PREVALENCE OF SERIOUS BACTERIAL INFECTIONS IN CHILDREN WITH SICKLE CELL DISEASE AT KING ABDULAZIZ HOSPITAL, AL AHSA Bacterial infections in children with sickle cell diseas
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Abstract
Aim: The main aim was to report the prevalence and severity of serious bacterial infections (SBI) in children with sickle cell disease at King Abdulaziz Hospital, Al Ahsa, Saudi Arabia to aid in determining whether outpatient management of such cases is appropriate.
Methods: We conducted a retrospective chart review of febrile children less than 14 years of age admitted with sickle cell disease 2005 through 2015.
Results: During 320 admissions, 25 children had SBIs (8%) including pneumonia (n=11), osteomyelitis (n=8), bacteremia (n=3, all with Salmonella species) and UTI (n=3). All recovered uneventfully.
Conclusion: It appears that in the current era, less than 10% of febrile children with sickle cell disease in our center are diagnosed with a SBI. Over an 11-year period, there were no sequelae or deaths from SBI. Given these excellent outcomes, outpatient ceftriaxone should be considered for febrile well appearing children with sickle cell disease if they have no apparent source and parents are judged to be reliable.
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References
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et al. Global distribution of the sickle cell gene and geographical
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2. Al-Qurashi MM, El-Mouzan MI, Al-Herbish AS, Al-Salloum AA, AlOmar AA. The prevalence of sickle cell disease in Saudi children and
adolescents. Saudi Med J. 2008;29(10):1480-3.
https://doi.org/10.4103/0256-4947.55163
PMid:19700891 PMCid:PMC2860399
3. Di Nuzzo D, Fonseca SF. Sickle cell disease and infection. J Pediatr (Rio
J). 2004;80(5):347-54.
https://doi.org/10.2223/1218
4. Elbashier AM, Al-Salem AH, Aliama A. Salmonella as a causative
organism of various infections in patients with sickle cell disease. Annals
of Saudi Medicine. 2003.
https://doi.org/10.5144/0256-4947.2003.358
PMid:16868368
5. Brown B, Dada-Adegbola H, Trippe C, Olopade O. Prevalence and
etiology of bacteremia in febrile children with sickle cell disease at a
Nigeria tertiary hospital. Mediterranean journal of hematology and
infectious diseases. 2017;9(1).
https://doi.org/10.4084/mjhid.2017.039
PMid:28698782 PMCid:PMC5499496
6. Williams TN, Uyoga S, Macharia A, Ndila C, McAuley CF etal.
Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective
cohort and case-control study. Lancet. 2009 Oct 17;374(9698):1364-70
https://doi.org/10.1016/S0140-6736(09)61374-X
7. Hernigou P, Daltro G, Flouzat-Lachaniette C-H, Roussignol X, Poignard
A. Septic arthritis in adults with sickle cell disease often is associated
with osteomyelitis or osteonecrosis. Clinical Orthopaedics and Related
Research®. 2010;468(6):1676-81.
https://doi.org/10.1007/s11999-009-1149-3
PMid:19885711 PMCid:PMC2865595
8. Chambers JB, Forsythe DA, Bertrand SL, Iwinski HJ, Steflik DE.
Retrospective review of osteoarticular infections in a pediatric sickle cell
age group. Journal of pediatric orthopaedics. 2000;20(5):682-5.
https://doi.org/10.1097/01241398-200009000-00025
PMid:11008753
9. Chang TP, Kriengsoontorkij W, Chan LS, Wang VJ. Clinical factors and
incidence of acute chest syndrome or pneumonia among children with
sickle cell disease presenting with a fever: a 17-year review. Pediatric
emergency care. 2013;29(7):781-6.
https://doi.org/10.1097/PEC.0b013e31829829f7
PMid:23823253
10. Gorham M, Smith C, Smith S, Wong L, Kreze O. Vaccinations in sickle
cell disease: An audit of vaccination uptake in sickle cell patients
attending Newham University Hospital. Vaccine. 2015;33(38):5005-11.
https://doi.org/10.1016/j.vaccine.2015.06.028
PMid:26151544
11. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. New England
Journal of Medicine. 2017;376(16):1561-73.
https://doi.org/10.1056/NEJMra1510865
PMid:28423290
12. Gaston MH, Verter JI, Woods G, Pegelow C, Kelleher J, Presbury G, et
al. Prophylaxis with oral penicillin in children with sickle cell anemia.
