The treatment of severely ill patients with sickle cell anemia and associated septic arthritis

The clinical features, pathogenesis, and results of conservative treatment of septic arthritis in 8 patients with sickle cell anemia (HbS) and one patient with HbS + C followed for an average of 2.8 years have been reviewed. All but one of the patients were children under 14 years of age. Hematogenous, symmetrical polyarticular arthritis predominated. The hip and the ankle were the joints most often affected. Clinically, the patients fell into 2 groups, namely, those with little or no systemic disturbance, in whom infection was localized to affected joints mainly; and critically ill patients in whom arthritis occurred later during the course of the illness. Gram-negative infection was dominant, and Salmonella was the most common organism cultured. There were no deaths, but the morbidity and complications were quite high. The sensitivity pattern of the bacteria isolated from this small series of patients suggests that a combination of gentamycin and cloxacillin possibly is the antibiotic combination of choice for the critically sick child with HbS complicated by polyarticular septic arthritis in West Africa, provided the child's renal function is adequate.