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Pneumococcal septicemia in children with sickle cell anemia. Changing trend of survival
Insights
Prompt medical supervision and rapid antibiotic treatment significantly reduced deaths and meningitis in children with sickle cell anemia (SS) from Streptococcus pneumoniae infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Streptococcus pneumoniae infections are a leading cause of mortality in children with sickle cell anemia (SS).
- Non-immunized SS children not on prophylactic penicillin face high risks of pneumococcal disease progression.
- Historically, pneumococcal septicemia frequently led to meningitis and death in this population.
Purpose of the Study:
- To analyze the changing patterns of pneumococcal septicemia, meningitis, and mortality in young children with SS.
- To evaluate the impact of a new clinical management program on disease outcomes.
Main Methods:
- Observational study of 233 children with SS under age 6 over 781 person-years.
- Comparison of outcomes (death, meningitis) before and after July 1972.
- Analysis of pneumococcal septicemia incidence and progression.
Main Results:
- Overall pneumococcal septicemia incidence was 5.9 episodes per 100 person-years.
- Before July 1972, 35% of septicemia cases resulted in death and 65% in meningitis.
- After July 1972, no deaths occurred, and meningitis incidence dropped to 18%.
Conclusions:
- A clinical program emphasizing close medical supervision for fever and prompt parenteral antibiotic therapy significantly decreased morbidity and mortality.
- Early intervention is critical for managing Streptococcus pneumoniae infections in children with sickle cell anemia.
Abstract:
Streptococcus pneumoniae infection has been the predominant cause of death among children with sickle cell anemia (SS). We report our observed change in the pattern of progression of septicemia to meningitis and death in nonimmunized SS children who were not receiving prophylactic penicillin in the face of a persistently high incidence of pneumococcal disease. Of 233 SS children less than ages 6 years observed for 781 person-years, the overall incidence rate of pneumococcal septicemia was 5.9 episodes per 100 person-years. Prior to July 1972, of 23 children who had pneumococcal septicemia, eight (35%) died and meningitis developed in 15 (65%), whereas since July 1972, 11 children have had pneumococcal septicemia, but no children died and meningitis developed in only two (18%). This decrease in major morbidity is attributed to the establishment of a clinical program that provides close medical supervision of the SS child with fever and the rapid institution of parenteral antibiotic therapy.