New England Journal of Medicine. 1986;314(25):1593-9.
https://doi.org/10.1056/NEJM198606193142501
PMid:3086721
13. Memish ZA, El-Saed A, Al-Otaibi B, Al Shaalan M, Al Alola S, Thaqafi
AO. Epidemiology of invasive pneumococcal infection in children aged
five years and under in Saudi Arabia: a five-year retrospective
surveillance study. International Journal of Infectious Diseases.
2010;14(8):e708-e12.
https://doi.org/10.1016/j.ijid.2010.02.2242
PMid:20627645
14. Halasa NB, Shankar SM, Talbot TR, Arbogast PG, Mitchel EF, Wang
WC, et al. incidence of invasive pneumococcal disease among
individuals with sickle cell disease before and after the introduction of
the pneumococcal conjugate vaccine. Clinical Infectious Diseases.
2007;44(11):1428-33.
https://doi.org/10.1086/516781
PMid:17479937
15. Adamkiewicz TV, Sarnaik S, Buchanan GR, Iyer RV, Miller ST,
Pegelow CH, et al. Invasive pneumococcal infections in children with
sickle cell disease in the era of penicillin prophylaxis, antibiotic
resistance, and 23-valent pneumococcal polysaccharide vaccination. The
Journal of pediatrics. 2003;143(4):438-44.
https://doi.org/10.1067/S0022-3476(03)00331-7
16. Knight-Madden J, Serjeant GR. Invasive pneumococcal disease in
homozygous sickle cell disease: Jamaican experience 1973-1997. The
Journal of pediatrics. 2001;138(1):65-70.
https://doi.org/10.1067/mpd.2001.109709
PMid:11148514
17. Adamkiewicz TV, Silk BJ, Howgate J, Baughman W, Strayhorn G,
Sullivan K, et al. Effectiveness of the 7-valent pneumococcal conjugate
vaccine in children with sickle cell disease in the first decade of life.
Pediatrics. 2008;121(3):562-9.
https://doi.org/10.1542/peds.2007-0018
PMid:18310206
18. Bansil NH. Incidence of Serious Bacterial Infections in Febrile Children
With Sickle Cell Disease. clinical pediatrics. May 2013.
https://doi.org/10.1177/0009922813488645
PMid:23661790
19. Abu-srair. incidence of major infection in sickle cell pediatric patients at
qatif Central Hospita. Annals of Saudi Medicine. 1991:267-70.
https://doi.org/10.5144/0256-4947.1991.267
PMid:17588101
20. El Mouzan MI, Al Awamy BH, Al Torki MT. Clinical features of sickle
cell disease in eastern Saudi Arab children. Journal of Pediatric
Hematology/Oncology. 1990;12(1):51-5.
https://doi.org/10.1097/00043426-199021000-00009
PMid:1689968
21. Alkot M, Almaghrabi W, Al-Najdi N, Al-Otaibi M, Shatla M.
Prevalence of complications of sickle cell disease at Makkah AlMukaramah, Saudi Arabia, 2017. Ann Clin Lab Res. 2018;6(1):226.
https://doi.org/10.21767/2386-5180.1000226
22. Yanda ANA, Nansseu JRN, Awa HDM, Tatah SA, Seungue J, Eposse
C, et al. Burden and spectrum of bacterial infections among sickle cell
disease children living in Cameroon. BMC infectious diseases.
