Abstract
BackgroundAlthough sickle cell disease (SCD) children are highly susceptible to bacterial infections (BIs), there is a dreadful lack of data related to the burden and spectrum of BIs in sub-Saharan Africa (SSA), the highest affected region with SCD. This study aimed to determine the burden and spectrum of BIs among SCD children hospitalized in a pediatric reference hospital in Cameroon, a SSA country.MethodsWe conducted a retrospective analysis of records of children hospitalized from November 2012 to August 2015 in the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, Cameroon. We enrolled all known SCD children aged 15 years or less, hospitalized for a suspicion of BI and who presented a positive culture of a body specimen.ResultsA total of 987 SCD children were hospitalized during the study period. Cultures were positive for 96 patients (9.7%) among whom 60.4% males. Ages ranged from 6 to 192 months with a median of 53 (Interquartile range (IQR) 21–101) months. For children no more covered by the Expanded Programme on Immunization, only 13 (18.8%) had received the Pneumo 23® and Meningo A&C® antigens, and 12 (17.4%), the Typhim vi® and the Haemophilus influenzae type b antigens; 58 children (84.1%) had received no vaccine. The specimen yielding positive cultures were: blood (70.7%), urine (13.1%), pus (9.1%), synovial fluid (4.1%), cerebrospinal fluid (2.0%), and bone fragment (1.0%). The different types of infection included: urinary tract infections (13.5%), myositis (8.3%), arthritis (6.3%), osteomyelitis (4.2%), and meningitis (2.1%); the site of infection was unidentified in 65.6% of cases. The main bacteria included: Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), Escherichia coli (10.4%), Enterobacter sp. (5.2%), Acinetobacter sp. (4.2%), Streptococcus sp. (4.2%) and Serratia sp. (4.2%).ConclusionThis retrospective analysis revealed 9.7% cases of BIs, mainly caused by Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), and Escherichia coli (10.4%).
Highlights
Sickle cell disease (SCD) children are highly susceptible to bacterial infections (BIs), there is a dreadful lack of data related to the burden and spectrum of Bacterial infection (BI) in sub-Saharan Africa (SSA), the highest affected region with sickle cell disease (SCD)
On the whole, 987 children suffering from SCD were hospitalized during the study period; cultures were positive for 96 patients (9.7%)
In this study we considered only known SCD patients, which could have underestimated the real burden of BIs in this vulnerable population
Summary
Sickle cell disease (SCD) children are highly susceptible to bacterial infections (BIs), there is a dreadful lack of data related to the burden and spectrum of BIs in sub-Saharan Africa (SSA), the highest affected region with SCD. This study aimed to determine the burden and spectrum of BIs among SCD children hospitalized in a pediatric reference hospital in Cameroon, a SSA country. In Cameroon, SCD is disastrous, mainly due to its acute and chronic complications, including painful vasoocclusive events, cerebral vasculopathy, priapism, chronic kidney disease, acute chest syndrome, pulmonary hypertension and bacterial infections (BIs) among others [5,6,7]. SCD and can occur either as an acute or a chronic condition As such, they constitute a major cause of morbidity and mortality among SCD children and adults [8, 9]. The increased susceptibility of SCD patients to BIs is multifactorial, including: (i) a functional asplenia; (ii) a default in complement activation; (iii) micronutrient deficiencies; (iv) a genetic predisposition, and (v) mechanical risk factors [8]
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