Recurrent infections in homozygous sickle cell disease
Stephen A Magnusa, Ian R Hambletona, Faridah Moosdeenb, Graham R Serjeanta
a The Medical
Research Council Laboratories, University of the West Indies, Kingston
7, Jamaica, b Department of Microbiology, University
of the West Indies
Correspondence to: Dr Serjeant. email: grserjnt{at}uwimona.edu.jm
Accepted 28 January
1999
The characteristics of 214 episodes of invasive bacterial
infection among 176 patients with homozygous sickle cell (SS) disease were examined. Streptococcus pneumoniae
occurred in 81 episodes, Salmonella spp in
70, Haemophilus influenzae type b in 30, Escherichia coli in 24, and
Klebsiella spp in nine. The cumulative
incidence showed that S pneumoniae
and H influenzae occurred predominantly before 5 years of age and were uncommon thereafter,
Salmonella spp increased almost linearly
with age, and Klebsiella spp and E coli predominated in patients over 10 years of age. Escherichia coli had a
different epidemiology
it was found in older children, almost entirely
girls. Excluding this organism from an analysis of recurrent bacterial
infections, the standardised incidence rates for second and third
infections were 4.8 and 15.8 times greater, respectively, than the SS
population average. This implies that the susceptibility to infection
is characteristic of a subgroup of patients with SS disease and that
sick patients with previous bacteraemia should be investigated early
and aggressively for further infection.
Keywords: sickle cell; bacteraemia; infection; Streptococcus pneumoniae
© 1999 by Archives of Disease in Childhood
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