2017;17(1):211.
https://doi.org/10.1186/s12879-017-2317-9
PMid:28298206 PMCid:PMC5353947
23. Saganuwan SA. The Pattern of Sickle Cell Disease in Sickle Cell
Patients from Northwestern Nigeria. Clinical Medicine Insights:
Therapeutics. 2016;8:CMT. S38164.
https://doi.org/10.4137/CMT.S38164
24. Vichinsky EP, et al. Causes and outcomes of the acute chest syndrome
in sickle cell disease. National Acute Chest Syndrome Study Group. N
Engl J Med 2000; 342:1855-1865.
https://doi.org/10.1056/NEJM200006223422502
PMid:10861320
25. Shinde S, Bakshi AP, Shrikhande A. Infections in sickle cell disease.
IAIM Int ArchIntegr Med IAIM. 2015;2:34-26.
26. Fontalis A, Hughes K, Nguyen M, Williamson M, Yeo A, Lui D, et al.
The challenge of differentiating vaso-occlusive crises from osteomyelitis
in children with sickle cell disease and bone pain: A 15-year
retrospective review. Journal of children's orthopaedics. 2019;13(1):33-
9.
https://doi.org/10.1302/1863-2548.12.180094
PMid:30838073 PMCid:PMC6376437
27. Kizito M, Mworozi E, Ndugwa C, Serjeant GR. Bacteraemia in
homozygous sickle cell disease in Africa: is pneumococcal prophylaxis
justified? Archives of disease in childhood. 2007;92(1):21-3.
https://doi.org/10.1136/adc.2005.088807
PMid:16531454 PMCid:PMC2083172
28. AAP. Health Supervision for Children with Sickle Cell Disease.
Pediatrics 2002;109;526
https://doi.org/10.1542/peds.109.3.526
PMid:11875155
29. Saborio P, Scheinman JI. Sickle cell nephropathy. Journal of the
American Society of Nephrology. 1999;10(1):187-92.
30. Hawasawi ZM, Nabi G, Al Magamci M, Awad KS. Sickle cell disease
in childhood in Madina. Annals of Saudi medicine. 1998;18(4):293-5.
https://doi.org/10.5144/0256-4947.1998.293
PMid:17344675
31. Chenou F, Azevedo J, Leal HF, de Souza Gonçalves M, Reis JN.
Bacterial meningitis in patients with sickle cell anemia in Salvador,
Bahia, Brazil: a report on ten cases. Hematology, Transfusion and Cell
Therapy. 2019.
https://doi.org/10.1016/j.htct.2019.06.006
PMid:31806417 PMCid:PMC7248505
32. Wilimas JA, Flynn PM, Harris S, Day SW, Smith R, Chesney PJ,
Rodman JH, Eguiguren JM, Fairclough DL, Wang WC. A randomized
study of outpatient treatment with ceftriaxone for selected febrile
children with sickle cell disease. N Engl J Med. 1993 Aug
12;329(7):472-6
https://doi.org/10.1056/NEJM199308123290705
PMid:8332152
33. LL Williams , J A Wilimas, S C Harris, S W Day, R M Dancy, W C
Wang. Outpatient Therapy With Ceftriaxone and Oral Cefixime for
Selected Febrile Children With Sickle Cell Disease. J Pediatr Hematol
Oncol . 1996 Aug;18(3):257-61
https://doi.org/10.1097/00043426-199608000-00004
PMid:8689337
34. M C Rahimy 1, A Gangbo, G Ahouignan, S Anagonou, V Boco, E
Alihonou. Outpatient Management of Fever in Children With Sickle Cell
Disease (SCD) in an African Setting. Am J Hematol 1999 Sep;62(1):1-
6
https://doi.org/10.1002/(SICI)1096-8652(199909)62:1<1::AIDAJH1>3.0.CO;2-C
35. Sokol E, Obringer E, Palama B, Hageman J, Peddinti R. Outpatient
Management of Febrile Children With Sickle Cell Disease. Clin Pediatr
(Phila). 2016 Mar;55(3):268-71
https://doi.org/10.1177/0009922815594345
PMid:26149843
36. Baskin MN, Goh XL, Heeney MM, Harper MB. Bacteremia risk and
outpatient management of febrile patients with sickle cell disease.
