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Osteomyelitis in Sickle Cell Anemia: Does Age Predict Risk of Salmonella Infection?
Erik M Hegeman1, Taylor Bates, Tom Lynch
1From the San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, TX.
The Pediatric Infectious Disease Journal
|April 20, 2023
Summary
Nontyphoid Salmonella is the most common cause of osteomyelitis in sickle cell anemia (SCA) patients, particularly those under 12. Geographic and socioeconomic factors influence diagnosis age and pathogen prevalence in SCA osteomyelitis.
Area of Science:
- Infectious Diseases
- Hematology
- Orthopedic Surgery
Background:
- Osteomyelitis is a significant complication in sickle cell anemia (SCA).
- While Staphylococcus aureus infections are increasing, Salmonella has historically been considered the most frequent pathogen.
- This review investigates the predominant causative organism and age-related associations in Salmonella osteomyelitis within the SCA population.
Approach:
- A systematic review of studies on osteomyelitis in SCA was conducted.
- Databases searched included PubMed, EMBASE, and Cochrane.
- Exclusion criteria comprised non-English literature, case reports, reviews, and non-bony infections.
Key Points:
- Nontyphoid Salmonella was the most common pathogen (60.9%), followed by S. aureus (21.8%).
- The average age of presentation for Salmonella osteomyelitis was 6.8 years, versus 22.1 years for S. aureus.
- African countries showed later diagnosis ages (13.1 years) with different pathogen profiles compared to other regions.
Conclusions:
- Salmonella remains the most common pathogen in acute osteomyelitis among SCA patients, especially those under 12.
- Later diagnosis ages in Sub-Saharan Africa suggest potential links to socioeconomic factors and healthcare access.
- Age of presentation may serve as an indicator for geographic and socioeconomic influences on osteomyelitis in SCA.
