Abstract
Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clin- ical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5˚C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Com- plete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and head- ache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infec- tions (22.4%). The white blood cell count was >20,000/mm 3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels * Corresponding author.
Highlights
Sickle cell disease (SCD) is the most widespread and most serious form of hemoglobin disorders [1]
Analysis of symptoms associated with the fever (Table 1) indicated a significant difference (p = 0.002) between respiratory tract infections and malaria in terms of coughing fits
White blood cell counts were >20,000/mm3 for 47% of the cases involving respiratory infections, 43.5% of the malaria cases and 55.25% of the cases of fever with unknown origin (Table 3); and there was no significant difference between these values
Summary
Sickle cell disease (SCD) is the most widespread and most serious form of hemoglobin disorders [1]. The initiation of effective preventive measures (newborn screening, oral penicillin prophylaxis, pneumococcal and Haemophilus type b immunization) has resulted in the dramatic reduction in these rates [7] [12] [13]. This preventive strategy remains not accessible in sub-Saharan Africa, except for some pilot projects [14] [15]. The aim of this study was to determine the main causes of fever in children with sickle cell disease in our context, in order to optimize therapeutic management
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