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Recurrent Streptococcus pneumoniae sepsis in children with sickle cell disease
S Hongeng1, J A Wilimas, S Harris
1Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101, USA.
Insights
Patients with sickle cell disease are at high risk for Streptococcus pneumoniae sepsis. Lifelong penicillin prophylaxis is crucial for those with a history of pneumococcal sepsis to prevent recurrence and death.
Area of Science:
- Infectious Diseases
- Hematology
- Pediatrics
Background:
- Streptococcus pneumoniae is the most common cause of invasive infection in sickle cell disease patients.
- Recurrent sepsis episodes in these patients carry a significantly higher risk of mortality.
Purpose of the Study:
- To emphasize the critical need for continuous penicillin prophylaxis in sickle cell disease patients with a history of pneumococcal sepsis.
- To advise against outpatient management of febrile episodes in this high-risk population.
Main Methods:
- Review of clinical guidelines and existing literature on managing infections in sickle cell disease.
- Analysis of risk factors for recurrent sepsis and mortality in sickle cell disease patients.
Main Results:
- Patients with sickle cell disease and a history of pneumococcal sepsis face a substantially elevated risk of recurrent sepsis.
- Mortality risk is significantly higher following a prior septic event in this cohort.
Conclusions:
- Indefinite penicillin prophylaxis is essential for sickle cell disease patients with a history of pneumococcal sepsis.
- Outpatient management of febrile episodes is not recommended for these patients due to high recurrence and mortality risks.
Abstract:
Streptococcus pneumoniae sepsis is the most common invasive infection among patients with sickle cell disease. The risk of a recurrent episode of sepsis and subsequent death in those patients who have had a previous septic event is much higher. Patients with sickle disease who have had pneumococcal sepsis should continue penicillin prophylaxis indefinitely and should not be candidates for out-patient management of febrile episodes.