1
|
Furgier A, Goutines J, Dobian S, Zappa M, Demar M, Aigoun N, Oubda B, Faye A, Elenga N, Osei L. Bone and Joint Infections in Children With Sickle Cell Disease in French Guiana: A 13-Year Retrospective Multicenter Review. Pediatr Infect Dis J 2024; 43:946-952. [PMID: 38986011 DOI: 10.1097/inf.0000000000004416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a genetic disorder with a high infectious morbidity and mortality and a heterogeneous distribution in France. One of the challenges is to differentiate a bone and joint infection (BJI) from a vaso-occlusive crisis. This challenge is particularly prevalent in French Guiana, an overseas territory with the highest incidence of SCD in France. The aim of this study was to describe the epidemiology of BJI in children with SCD in French Guiana. METHOD This was a retrospective multicentric descriptive study of SCD patients living in French Guiana aged under 18 and diagnosed with a BJI between 2010 and 2022. These BJI were divided into 2 groups: those with microbiological documentation (d-BJI) and those without microbiological identification (ud-BJI). RESULTS A total of 53 episodes of BJI in 42 patients (mean age 7.2 years) were reported. Clinical symptoms on arrival were comparable between the d-BJI and ud-BJI groups. Patients in the d-BJI group had longer average hospital stays (40.4 days vs. 16.8 days, P = 0.01) and Salmonella spp. were the most identified bacteria (n = 8/13). White blood cell count was greater in the d-BJI group (30.3 G/L vs. 18.G/L, P = 0.01) and a collection was more frequently identified on imaging (11/13 vs. 16/40, P = 0.01) in this group. Initial in-hospital antibiotic therapy was longer in the d-BJI group (17.2 days vs. 12.8, P = 0.02), as were infection-related complications (9/13 vs. 12/40 P = 0.01). CONCLUSION BJI in children with SCD is not sufficiently microbiologically documented. Progress must be made to improve the documentation of BJI.
Collapse
Affiliation(s)
- Apolline Furgier
- From the Departement of Infectiology Pediatric in Robert Debre, AP-HP
| | - Juliette Goutines
- AP-HP, Department of Infectiology Pediatric in Robert Debre, University of Paris Cite, Paris
| | | | | | | | - Nadjia Aigoun
- Department of Pediatric in Saint Laurent Du Maroni Hospital
| | | | - Albert Faye
- AP-HP, Department of Infectiology Pediatric in Robert Debre, University of Paris Cite, Paris
| | - Narcisse Elenga
- Department of Pediatric in Cayenne Hospital, University of Antilles, French Guiana, France
| | - Lindsay Osei
- Department of Pediatric in Cayenne Hospital, University of Antilles, French Guiana, France
| |
Collapse
|
2
|
Tashkandi DA, Hanafy E, Alotaibi N, Abuharfel D, Alnijaidi A, Banjar AM, Abufara F, Riyad S, Alhalabi M, Alblowi N. Indicators for Osteomyelitis in Children With Sickle Cell Disease Admitted With Vaso-Occlusive Crises. Cureus 2024; 16:e68265. [PMID: 39238724 PMCID: PMC11375391 DOI: 10.7759/cureus.68265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the presence of a mutated form of hemoglobin (Hb) known as sickle hemoglobin (HbS). Individuals with SCD are susceptible to a variety of osteoarticular complications. Osteomyelitis is a commonly seen infection affecting the tibia, diaphysis of the femur and humerus, and vertebras. AIM The aim of this study was to define the indicators suggesting the diagnosis of osteomyelitis in patients with SCD. METHODS This study is a descriptive, analytical, non-interventional, prospective study of pediatric patients with SCD admitted with vaso-occlusive crisis (VOC) and/or osteomyelitis, which were identified by laboratory and radiological features. Retrospective data was included for patients who met the inclusion criteria. The statistical analysis included a description of the primary and secondary outcomes in the cohort. RESULTS A total of 28 children were included in this study. Participants' ages ranged from 11 months to 13 years. Males represented the majority (64.3%) of the participants. The blood culture of most of the participants (89.3%) showed no growth; however, 7.1% had salmonella, and only 3.6% had Gram-positive cocci. Most cases (75%) had leukocytosis. Thrombocytosis was present mainly in patients with VOC (40%). CRP was 1-4.9 mg/dL, mainly in patients with osteomyelitis (50%). The ferritin level exceeded 5000 ng/mL in patients with osteomyelitis or both osteomyelitis and VOC (50%). Ultrasound examinations revealed no hip effusion in 24 of the 28 examined patients. A plain X-ray examination showed no abnormality in 24 out of the 28 examined cases; with MRI, three cases exhibited marrow edema with bone enhancement, two (66.7%) were complicated by osteomyelitis, and the last (33.3%) had osteomyelitis and VOC. Aspiration was performed only in seven of the 28 examined, of which six (85.7%) were complicated by osteomyelitis, while the last one (14.3%) had acute chest syndrome. CONCLUSION Based on the outcomes of this study, we recommend an individualized multidisciplinary examination (hematology, infectious disease, orthopedic surgery, and interventional radiology) for SCD patients with suspected osteomyelitis admitted with VOC, considering the entire clinical history and laboratory and MRI results.
