Fever in Children With Sickle Cell Disease: Are All Fevers Equal?

Shihabuddin, Bashar; Scarfi, Catherine A.

doi:10.1016/j.jemermed.2014.06.025

Cited by 10 publications

(17 citation statements)

References 25 publications

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“…Bacterial infections represent the main complication associated with SCD, resulting in elevated morbidity and mortality rates [4] [7]- [12]. Therefore, in case of fever, most protocols of care as well as international recommendations advocate routine prescription of broad-spectrum antibiotics [7] [10]- [12] [16]- [20]. It is however difficult to implement such treatment in Africa since these drugs are expensive and are not always readily available in the health facilities.…”

Section: Discussionmentioning

confidence: 99%

“…This preventive strategy remains not easily accessible in sub-Saharan Africa, except for some pilot projects [14] [15]. Fever may be the expression of these infections, as shown by several authors [16]- [20], but to our knowledge no similar studies have been conducted to date in Gabon. Also in case of occurrence of fever, the physician is confronted with the haunting of a serious infection requiring prompt and aggressive treatment.…”

Section: Introductionmentioning

confidence: 94%

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Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Koko¹,

Gahouma²,

Ategbo³

et al. 2014

OJPed

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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 clinical 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: Complete 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 headache (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 infections (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. J. Koko et al. 263were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Koko¹,

Gahouma²,

Ategbo³

et al. 2014

OJPed

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“…Nonetheless, invasive bacterial infections are now rare with current vaccines and penicillin prophylaxis. Recent studies in Canada and the United States have shown that less than 1 % of febrile children with SCD have bacteremia (Rogovik et al 2010 ;Baskin et al 2013 ;Shihabuddin and Scarfi 2014 ).…”

Section: Infectionmentioning

confidence: 99%

Clinical Manifestations of Sickle Cell Anemia: Infants and Children

Nickel

Hsu

2016

Sickle Cell Anemia

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Children with sickle cell disease (SCD) have varied clinical problems. The hallmark manifestation of SCD, the pain crisis, typically fi rst occurs in early childhood presenting as dactylitis. Pain increases in frequency and severity as children age, especially during adolescence. Due to functional asplenia, children with SCD are at signifi cantly increased risk for certain infections, most notably Streptococcus pneumoniae. Other infections like parvovirus B19 are also special threats and can trigger an aplastic crisis. Unique, potentially life-threatening acute complications like splenic sequestration and acute chest syndrome occur in these children. They are at risk for neurologic disease, the most serious being stroke. In addition, the chronic hemolysis of SCD causes gallstones, which can lead to biliary tract disease. Children with SCD also frequently face chronic issues that include nocturnal enuresis and decreased growth. Despite these many potential problems, with advances in care including antibiotic treatment, stroke screening, blood transfusions, and hydroxyurea therapy, children with SCD rarely die in childhood and can become productive adults.

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“…pre-or post-PCV era); this study was excluded. The remaining 16 studies were included in the final analysis (Halasa et al, 2007;Adamkiewicz et al, 2008;Rogovik et al, 2010;McCavit et al, 2011;Narang et al, 2012;Baskin et al, 2013;Chang et al, 2013;Ellison et al, 2013;Patel et al, 2013;Payne et al, 2013;Shihabuddin & Scarfi, 2014;Soothill et al, 2016;Brown et al, 2017;Navalkele et al, 2017;Martin et al, 2018;Oligbu et al, 2018). We found large variations in study methodology and quality.…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature

et al. 2019

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Summary Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive pneumococcal diseases (IPD) in children, including those with sickle cell disease (SCD). A systematic review of the English literature published between 2000 and 2017 was undertaken to evaluate the serotype distribution, clinical presentation and outcomes of IPD in children with SCD in PCV programmes. We identified 475 potential studies and included 16 publications, involving 9438 children up to 22 years of age with SCD and 182 IPD episodes (prevalence, 1·9%. 95% confidence interval [CI], 1·7–2·2%). Septicaemia was the most prevalent clinical presentation (84/137; 61%) followed by lower respiratory tract infection (39/137; 29%) and meningitis (12/137, 9%). More than half the serotypes associated with IPD (88/148; 59·5%) were not included in the 13‐valent PCV; of these, 54% (44/82) were due to serogroup 15. The crude case fatality rate was 11·5% (21/182 cases; 95% CI, 7·3–17·1%). Most cases of IPD in children with SCD were due to serotypes that are not included in any of the licensed PCVs. IPD in children with SCD remains associated with high morbidity and mortality, highlighting the importance of strict adherence to daily penicillin prophylaxis. Until a serotype‐independent pneumococcal vaccine becomes available, higher‐valent PCVs should include serogroup 15 to protect this highly vulnerable group of children.

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Fever in Children With Sickle Cell Disease: Are All Fevers Equal?

Cited by 10 publications

References 25 publications

Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Clinical Manifestations of Sickle Cell Anemia: Infants and Children

Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature

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