Bacteraemia in homozygous sickle cell disease in africa: is pneumococcal prophylaxis justified?

Monica Etima ¹, Edward Mworozi ¹, Ndugwa Christopher ¹ and Graham R Serjeant ^2*

¹ Dept. of Paediatrics, Mulago Hospital, Uganda
² Sickle Cell Trust (Jamaica), Jamaica

^* To whom correspondence should be addressed. E-mail: grserjeant{at}cwjamaica.com.

Accepted 27 February 2006

Abstract

Background:The high frequency of Streptococcus pneumoniae as a cause of bacteraemia in homozygous sickle cell (SS) disease and its effective prevention has led to the routine use of pneumococcal prophylaxis in developed countries. Data from Africa suggest that this organism is uncommon as a cause of bacteraemia in SS disease casting doubt on the need for pneumococcal prophylaxis.

Methods:A study of blood cultures in 155 Ugandan children (165 episodes) with SS disease and axillary temperatures of 38.0oC or above, attending the University Teaching Hospital in Kampala.

Findings: Positive blood cultures, obtained in 47 (28%) episodes, revealed Staphylococcus aureus in 28 (60%), Haemophilus influenzae in 9 (19%), Staphylococcus epidermidis in 4 (9%), and single cases of Streptococcus viridans, Escherichia coli, and an unidentified Gram-ve rod. Streptococcus pneumoniae was identified in only 3 (6%) of episodes.

Interpretation:The paucity of Streptococcus pneumoniae along with similar observations from four Nigerian studies, casts doubt on the value of pneumococcal prophylaxis in malarial areas. A trial of pneumococcal prophylaxis is necessary to determine its role in African children and to provide the evidence base for health care authorities in equatorial Africa.

Keywords: SS disease, bacteraemia, malaria, pneumococcal prophylaxis, streptococcus pneumoniae

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