Collapse
Affiliation(s)
| | - Ehab Hanafy
- Prince Sultan Oncology Center, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Norah Alotaibi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Doha Abuharfel
- Pediatric Medicine, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Ali Alnijaidi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Fadwa Abufara
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Shaima Riyad
- Hematology and Oncology, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Maisa Alhalabi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Naif Alblowi
- Hematology and Oncology, Prince Sultan Oncology Center, King Salman Armed Forces Hospital, Tabuk, SAU
| |
Collapse
|
3
|
Chapman TJ, Olarte L, Dbaibo G, Houston AM, Tamms G, Lupinacci R, Feemster K, Buchwald UK, Banniettis N. PCV15, a pneumococcal conjugate vaccine, for the prevention of invasive pneumococcal disease in infants and children. Expert Rev Vaccines 2024; 23:137-147. [PMID: 38111990 DOI: 10.1080/14760584.2023.2294153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Streptococcus pneumoniae is a causative agent of pneumonia and acute otitis media (AOM), as well as invasive diseases such as meningitis and bacteremia. PCV15 (V114) is a new 15-valent pneumococcal conjugate vaccine (PCV) approved for use in individuals ≥6 weeks of age for the prevention of pneumonia, AOM, and invasive pneumococcal disease. AREAS COVERED This review summarizes the V114 Phase 3 development program leading to approval in infants and children, including pivotal studies, interchangeability and catch-up vaccination studies, and studies in at-risk populations. An integrated safety summary is presented in addition to immunogenicity and concomitant use of V114 with other routine pediatric vaccines. EXPERT OPINION Across the development program, V114 demonstrated a safety profile that is comparable to PCV13 in infants and children. Immunogenicity of V114 is comparable to PCV13 for all shared serotypes except serotype 3, where V114 demonstrated superior immunogenicity. Higher immune responses were demonstrated for V114 serotypes 22F and 33F. Results of the ongoing study to evaluate V114 efficacy against vaccine-type pneumococcal AOM and anticipated real-world evidence studies will support assessment of vaccine effectiveness and impact, with an additional question of whether higher serotype 3 immunogenicity translates to better protection against serotype 3 pneumococcal disease.
Collapse
Affiliation(s)
| | - Liset Olarte
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ghassan Dbaibo
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | | | | | |
Collapse
|
4
|
Lo SW, Hawkins PA, Jibir B, Hassan-Hanga F, Gambo M, Olaosebikan R, Olanipekun G, Munir H, Kocmich N, Rezac-Elgohary A, Gambo S, Bagenda D, Fey P, Breiman RF, McGee L, Bentley SD, Obaro SK. Molecular characterization of Streptococcus pneumoniae causing disease among children in Nigeria during the introduction of PCV10 (GSK). Microb Genom 2023; 9:001094. [PMID: 37712828 PMCID: PMC10569732 DOI: 10.1099/mgen.0.001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is a leading vaccine-preventable cause of childhood invasive disease. Nigeria has the second highest pneumococcal disease burden globally, with an estimated ~49 000 child deaths caused by pneumococcal infections each year. Ten-valent pneumococcal conjugate vaccine (GSK; PCV10) was introduced in December 2014 in a phased approach. However, few studies have characterized the disease-causing pneumococci from Nigeria. This study assessed the prevalence of serotypes, antibiotic susceptibility and genomic lineages using whole genome sequencing and identified lineages that could potentially escape PCV10 (GSK). We also investigated the potential differences in pneumococcal lineage features between children with and without sickle cell disease. A collection of 192 disease-causing pneumococcal isolates was obtained from Kano (n=189) and Abuja (n=3) states, Nigeria, between 1 January 2014 and 31 May 2018. The majority (99 %, 190/192) of specimens were recovered from children aged 5 years or under. Among them, 37 children had confirmed or traits of sickle cell disease. Our findings identified 25 serotypes expressed by 43 Global Pneumococcal Sequence Clusters (GPSCs) and 85 sequence types (STs). The most common serotypes were 14 (18 %, n=35), 6B (16 %, n=31), 1 (9 %, n=17), 5 (9 %, n=17) and 6A (9 %, n=17); all except serotype 6A are included in PCV10 (GSK). PCV10 (SII; PNEUMOSIL) and PCV13 formulations include serotypes 6A and 19A which would increase the overall coverage from 67 % by PCV10 (GSK) to 78 and 82 %, respectively. The pneumococcal lineages were a mix of globally spreading and unique local lineages. Following the use of PCV10 (GSK), GPSC5 expressing serotype 6A, GPSC10 (19A), GPSC26 (12F and 46) and GPSC627 (9L) are non-vaccine type lineages that could persist and potentially expand under vaccine-selective pressure. Approximately half (52 %, 99/192) of the pneumococcal isolates were resistant to the first-line antibiotic penicillin and 44 % (85/192) were multidrug-resistant. Erythromycin resistance was very low (2 %, 3/192). There was no significant difference in clinical manifestation, serotype prevalence or antibiotic resistance between children with and without traits of or confirmed sickle cell disease. In summary, our findings show that a high percentage of the pneumococcal disease were caused by the serotypes that are covered by currently available vaccines. Given the low prevalence of resistance, macrolide antibiotics, such as erythromycin, should be considered as an option to treat pneumococcal disease in Nigeria. However, appropriate use of macrolide antibiotics should be vigilantly monitored to prevent the potential increase in macrolide resistance.
