Salmonella as a Causative Organism of Various Infections in Patients with Sickle Cell Disease

Abstract

Background:Patients with sickle cell disease (SCD) are susceptible to a variety of bacterial infections, including infections caused by Salmonella species. We sought to identify the most common infections caused by Salmonella spp. in SCD patients at our hospital, and to determine their mortality rates and susceptibility to commonly used antimicrobial agents. Patients and Methods:We conducted a retrospective review of all Salmonella infections in SCD patients admitted to Qatif Central Hospital during the last 11 years. Results: During the 11 years of the study, 331 episodes of Salmonella infection occurred in 319 patients. The incidence of Salmonella infection in SCD patients was 11.5% compared to only 0.65% in the general hospital population. The commonest sites of Salmonella infection were blood (42% of isolates), followed by gastrointestinal tract (23.5%) and the skeletal system (22.5%). Salmonella infection was commonly seen in patients less than 15 years of age. The case fatality rate in patients with Salmonella sepsis was 2.2% (3/139), but there were no deaths associated with other types of Salmonella infections. Ampicillin and cotrimoxazole resistance occurred in 29% and 24% of the isolates, respectively, but only 0.6% were resistant to ceftriaxone and 1.8% had intermediate resistance to ciprofloxacin. Conclusions: Salmonella is a common cause of sepsis and osteomyelitis in patients with SCD in our locality. Qatif Central Hospital is the major referral hospital for the Inhabitants of Qatif, an area that has the highest incidence of the sickle cell gene in Saudi Arabia.12 Patients with sickle cell disease (SCD) are susceptible to a variety of bacterial infections, which are a major cause of morbidity and mortality. This increased susceptibility to infections is related to abnormalities in the defense mechanisms of these patients, including functional hyposplenism, 3 an abnormality in the alternative pathway of complement activities, 4 and defective neutrophil function.5 Devitalisation of the gut and bone due to repetitive vaso-occlusive crises, macrophage saturation with red cell breakdown products as a result of chronic haemolysis, and underlying splenic and hepatic dysfunction, are known to predispose patients with SCD to Salmonella infection. This study was designed to identify the most common infections caused by Salmonella spp. in SCD patients at our hospital, the mortality rate associated with these infections, and antibiotic susceptibility patterns. Patients and MethodsA retrospective review was carried out on all SCD patients who were admitted to Qatif Central Hospital between January 1990 through December 2000, with documented Salmonella isolation from the blood, pus, aspirate, stool, or mid-stream urine. Patients with SCD (Hb SS genotype) were identified on the basis of a positive sickling test and hemoglobin electrophoresis. The records of these patients were examined for age at onset, sex, site of Salmonella infection, mortality rate, and the antibiotic susceptibility of the isolates.Blood cultu...

Both Hemolytic Anemia and Malaria Parasite-Specific Factors Increase Susceptibility to NontyphoidalSalmonella entericaSerovar Typhimurium Infection in Mice

“…Experimentally induced hemolytic anemia was previously implicated in an increased susceptibility of mice to S. Typhimurium (20,21). This notion is also supported by epidemiological studies, which showed that anemia from sickle cell disease is associated with an increased susceptibility to disseminated NTS infection (10,60). Based on an increased recovery of S. Typhimurium from macrophages after erythrophagocytosis, it was proposed that hemolytic anemia increases susceptibility to S. Typhimurium infection by reducing the microbicidal activity of macrophages (11).…”

“…Clinical reports documenting that individuals with sickle cell disease are at an increased risk of developing systemic NTS infection (10,28,59,60) suggest that hemolytic anemia may be a factor contributing to S. Typhimurium bacteremia. To test whether hemolytic anemia in the absence of malaria parasite infection could increase systemic loads of S. Typhimurium in our model, we injected rabbit anti-mouse RBC immunoglobulin (IgG) intraperitoneally, fol- on May 11, 2018 by guest http://iai.asm.org/ lowed by infection with S. Typhimurium.…”

Indications and complications of splenectomy for children with sickle cell disease

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Splenic Complications of Sickle Cell Anemia and the Role of Splenectomy

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