Pediatrics. 2013 Jun;131(6):1035-41
https://doi.org/10.1542/peds.2012-2139
PMid:2366952
et al. Global distribution of the sickle cell gene and geographical
confirmation of the malaria hypothesis. Nature communications.
2010;1(1):1-7.
https://doi.org/10.1038/ncomms1104
PMid:21045822 PMCid:PMC3060623
2. Al-Qurashi MM, El-Mouzan MI, Al-Herbish AS, Al-Salloum AA, AlOmar AA. The prevalence of sickle cell disease in Saudi children and
adolescents. Saudi Med J. 2008;29(10):1480-3.
https://doi.org/10.4103/0256-4947.55163
PMid:19700891 PMCid:PMC2860399
3. Di Nuzzo D, Fonseca SF. Sickle cell disease and infection. J Pediatr (Rio
J). 2004;80(5):347-54.
https://doi.org/10.2223/1218
4. Elbashier AM, Al-Salem AH, Aliama A. Salmonella as a causative
organism of various infections in patients with sickle cell disease. Annals
of Saudi Medicine. 2003.
https://doi.org/10.5144/0256-4947.2003.358
PMid:16868368
5. Brown B, Dada-Adegbola H, Trippe C, Olopade O. Prevalence and
etiology of bacteremia in febrile children with sickle cell disease at a
Nigeria tertiary hospital. Mediterranean journal of hematology and
infectious diseases. 2017;9(1).
https://doi.org/10.4084/mjhid.2017.039
PMid:28698782 PMCid:PMC5499496
6. Williams TN, Uyoga S, Macharia A, Ndila C, McAuley CF etal.
Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective
cohort and case-control study. Lancet. 2009 Oct 17;374(9698):1364-70
https://doi.org/10.1016/S0140-6736(09)61374-X
7. Hernigou P, Daltro G, Flouzat-Lachaniette C-H, Roussignol X, Poignard
A. Septic arthritis in adults with sickle cell disease often is associated
with osteomyelitis or osteonecrosis. Clinical Orthopaedics and Related
Research®. 2010;468(6):1676-81.
https://doi.org/10.1007/s11999-009-1149-3
PMid:19885711 PMCid:PMC2865595
8. Chambers JB, Forsythe DA, Bertrand SL, Iwinski HJ, Steflik DE.
Retrospective review of osteoarticular infections in a pediatric sickle cell
age group. Journal of pediatric orthopaedics. 2000;20(5):682-5.
https://doi.org/10.1097/01241398-200009000-00025
PMid:11008753
9. Chang TP, Kriengsoontorkij W, Chan LS, Wang VJ. Clinical factors and
incidence of acute chest syndrome or pneumonia among children with
sickle cell disease presenting with a fever: a 17-year review. Pediatric
emergency care. 2013;29(7):781-6.
https://doi.org/10.1097/PEC.0b013e31829829f7
PMid:23823253
10. Gorham M, Smith C, Smith S, Wong L, Kreze O. Vaccinations in sickle
cell disease: An audit of vaccination uptake in sickle cell patients
attending Newham University Hospital. Vaccine. 2015;33(38):5005-11.
https://doi.org/10.1016/j.vaccine.2015.06.028
PMid:26151544
11. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. New England
Journal of Medicine. 2017;376(16):1561-73.
https://doi.org/10.1056/NEJMra1510865
PMid:28423290
12. Gaston MH, Verter JI, Woods G, Pegelow C, Kelleher J, Presbury G, et
al. Prophylaxis with oral penicillin in children with sickle cell anemia.
New England Journal of Medicine. 1986;314(25):1593-9.
https://doi.org/10.1056/NEJM198606193142501
PMid:3086721
13. Memish ZA, El-Saed A, Al-Otaibi B, Al Shaalan M, Al Alola S, Thaqafi
AO. Epidemiology of invasive pneumococcal infection in children aged
five years and under in Saudi Arabia: a five-year retrospective
surveillance study. International Journal of Infectious Diseases.