Collapse
Affiliation(s)
- Stephanie W. Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | | | - Binta Jibir
- Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | | | | | - Rasaq Olaosebikan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Olanipekun
- International Foundation against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Huda Munir
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nicholas Kocmich
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amy Rezac-Elgohary
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Safiya Gambo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - Danstan Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Fey
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, Nebraska, USA
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
- Rollins School Public Health, Emory University, Atlanta, GA, USA
| | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stephen K. Obaro
- Aminu Kano Teaching Hospital, Kano, Nigeria
- International Foundation against Infectious Diseases in Nigeria, Abuja, Nigeria
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, Nebraska, USA
- Pediatric - Infectious Disease, School of Medicine, The University of Alabama, Birmingham, AL, USA
| |
Collapse
|
5
|
Abdulmanea AA, Alharbi NS, Somily AM, Khaled JM, Algahtani FH. The Prevalence of the Virulence Genes of Staphylococcus aureus in Sickle Cell Disease Patients at KSUMC, Riyadh, Saudi Arabia. Antibiotics (Basel) 2023; 12:1221. [PMID: 37508317 PMCID: PMC10416153 DOI: 10.3390/antibiotics12071221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Staphylococcus aureus in the blood of sickle cell disease (SCD) patients may result in a significant increase in morbidity and mortality. S. aureus strains contain various virulence characteristics, including the ability to create a variety of toxins and develop drug resistance. The current study sought to assess the prevalence of S. aureus in SCD patients and to identify the pathogen's virulence characteristics. Between 2017 and 2021, blood samples and data were collected at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. The Vitek system PCR and gene sequencing methods were used for identification, antibiotic resistance patterns, and genetic analysis. During the study period, 47 S. aureus blood isolates (methicillin-resistant S. aureus (MRSA) 41.6% and non-MRSA 58.4%) were isolated from 2406 SCD patients. The prevalence percentages of virulence genes (finbB, sdrC, sdrD, icaA, coa, nuc, hlg, hla, finbA, clfA, efb, pvl, agr, spa, seb, sea, sec, tst, and sed) among all the isolates from the SCD patients compared with non-SCD patients (control group) were as follows: (100% vs. 100%), (100% vs. 100%), (100% vs. 100%), (100% vs. 87.5%), (100% vs. 81.3%), (100% vs. 100%), (100% vs. 100%), (100% vs. 100%), (97.9% vs. 81.3%), (97.9% vs. 100%), (97.9% vs. 87.5%), (54.3% vs. 56.3%), (46.8% vs. 75%), (42.6% vs. 43.8%), (27.7% vs. 0%), (25.5% vs. 12.5%), (12.8% vs. 6.3%), (4.3% vs. 12.5%), and (4.3% vs. 0%). Regarding the resistance genes (plaZ, mecA, ermA, ermC, tetK, tetM, and ermB) of the S. aureus strains isolated from the SCD patients compared with non-SCD patients (control group), the prevalence percentages were as follows: (100% vs. 100%), (100% vs. 56.3%), (0% vs. 31.3%), (31.9% vs. 18.8%), (40.4% vs. 25%), (0% vs. 0%), and (0% vs. 0%). As for the antibiotic (ampicillin, penicillin, amoxicillin, cefazolin, imipenem, oxacillin, erythromycin, tetracycline, azithromycin, ciprofloxacin, moxifloxacin, and levofloxacin) resistance of the S. aureus strains isolated from the SCD patients compared with non-SCD patients (control group), the prevalence percentages were as follows: (100% vs. 100%), (97.9% vs. 100%), (72.3% vs. 25%), (68.1% vs. 37.5%), (68.1% vs. 25%), (66% vs. 25%), (36.2% vs. 18.8%), (23.4% vs. 12.5%), (19.1% vs. 12.5%), (17% vs. 12.5%), (14.9% vs. 25%), and (10.6% vs. 18.7%). This study concluded that several virulence genes were present in the S. aureus strains recovered from the SCD patients at KSUMC, with all the isolates containing the finbB, sdrC, sdrD, icaA, coa, nuc, hlg, and hla genes.
Collapse
Affiliation(s)
- Adel A. Abdulmanea
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (N.S.A.); (J.M.K.)
| | - Naiyf S. Alharbi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (N.S.A.); (J.M.K.)
| | - Ali M. Somily
- Department of Pathology, College of Medicine, King Saud University and King Saud University Medical City, P.O. Box 2925, Riyadh 11451, Saudi Arabia;
| | - Jamal M. Khaled
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (N.S.A.); (J.M.K.)
| | - Farjah H. Algahtani
- Department of Hematology, College of Medicine, King Saud University and King Saud University Medical City, P.O. Box 2925, Riyadh 11451, Saudi Arabia;
| |
Collapse
|
6
|
Carrol ED, Ranjit S, Menon K, Bennett TD, Sanchez-Pinto LN, Zimmerman JJ, Souza DC, Sorce LR, Randolph AG, Ishimine P, Flauzino de Oliveira C, Lodha R, Harmon L, Watson RS, Schlapbach LJ, Kissoon N, Argent AC. Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce. Pediatr Crit Care Med 2023; 24:e263-e271. [PMID: 37097029 PMCID: PMC10226471 DOI: 10.1097/pcc.0000000000003263] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a "Think globally, act locally" approach is required.
Collapse
Affiliation(s)
- Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | | | - Kusum Menon
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Tellen D Bennett
- Departments of Biomedical Informatics and Pediatrics (Critical Care Medicine), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO
| | - L Nelson Sanchez-Pinto
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jerry J Zimmerman
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Daniela C Souza
- Hospital Universitário da Universidade de São Paulo and Hospital Sírio Libanês, São Paulo, Brazil
| | - Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care Medicine and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anesthesia and Pediatrics, Harvard Medical School, Boston, MA
| | - Paul Ishimine
- Departments of Emergency Medicine and Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA
| | | | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Lori Harmon
- Society of Critical Care Medicine, Chicago, IL
| | - R Scott Watson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, British Columbia Women and Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
7
|
Délicat-Loembet LM, Baraïka MA, Bougoudogo F, Diallo DA. Bacterial Infection in the Sickle Cell Population: Development and Enabling Factors. Microorganisms 2023; 11:microorganisms11040859. [PMID: 37110283 PMCID: PMC10142700 DOI: 10.3390/microorganisms11040859] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 03/30/2023] Open
Abstract
The high frequency of bacterial infections represents a major threat to public health. In developing countries, they are still responsible for significant morbidity and mortality in pediatric populations with sickle cell disease, particularly in children under 5 years of age. Indeed, they have an increased susceptibility to bacterial infections due to their immune deficiency. This susceptibility is even greater for pneumococcal and salmonella infections. In addition, the underdevelopment of some countries and socio-economic factors increases this condition. This review examines the common and specific factors leading to infections in people with sickle cell disease in different types of developed and undeveloped countries. The threat of bacterial infections, particularly those caused by S. pneumoniae and Salmonella, is of increasing concern due to the rise in bacterial resistance to antibiotics. In light of this disturbing data, new strategies to control and prevent these infections are needed. Solutions could be systematic penicillin therapy, vaccinations, and probabilistic antibiotic therapy protocols.
