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Pattern of bacterial infections in homozygous sickle cell disease. A report from Saudi Arabia
Insights
In children with sickle cell disease, gram-negative infections like Salmonella are more common than Streptococcus pneumoniae. This may be due to milder disease and preserved spleen function, impacting treatment strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Streptococcus pneumoniae is a primary pathogen in children with sickle cell disease.
- Infections in these children can lead to severe outcomes like septicemia, meningitis, and osteomyelitis/septic arthritis.
Purpose of the Study:
- To investigate the causative pathogens of serious infections in children with sickle cell disease.
- To explore potential reasons for observed infection patterns in this population.
Main Methods:
- Retrospective analysis of 40 pediatric patients with sickle cell disease and severe infections.
- Identification of causative organisms, including Streptococcus pneumoniae and gram-negative bacteria (primarily Salmonella).
Main Results:
- Gram-negative organisms, mainly Salmonella, caused 70% of infections.
- Streptococcus pneumoniae accounted for 20% of infections.
- 45% of gram-negative infections occurred within the first decade of life.
Conclusions:
- The high rate of gram-negative infections may be linked to milder sickle cell disease, persistent splenic function, and possibly pneumococcal vaccination.
- Intestinal microinfarcts may facilitate gram-negative organism entry into circulation.
- Initial antibiotic therapy should target common gram-negative pathogens like Salmonella, with adjustments based on sensitivity testing.
Abstract:
Streptococcus pneumoniae is the leading pathogen in children with sickle cell disease. Forty children younger than 20 years of age who had sickle cell disease and septicemia, meningitis, or osteomyelitis/septic arthritis were identified. The causes included Streptococcus pneumoniae (20%) and gram-negative organisms (mainly Salmonella) (70%). The gram-negative infections occurred in the first decade of life in 45% of our patients. We believe that this pattern of infection is different and related to the mild nature of sickle cell disease in our patients and to their persistent splenic function. The administration of pneumococcal vaccination may also have played a role. Microinfarcts of the intestinal wall allow the access of gram-negative organisms to the circulation. In places where gastrointestinal tract infections, especially Salmonella, are common, antibiotic therapy effective against these organisms is recommended initially with adjustment after identification and sensitivities are known.