2010;14(8):e708-e12.
https://doi.org/10.1016/j.ijid.2010.02.2242
PMid:20627645
14. Halasa NB, Shankar SM, Talbot TR, Arbogast PG, Mitchel EF, Wang
WC, et al. incidence of invasive pneumococcal disease among
individuals with sickle cell disease before and after the introduction of
the pneumococcal conjugate vaccine. Clinical Infectious Diseases.
2007;44(11):1428-33.
https://doi.org/10.1086/516781
PMid:17479937
15. Adamkiewicz TV, Sarnaik S, Buchanan GR, Iyer RV, Miller ST,
Pegelow CH, et al. Invasive pneumococcal infections in children with
sickle cell disease in the era of penicillin prophylaxis, antibiotic
resistance, and 23-valent pneumococcal polysaccharide vaccination. The
Journal of pediatrics. 2003;143(4):438-44.
https://doi.org/10.1067/S0022-3476(03)00331-7
16. Knight-Madden J, Serjeant GR. Invasive pneumococcal disease in
homozygous sickle cell disease: Jamaican experience 1973-1997. The
Journal of pediatrics. 2001;138(1):65-70.
https://doi.org/10.1067/mpd.2001.109709
PMid:11148514
17. Adamkiewicz TV, Silk BJ, Howgate J, Baughman W, Strayhorn G,
Sullivan K, et al. Effectiveness of the 7-valent pneumococcal conjugate
vaccine in children with sickle cell disease in the first decade of life.
Pediatrics. 2008;121(3):562-9.
https://doi.org/10.1542/peds.2007-0018
PMid:18310206
18. Bansil NH. Incidence of Serious Bacterial Infections in Febrile Children
With Sickle Cell Disease. clinical pediatrics. May 2013.
https://doi.org/10.1177/0009922813488645
PMid:23661790
19. Abu-srair. incidence of major infection in sickle cell pediatric patients at
qatif Central Hospita. Annals of Saudi Medicine. 1991:267-70.
https://doi.org/10.5144/0256-4947.1991.267
PMid:17588101
20. El Mouzan MI, Al Awamy BH, Al Torki MT. Clinical features of sickle
cell disease in eastern Saudi Arab children. Journal of Pediatric
Hematology/Oncology. 1990;12(1):51-5.
https://doi.org/10.1097/00043426-199021000-00009
PMid:1689968
21. Alkot M, Almaghrabi W, Al-Najdi N, Al-Otaibi M, Shatla M.
Prevalence of complications of sickle cell disease at Makkah AlMukaramah, Saudi Arabia, 2017. Ann Clin Lab Res. 2018;6(1):226.
https://doi.org/10.21767/2386-5180.1000226
22. Yanda ANA, Nansseu JRN, Awa HDM, Tatah SA, Seungue J, Eposse
C, et al. Burden and spectrum of bacterial infections among sickle cell
disease children living in Cameroon. BMC infectious diseases.
2017;17(1):211.
https://doi.org/10.1186/s12879-017-2317-9
PMid:28298206 PMCid:PMC5353947
23. Saganuwan SA. The Pattern of Sickle Cell Disease in Sickle Cell
Patients from Northwestern Nigeria. Clinical Medicine Insights:
Therapeutics. 2016;8:CMT. S38164.
https://doi.org/10.4137/CMT.S38164
24. Vichinsky EP, et al. Causes and outcomes of the acute chest syndrome
in sickle cell disease. National Acute Chest Syndrome Study Group. N
Engl J Med 2000; 342:1855-1865.
https://doi.org/10.1056/NEJM200006223422502
PMid:10861320
25. Shinde S, Bakshi AP, Shrikhande A. Infections in sickle cell disease.
IAIM Int ArchIntegr Med IAIM. 2015;2:34-26.