Collapse
|
8
|
Niemelä S, Lempinen L, Löyttyniemi E, Oksi J, Jero J. Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland. BMC Infect Dis 2023; 23:45. [PMID: 36690945 PMCID: PMC9869503 DOI: 10.1186/s12879-023-07999-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Bacterial meningitis (BM) causes significant morbidity and mortality. We investigated predisposing factors, clinical characteristics, spectrum of etiological bacteria, and clinical outcome of community-acquired and nosocomial BM. METHODS In this retrospective study we analyzed data of 148 adults (age > 16 years) with BM treated in Turku University Hospital, Southwestern Finland, from 2011 to 2018. Besides culture- or polymerase chain reaction (PCR)-positive cases we also included culture-negative cases with laboratory parameters strongly suggestive of BM and those with meningitis-related findings in imaging. We used Glasgow Outcome Scale (GOS) score 1-4 to determine unfavorable outcome. RESULTS The median age of patients was 57 years and 48.6% were male. Cerebrospinal fluid (CSF) culture for bacteria showed positivity in 50 (33.8%) cases, although pre-diagnostic antibiotic use was frequent (85, 57.4%). The most common pathogens in CSF culture were Streptococcus pneumoniae (11, 7.4%), Staphylococcus epidermidis (7, 4.7%), Staphylococcus aureus (6, 4.1%) and Neisseria meningitidis (6, 4.1%). Thirty-nine patients (26.4%) presented with the triad of fever, headache, and neck stiffness. A neurosurgical procedure or an acute cerebral incident prior BM was recorded in 74 patients (50%). Most of the patients had nosocomial BM (82, 55.4%) and the rest (66, 44.6%) community-acquired BM. Ceftriaxone and vancomycin were the most used antibiotics. Causative pathogens had resistances against the following antibiotics: cefuroxime with a frequency of 6.8%, ampicillin (6.1%), and tetracycline (6.1%). The case fatality rate was 8.8% and the additional likelihood of unfavorable outcome 40.5%. Headache, decreased general condition, head computed tomography (CT) and magnetic resonance imaging (MRI), hypertension, altered mental status, confusion, operative treatment, neurological symptoms, pre-diagnostic antibiotic use and oral antibiotics on discharge were associated with unfavorable outcome. CONCLUSIONS The number of cases with nosocomial BM was surprisingly high and should be further investigated. The usage of pre-diagnostic antibiotics was also quite high. Headache was associated with unfavorable outcome. The frequency of unfavorable outcome of BM was 40.5%, although mortality in our patients was lower than in most previous studies.
Collapse
Affiliation(s)
- Sakke Niemelä
- grid.410552.70000 0004 0628 215XDepartment of Otorhinolaryngology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20540 Turku, Finland
| | - Laura Lempinen
- grid.7737.40000 0004 0410 2071Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Eliisa Löyttyniemi
- grid.1374.10000 0001 2097 1371Unit of Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jarmo Oksi
- grid.410552.70000 0004 0628 215XDepartment of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Jero
- grid.15485.3d0000 0000 9950 5666Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
9
|
Safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in children with SCD: a V114-023 (PNEU-SICKLE) study. Blood Adv 2022; 7:414-421. [PMID: 36383730 PMCID: PMC9979710 DOI: 10.1182/bloodadvances.2022008037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disease that results in a multitude of medical complications, including an increased risk of invasive disease caused by encapsulated bacteria, such as Streptococcus pneumoniae. Pneumococcal vaccines have contributed to a significant reduction in pneumococcal disease (PD) in children and adults, including those with SCD. This phase 3 study evaluated the safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine (PCV), in children with SCD. A total of 103 children aged 5 to 17 years with SCD were randomized and received a single dose of V114 or Prevnar 13 (PCV13). Safety was evaluated as the proportion of participants with adverse events (AEs). Serotype-specific immunoglobulin G (IgG) levels and opsonophagocytic activity (OPA) were measured immediately before vaccination and 30 days after vaccination. Overall, the rates of injection-site and systemic AEs reported after vaccination were similar between the vaccination groups. Up to 6 months after vaccination, serious AEs were those expected for patients with SCD, and none were assessed to be vaccine related. IgG geometric mean concentrations (GMCs) and OPA geometric mean titers (GMTs) for the 13 shared serotypes were generally comparable between recipients of V114 and PCV13. Additionally, V114 induced immune responses to serotypes 22F and 33F, which are not included in PCV13. The safety and tolerability profiles of V114 were consistent with those reported for PCV13. Immune responses following vaccination with V114 were generally comparable to PCV13 for the shared serotypes and higher for unique serotypes 22F and 33F. These results support the use of V114 in children with SCD. This trial was registered at www.clinicaltrials.gov as #NCT03731182.
