Hospices Civils de Lyon,
Hôpital Edouard Herriot, Médecine Interne, Centre de Référence
Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies at Autres
Pathologies Rares du Globule Rouge et de l’Erythropoïèse; Lyon, France.
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especially pneumococcal septicemia, meningitis, and Salmonella
osteomyelitis, are a major cause of morbidity and mortality in patients
with sickle cell disease (SCD). SCD increased susceptibility to
infection, while infection leads to SCD-specific pathophysiological
changes. The risk of infectious complications is highest in children
with a palpable spleen before six months of age. Functional
splenectomy, the results of repeated splenic infarctions, appears to be
a severe host-defense defect. Infection is the leading cause of death,
particularly in less developed countries. Defective host-defense
mechanisms enhance the risk of pneumococcal complications.
Susceptibility to Salmonella infections can be explained at least in
part by a similar mechanism. In high-income countries, the efficacy of
the pneumococcal vaccine has been demonstrated in this disease. A
decreased in infection incidence has been noted in SCD patients treated
prophylactically with daily oral penicillin. Studies in low-income
countries suggest the involvement of a different spectrum of
Environmental Determinants SCD and Infections
Impaired Splenic Function in SCD and Infections
Interactions Between SCD and Infections
|Figure 1. Relationship between SCD and infections under the potential influence of environmental determinants: SCD increases susceptibility to infections, while infections lead to SCD-specific pathophysiological changes. Prophylactic therapy could lead to substantial improvement in both low- and high-income countries.|
Infections with Specific Pathogens in SCD.
|Table 1. Immunization recommendations for all forms of SCD.|