26. Fontalis A, Hughes K, Nguyen M, Williamson M, Yeo A, Lui D, et al.
The challenge of differentiating vaso-occlusive crises from osteomyelitis
in children with sickle cell disease and bone pain: A 15-year
retrospective review. Journal of children's orthopaedics. 2019;13(1):33-
9.
https://doi.org/10.1302/1863-2548.12.180094
PMid:30838073 PMCid:PMC6376437
27. Kizito M, Mworozi E, Ndugwa C, Serjeant GR. Bacteraemia in
homozygous sickle cell disease in Africa: is pneumococcal prophylaxis
justified? Archives of disease in childhood. 2007;92(1):21-3.
https://doi.org/10.1136/adc.2005.088807
PMid:16531454 PMCid:PMC2083172
28. AAP. Health Supervision for Children with Sickle Cell Disease.
Pediatrics 2002;109;526
https://doi.org/10.1542/peds.109.3.526
PMid:11875155
29. Saborio P, Scheinman JI. Sickle cell nephropathy. Journal of the
American Society of Nephrology. 1999;10(1):187-92.
30. Hawasawi ZM, Nabi G, Al Magamci M, Awad KS. Sickle cell disease
in childhood in Madina. Annals of Saudi medicine. 1998;18(4):293-5.
https://doi.org/10.5144/0256-4947.1998.293
PMid:17344675
31. Chenou F, Azevedo J, Leal HF, de Souza Gonçalves M, Reis JN.
Bacterial meningitis in patients with sickle cell anemia in Salvador,
Bahia, Brazil: a report on ten cases. Hematology, Transfusion and Cell
Therapy. 2019.
https://doi.org/10.1016/j.htct.2019.06.006
PMid:31806417 PMCid:PMC7248505
32. Wilimas JA, Flynn PM, Harris S, Day SW, Smith R, Chesney PJ,
Rodman JH, Eguiguren JM, Fairclough DL, Wang WC. A randomized
study of outpatient treatment with ceftriaxone for selected febrile
children with sickle cell disease. N Engl J Med. 1993 Aug
12;329(7):472-6
https://doi.org/10.1056/NEJM199308123290705
PMid:8332152
33. LL Williams , J A Wilimas, S C Harris, S W Day, R M Dancy, W C
Wang. Outpatient Therapy With Ceftriaxone and Oral Cefixime for
Selected Febrile Children With Sickle Cell Disease. J Pediatr Hematol
Oncol . 1996 Aug;18(3):257-61
https://doi.org/10.1097/00043426-199608000-00004
PMid:8689337
34. M C Rahimy 1, A Gangbo, G Ahouignan, S Anagonou, V Boco, E
Alihonou. Outpatient Management of Fever in Children With Sickle Cell
Disease (SCD) in an African Setting. Am J Hematol 1999 Sep;62(1):1-
6
https://doi.org/10.1002/(SICI)1096-8652(199909)62:1<1::AIDAJH1>3.0.CO;2-C
35. Sokol E, Obringer E, Palama B, Hageman J, Peddinti R. Outpatient
Management of Febrile Children With Sickle Cell Disease. Clin Pediatr
(Phila). 2016 Mar;55(3):268-71
https://doi.org/10.1177/0009922815594345
PMid:26149843
36. Baskin MN, Goh XL, Heeney MM, Harper MB. Bacteremia risk and
outpatient management of febrile patients with sickle cell disease.
Pediatrics. 2013 Jun;131(6):1035-41
https://doi.org/10.1542/peds.2012-2139
PMid:2366952
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Jan 1, 2021
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Alsaif, M. (2021) “PREVALENCE OF SERIOUS BACTERIAL INFECTIONS IN CHILDREN WITH SICKLE CELL DISEASE AT KING ABDULAZIZ HOSPITAL, AL AHSA: Bacterial infections in children with sickle cell diseas”, Mediterranean Journal of Hematology and Infectious Diseases, 13(1), p. e2021002. doi: 10.4084/mjhid.2021.002.
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