Collapse
|
10
|
Han J, Zhang X, Molokie RE, Njoku FU, Hussain FA, Farooqui M, Rizvi I, Saraf SL, Gordeuk VR. COVID-19 vaccination status and disease burden in patients with sickle cell disease. Br J Haematol 2022; 199:e21-e24. [PMID: 36058234 PMCID: PMC9538477 DOI: 10.1111/bjh.18443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.,Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xu Zhang
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert E Molokie
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Franklin U Njoku
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Faiz A Hussain
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marwah Farooqui
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Insia Rizvi
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Santosh L Saraf
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
11
|
Assessment of humoral immunity and nutritionally essential trace elements in steady-state sickle cell disease Nigerian children before and after Prevenar 13 pneumococcal vaccination. BLOOD SCIENCE 2022; 4:170-173. [PMID: 36518602 PMCID: PMC9742099 DOI: 10.1097/bs9.0000000000000115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/11/2022] [Indexed: 02/07/2023] Open
Abstract
Children with sickle cell disease (SCD) are particularly prone to pneumococcal infection and administration of Prevenar 13 pneumococcal vaccine in Nigerian children with SCD is yet to be wide spread. This call for the need to study humoral immune responses stimulated by Prevenar 13 pneumococcal vaccine in SCD children to confirm the benefit or otherwise for the use of Prevenar 13 pneumococcal vaccine. Method The levels of humoral (innate and adaptive) immune factors and associated nutritionally essential trace elements were determined following Prevenar 13 pneumococcal vaccination of 23 Nigerian children with SCD. Serum innate humoral immune factors [Complement factors (C1q and C4), transferrin, ferritin, and C-reactive protein (CRP)] and adaptive humoral immune factors [IgG, IgA, IgM, and IgE] were determined using ELISA. Nutritionally essential trace elements such as iron (Fe), copper (Cu), and zinc (Zn) were measured also using an atomic absorption spectrophotometer. Results The serum levels of certain innate humoral immune factors (ferritin, CRP, and C4), only one adaptive humoral immune factors (IgE), and essential trace elements (Fe, Zn, and Cu) were significantly elevated in children with SCD post Prevenar 13 pneumococcal vaccination when compared to prevaccination levels. Conclusion Vaccination of children with SCD with Prevenar 13 pneumococcal vaccine was associated with increased levels of more innate humoral immune factors than adaptive factors. This study thus supports the administration of Prevenar 13 pneumococcal vaccination to children with SCD.
Collapse
|
12
|
Tuberculosis in sickle cell disease patients. Infect Dis Now 2022; 52:202-207. [DOI: 10.1016/j.idnow.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022]
|
13
|
Yee ME, Lai KW, Bakshi N, Grossman JK, Jaggi P, Mallis A, Wang YF, Jerris RC, Lane PA, Yildirim I. Bloodstream Infections in Children With Sickle Cell Disease: 2010-2019. Pediatrics 2022; 149:183842. [PMID: 34913059 PMCID: PMC8959248 DOI: 10.1542/peds.2021-051892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for bloodstream infections (BSIs), mainly because of functional asplenia. Immunizations and antibiotic prophylaxis have reduced the prevalence of invasive bacterial infections, but contemporary analysis of BSI in children with SCD is limited. METHODS We conducted a retrospective cohort study of children aged <18 years with SCD who had blood cultures collected at our institution from 2010 to 2019 to identify BSI. Probable contaminant organisms were identified and not included as BSI. We calculated the annual incidence of BSI at our institution with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations. RESULTS There were 2694 eligible patients with 19 902 blood cultures. Excluding repeated cultures and contaminant cultures, there were 156 BSI episodes in 144 patients. The median age at BSI was 7.5 years. The average incidence rate of BSI was 0.89 per 100 person-years (95% CI 0.45-1.32). The most common pathogens were Streptococcus pneumoniae (16.0%), Streptococcus viridans group (9.0%), Escherichia coli (9.0%), Staphylococcus aureus (7.7%), Bordetella holmesii (7.7%), Haemophilus influenzae (7.1%), and Salmonella species (6.4%). Odds of BSI were higher with sickle cell anemia genotypes (odds ratio [OR] 1.88; 95% CI 1.20-2.94) and chronic transfusions (OR 2.66; 95% CI 1.51-4.69) and lower with hydroxyurea (OR 0.57; 95% CI 0.39-0.84). CONCLUSIONS BSI remains a risk for children with SCD. Overall incidence, risk factors, and spectrum of pathogens are important considerations to guide prevention and empirical treatment of suspected infection in SCD.
Collapse
Affiliation(s)
- Marianne E. Yee
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics,Address correspondence to Marianne E. Yee, MD, MSc, Pediatric Hematology/Oncology, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Rd, NE, Atlanta, GA 30322. E-mail:
| | | | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | | | | | | | - Yun F. Wang
- Pathology and Laboratory Medicine, School of Medicine,Department of Pathology and Laboratory Medicine, Grady Health System, Atlanta, Georgia
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia,Pathology and Laboratory Medicine, School of Medicine
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | - Inci Yildirim
- Departments of Pediatrics,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Center for Childhood Infections and Vaccines, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|
14
|
Ibrahim HA, Yakubu YM, Farouk AG, Ambe P, Gadzama GB. Profile of bacterial pathogens causing infections in children with sickle cell anaemia in Maiduguri. Niger Postgrad Med J 2021; 28:218-224. [PMID: 34708710 DOI: 10.4103/npmj.npmj_531_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Sickle cell disease (SCD) is a major cause of morbidity and mortality in African children. Infection has been found to be a major cause of hospitalisation, a major precipitant of crises and one of the greatest causes of death among SCD patients at all ages. Objectives The objective of the study was to determine the prevalence of bacterial infection, pattern of the isolates and the antibiotic sensitivity of isolated bacteria among children with sickle cell anaemia (SCA). Materials and Methods A cross-sectional study carried out in the University of Maiduguri Teaching Hospital. A total of 242 hospitalised children with SCA with symptoms and signs of infection were recruited for the study using consecutive sampling technique. Sociodemographic and clinical data were obtained. Blood, urine, aspirates, swabs and cerebrospinal fluid samples were collected based on their clinical presentation and subjected to microbiological analysis. Results A total of 242 patients were studied. The age range was 9 months-15 years, with a mean age of 6.36 years ± 3.75 years. Male-to-female ratio was 1:1.14, with 41.7% of them belonging to low social class. Seventy seven of the 242 had confirmed bacterial infection giving an incidence of bacterial infection in SCA patients of 31.8%. Gram-negative organisms accounted for 64.5% of the isolates and they include Salmonella, Klebsiella, Escherichia coli and Coliforms. However, Staphylococcus aureus (32.9%) was the most frequent microorganism isolated, followed by Salmonella, (20.3%), Klebsiella (12.6%) and Coliforms (12.6%). Amoxicillin-clavulanate, cefixime and gentamicin showed more than 50% activity against the isolated bacterial pathogens while chloramphenicol was found to have low activity against Salmonella. Conclusion High index of suspicion of bacterial infection should be borne in mind of the attending physician when children with SCA present with features of infection. Detailed clinical evaluation and appropriate sample collection for microbiological analysis are recommended. Empirical treatment should be started on SCA patients who have clinical evidence of infection and should be broad enough to cover for common bacterial pathogens.
