Children with sickle cell disease are mainly exposed to various infections, among which there is bacterial meningitis. We present a brief report of a pneumococcal meningitis, due to Streptococcus pneumoniae 33F, in a 3-year-old boy of African race with sickle cell anemia. He was vaccinated against Streptococcus pneumoniae with 13-valent vaccine, and he was also on antibiotic prophylaxis. The child has been successfully treated with cephalosporins for a complete duration of 6 weeks, while hospitalization lasted about 3 weeks. Ceftriaxone was replaced by cefotaxime to avoid risk of hemolysis, as we found in literature. During recovery, the little boy presented with osteomyelitis, so vancomycin was added to therapy with good results. Finally, neurosensorial deafness was found, thus the child was quickly directed to cochlear implant intervention. This case report revealed that sometimes pneumococcal vaccination and antibiotic prophylaxis are not enough to prevent pneumococcal meningitis in children with sickle cell disease. Moreover, we noticed that cefotaxime avoids autoimmune hemolysis, which may be fatal to anemic children, while vancomycin may help to prevent complications such as osteomyelitis.

The overnight dexamethasone (DXM) test can give false-positive results in a few conditions (e.g. stress, strenuous exercise, depression, anorexia, anxiety, anticonvulsive therapy) in diagnosing simple obesity and hypercortisolism (HC). The loperamide (LP; a peripheral opioid agonist) test has proven useful in such conditions in adults. Thirty-one obese subjects (age 10.0-19.7 y) were studied by both overnight DXM test and LP test (8 mg orally, samples for cortisol at 0, 90, 150, 180 and 210 min) on 2 separate days. LP suppressed cortisol (< or = 138 nmol l-1) at a dose of 0.1 mg kg-1 bw (half the minimum recommended dose for the drug's antidiarrhoea effect) in 14 subjects who had normal urinary (< 4970 nmol l-1) and serum (< 552 nmol l-1) cortisol, in the absence of signs and symptoms of HC (group A). The DXM test failed to suppress cortisol in three subjects in group A, two of whom were on anticonvulsive treatment. The LP test suppressed cortisol in all of 13 subjects with elevated urinary and/or serum cortisol and/or with signs or symptoms of HC (but in whom HC was subsequently excluded on clinical grounds) (group B), while the DXM test failed to suppress cortisol in three subjects of this group. One of these was under anticonvulsive treatment and one suffered from anxiety and depression. In four patients with Cushing's syndrome (group C) neither DXM nor LP could suppress cortisol levels. Therefore, the sensitivity was 100% for both DXM and LP, while the specificity was 84% for DXM and 100% for LP. No side-effects were observed with either drug. In conclusion, LP is a useful alternative to DXM in those particular conditions that can affect its specificity in children.

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