosing ACS in SCA.
• The high prevalence of Chlamydia pneumoniae suggests macrolides should be considered in treatment, and M. tuberculosis should be ruled out in sub-Saharan African children with ACS.