Collapse
Affiliation(s)
- Halima Abubakar Ibrahim
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Yakubu Mohammed Yakubu
- Department of Medical Microbiology, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Abubakar Garba Farouk
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Pwavimbo Ambe
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Galadima Bala Gadzama
- Department of Medical Microbiology, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| |
Collapse
|
15
|
Srisuwananukorn A, Han J, Raslan R, Gowhari M, Hussain F, Njoku F, Molokie RE, Gordeuk VR, Saraf SL. Antimicrobial resistance is a risk factor for mortality in adults with sickle cell disease. Haematologica 2021; 106:1745-1748. [PMID: 33121239 PMCID: PMC8168496 DOI: 10.3324/haematol.2020.267872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Andrew Srisuwananukorn
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612
| | - Jin Han
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612; Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612
| | - Rasha Raslan
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, 23219
| | - Michel Gowhari
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612
| | - Faiz Hussain
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612
| | - Franklin Njoku
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612
| | - Robert E Molokie
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612; Department of Medicine; Jesse Brown VA Medical Center, Chicago IL 60612
| | - Victor R Gordeuk
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612
| | - Santosh L Saraf
- Sickle Cell Center; Department of Medicine; University of Illinois at Chicago, Chicago IL 60612.
| |
Collapse
|
16
|
Khalife S, Hanna-Wakim R, Ahmad R, Haidar R, Makhoul PG, Khoury N, Dbaibo G, Abboud MR. Emergence of gram-negative organisms as the cause of infections in patients with sickle cell disease. Pediatr Blood Cancer 2021; 68:e28784. [PMID: 33128443 DOI: 10.1002/pbc.28784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis and document a vast decrease in Streptococcus pneumoniae bacteremia rates. METHODS We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis. RESULTS The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew Streptococcus pneumoniae, 14 grew coagulase-negative staphylococci (1.5%), one grew Salmonella enterica Paratyphi B, and three grew Salmonella enterica group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including Enterobacter cloacae, Bacteroides, Pseudomonas aeruginosa, and Salmonella enterica group C. CONCLUSIONS Immunization against Streptococcus pneumoniae and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis in patients with sickle cell disease.
Collapse
Affiliation(s)
- Sara Khalife
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rasha Ahmad
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachid Haidar
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Peter G Makhoul
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
17
|
Kao CM, Lai K, McAteer JM, Elmontser M, Quincer EM, Yee MEM, Tippet A, Jerris RC, Lane PA, Anderson EJ, Bakshi N, Yildirim I. Influenza vaccine effectiveness and disease burden in children and adolescents with sickle cell disease: 2012-2017. Pediatr Blood Cancer 2020; 67:e28358. [PMID: 32469138 PMCID: PMC8221251 DOI: 10.1002/pbc.28358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data are limited on the burden of influenza and seasonal influenza vaccine effectiveness (VE) in children with sickle cell disease (SCD). METHODS We used a prospectively collected clinical registry of SCD patients 6 months to 21 years of age to determine the influenza cases per 100 patient-years, vaccination rates, and a test-negative case-control study design to estimate influenza VE against medically attended laboratory-confirmed influenza infection. Influenza-positive cases were randomly matched to test-negative controls on age and influenza season in 1:1 ratio. We used adjusted logistic regression models to compare odds ratio (OR) of vaccination in cases to controls. We calculated VE as [100% × (1 - adjusted OR)] and computed 95% confidence intervals (CIs) around the estimate. RESULTS There were 1037 children with SCD who were tested for influenza, 307 children (29.6%) had at least one influenza infection (338 infections, incidence rate 3.7 per 100 person-years; 95% CI, 3.4-4.1) and 56.2% of those tested received annual influenza vaccine. Overall VE pooled over five seasons was 22.3% (95% CI, -7.3% to 43.7%). Adjusted VE estimates ranged from 39.7% (95% CI, -70.1% to 78.6%) in 2015/2016 to -5.9% (95% CI, -88.4% to 40.4%) in the 2016/17 seasons. Influenza VE varied by age and was highest in children 1-5 years of age (66.6%; 95% CI, 30.3-84.0). Adjusted VE against acute chest syndrome during influenza infection was 39.4% (95% CI, -113.0 to 82.8%). CONCLUSIONS Influenza VE in patients with SCD varies by season and age. Multicenter prospective studies are needed to better establish and monitor influenza VE among children with SCD.
Collapse
Affiliation(s)
- Carol M Kao
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - John M McAteer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Mohnd Elmontser
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Elizabeth M Quincer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Marianne EM Yee
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ashley Tippet
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Robert C Jerris
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Peter A Lane
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Evan J Anderson
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Nitya Bakshi
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
| |
Collapse
|
18
|
Silva RCMC, Travassos LH, Paiva CN, Bozza MT. Heme oxygenase-1 in protozoan infections: A tale of resistance and disease tolerance. PLoS Pathog 2020; 16:e1008599. [PMID: 32692767 PMCID: PMC7373268 DOI: 10.1371/journal.ppat.1008599] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Heme oxygenase (HO-1) mediates the enzymatic cleavage of heme, a molecule with proinflammatory and prooxidant properties. HO-1 activity deeply impacts host capacity to tolerate infection through reduction of tissue damage or affecting resistance, the ability of the host to control pathogen loads. In this Review, we will discuss the contribution of HO-1 in different and complex protozoan infections, such as malaria, leishmaniasis, Chagas disease, and toxoplasmosis. The complexity of these infections and the pleiotropic effects of HO-1 constitute an interesting area of study and an opportunity for drug development.
Collapse
Affiliation(s)
- Rafael C. M. C. Silva
- Laboratório de Inflamação e Imunidade, Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Leonardo H. Travassos
- Laboratório de Imunoreceptores e Sinalização, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia N. Paiva
- Laboratório de Inflamação e Imunidade, Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Marcelo T. Bozza
- Laboratório de Inflamação e Imunidade, Departamento de Imunologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- * E-mail:
| |
Collapse
|
19
|
Abstract
Sickle cell disease (SCD) is a group of inherited blood disorders affecting the hemoglobin, shortening the lifespan of erythrocytes, and causing them to take on a distinctive sickled shape that can lead to vaso-occlusion. Current treatment aims to reduce morbidity and mortality through hydroxyurea, erythrocyte transfusion, and hematopoietic stem cell transplantation. This article reviews the disease process, typical presentations, complications, and acute and chronic treatment options.
Collapse
|
20
|
Yee M, Bakshi N, Graciaa SH, Lane PA, Jerris RC, Wang YF, Yildirim I. Incidence of invasive Haemophilus influenzae infections in children with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27642. [PMID: 30724001 PMCID: PMC6472970 DOI: 10.1002/pbc.27642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for invasive infection with encapsulated bacteria. Antibiotic prophylaxis and immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) have decreased the overall incidence of invasive infections and have shifted distribution of serotypes causing disease toward those not covered by immunizations. We sought to determine the current incidence of invasive H. influenzae infections in children with SCD and to describe the clinical features and management of these infections. METHODS Microbiology reports of a large pediatric tertiary care center were reviewed to identify all isolates of H. influenzae detected in sterile body fluid cultures from January 1, 2010 to December 31, 2017. Results were compared with the center's comprehensive clinical database of all children with SCD to identify all cases of children ages 0 to18 years with SCD with invasive H. influenzae disease for the same time period. RESULTS We captured 2444 patients with SCD, with 14,336 person-years. There were eight episodes of H. influenzae bacteremia in seven children with SCD (five type f, two non-typable, one type a). Most episodes (7 of 8) were in children < 5 years. The incidence rate of invasive H. influenzae in SCD was 0.58/1000 person-years for ages 0 to 18 years and 1.60/1000 person-years for children age < 5 years. There were no deaths from H. influenzae infection. CONCLUSIONS In the era of universal antibiotic prophylaxis and immunization against Hib, invasive H. influenzae disease due to nonvaccine serotypes remains a risk for children with SCD, particularly those under five years of age.
Collapse
Affiliation(s)
- Marianne Yee
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nitya Bakshi
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sara H. Graciaa
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Yun F. Wang
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
21
|
Houwing ME, de Pagter PJ, van Beers EJ, Biemond BJ, Rettenbacher E, Rijneveld AW, Schols EM, Philipsen JNJ, Tamminga RYJ, van Draat KF, Nur E, Cnossen MH. Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Rev 2019; 37:100580. [PMID: 31128863 DOI: 10.1016/j.blre.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Sickle cell disease is an autosomal recessive, multisystem disorder, characterised by chronic haemolytic anaemia, painful episodes of vaso-occlusion, progressive organ failure and a reduced life expectancy. Sickle cell disease is the most common monogenetic disease, with millions affected worldwide. In well-resourced countries, comprehensive care programs have increased life expectancy of sickle cell disease patients, with almost all infants surviving into adulthood. Therapeutic options for sickle cell disease patients are however, still scarce. Predictors of sickle cell disease severity and a better understanding of pathophysiology and (epi)genetic modifiers are warranted and could lead to more precise management and treatment. This review provides an extensive summary of the pathophysiology and management of sickle cell disease and encompasses the characteristics, complications and current and future treatment options of the disease.
Collapse
Affiliation(s)
- M E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E J van Beers
- Department of Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, Internal mail no C.01.412, 3508, GA, Utrecht, the Netherlands.
| | - B J Biemond
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - E Rettenbacher
- Department of Paediatric Haematology, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6500, HB, Nijmegen, the Netherlands.
| | - A W Rijneveld
- Department of Haematology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E M Schols
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - J N J Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - R Y J Tamminga
- Department of Paediatric Oncology and Haematology, University Medical Center Groningen - Beatrix Children's Hospital, Postbus 30001, 9700, RB, Groningen, the Netherlands..
| | - K Fijn van Draat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Plasma Proteins, Sanquin Research, the Netherlands.
| | - E Nur
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| |
Collapse
|
22
|
Oligbu G, Fallaha M, Pay L, Ladhani S. Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature. Br J Haematol 2019; 185:743-751. [DOI: 10.1111/bjh.15846] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group Institute for Infection and Immunity St. George's, University of LondonLondon UK
| | | | - Leon Pay
- Faculty of Medicine Imperial CollegeLondon UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group Institute for Infection and Immunity St. George's, University of LondonLondon UK
- Immunisation and Countermeasures Division Public Health England London UK
| |
Collapse
|
23
|
Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, Abd-Allah F, Abdela J, Abdelalim A, Adamu AA, Adib MG, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akseer N, Al-Raddadi RM, Alahdab F, Alene KA, Aljunid SM, AlMazroa MA, Altirkawi K, Alvis-Guzman N, Animut MD, Anjomshoa M, Ansha MG, Asghar RJ, Avokpaho EFGA, Awasthi A, Badali H, Barac A, Bärnighausen TW, Bassat Q, Bedi N, Belachew AB, Bhattacharyya K, Bhutta ZA, Bijani A, Butt ZA, Carvalho F, Castañeda-Orjuela CA, Chitheer A, Choi JYJ, Christopher DJ, Dang AK, Daryani A, Demoz GT, Djalalinia S, Do HP, Dubey M, Dubljanin E, Duken EE, El Sayed Zaki M, Elyazar IRF, Fakhim H, Fernandes E, Fischer F, Fukumoto T, Ganji M, Gebre AK, Gebremeskel A, Gessner BD, Gopalani SV, Guo Y, Gupta R, Hailu GB, Haj-Mirzaian A, Hamidi S, Hay SI, Henok A, Irvani SSN, Jha RP, JÜRISSON M, Kahsay A, Karami M, Karch A, Kasaeian A, Kassa GM, Kassa TDD, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Kimokoti RW, Kisa A, Lami FH, Levi M, Li S, Loy CT, Majdan M, Majeed A, Mantovani LG, Martins-Melo FR, Mcalinden C, Mehta V, Melese A, Memish ZA, Mengistu DT, Mengistu G, Mestrovic T, Mezgebe HB, Miazgowski B, Milosevic B, Mokdad AH, Monasta L, Moradi G, Moraga P, Mousavi SM, Mueller UO, Murthy S, Mustafa G, Naghavi M, Naheed A, Naik G, Newton CRJ, Nirayo YL, Nixon MR, Ofori-Asenso R, Ogbo FA, Olagunju AT, Olagunju TO, Olusanya BO, Ortiz JR, Owolabi MO, Patel S, Pinilla-Monsalve GD, Postma MJ, Qorbani M, Rafiei A, Rahimi-Movaghar V, Reiner RC, Renzaho AM, Rezai MS, Roba KT, Ronfani L, Roshandel G, Rostami A, Safari H, Safari S, Safiri S, Sagar R, Samy AM, Santric Milicevic MM, Sartorius B, Sarvi S, Sawhney M, Saxena S, Shafieesabet A, Shaikh MA, Sharif M, Shigematsu M, Si S, Skiadaresi E, Smith M, Somayaji R, Sufiyan MB, Tawye NY, Temsah MH, Tortajada-Girbés M, Tran BX, Tran KB, Ukwaja KN, Ullah I, Vujcic IS, Wagnew FS, Waheed Y, Weldegwergs KG, Winkler AS, Wiysonge CS, Wiyeh AB, Wyper GM, Yimer EM, Yonemoto N, Zaidi Z, Zenebe ZM, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17:1061-1082. [PMID: 30507391 PMCID: PMC6234314 DOI: 10.1016/s1474-4422(18)30387-9] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes. METHODS The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education. FINDINGS Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426-458 514) to 318 400 (265 218-408 705). Incident cases globally increased from 2·50 million (95% UI 2·19-2·91) in 1990 to 2·82 million (2·46-3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585-978 219) globally, but decreased the most (-49·1%) to become the least common cause in 2016, with 397 297 cases (291 076-533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358-221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682-178 022]) and incident cases (1·25 million [1·06-1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787-839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04-1·96) YLDs were due to meningitis compared with 21·87 million (18·20-28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes. INTERPRETATION Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
24
|
Oligbu G, Collins S, Sheppard C, Fry N, Dick M, Streetly A, Ladhani S. Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010-2015. Arch Dis Child 2018; 103:643-647. [PMID: 29282225 DOI: 10.1136/archdischild-2017-313611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the clinical presentation, risk factors, serotype distribution and outcomes of invasive pneumococcal disease (IPD) in children with sickle cell disease (SCD) following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the UK. DESIGN Prospective national newborn screening for SCD and enhanced national IPD surveillance. PARTICIPANTS Children with SCD born in England between 1 September 2010 and 31 August 2014 who developed laboratory-confirmed IPD by 31 December 2015. MAIN OUTCOMES AND MEASURES Risk of IPD in children with SCD compared with children without SCD during the surveillance period. RESULTS Eleven children homozygote for haemoglobin S (HbSS) and one double heterozygote for haemoglobin S and C (HbSC) developed IPD. Septicaemia (n=7) and lower respiratory tract infection (n=4) were the main clinical presentations, and serogroup 15 (not present in PCV13) was responsible for 73% (8/11) of cases. Three children with HbSS (27%) died compared with <5% nationally. Children with HbSS had a 49-fold (95% CI 27 to 89, P<0.001) higher risk of IPD compared with their peers without SCD. CONCLUSIONS Children with SCD remain at increased risk of IPD despite national newborn screening, early penicillin prophylaxis and high pneumococcal vaccine uptake. They are also more likely to die of their infection compared with their peers without SCD. Most IPD cases are now due to serotypes not covered by PCV13. Healthcare professionals need to work more closely with families with SCD and local communities to emphasise the importance of penicillin prophylaxis, explore barriers, allay misguided beliefs and facilitate rapid access to healthcare.
Collapse
Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
| | - Sarah Collins
- Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
| | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England, London, UK
| | - Norman Fry
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England, London, UK
| | - Moira Dick
- Division of Health and Social Care Research, King's College London, London, UK
| | - Allison Streetly
- Division of Health and Social Care Research, King's College London, London, UK.,Deputy National Lead Healthcare Public Health, Public Health England, London, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, London, UK
| |
Collapse
|
25
|
Population Pharmacokinetics of Cefotaxime and Dosage Recommendations in Children with Sickle Cell Disease. Antimicrob Agents Chemother 2018; 62:AAC.00637-17. [PMID: 29378711 DOI: 10.1128/aac.00637-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 01/07/2018] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetic profile of most drugs is dependent on the patient's covariates and may be influenced by the disease. Cefotaxime is frequently prescribed in pediatric patients with sickle cell disease (SCD), characterized by vaso-occlusive complications, chronic hemolytic anemia, and a defective immunological function predisposing the individual to severe infection. Data on the impact of the disease on the disposition of cefotaxime are missing. In the present study, our aims were to determine cefotaxime pharmacokinetics when prescribed to children with SCD for suspected or proven bacterial infection, identify significant covariates, and perform Monte Carlo simulations to optimize the drug dosage. Cefotaxime serum concentrations were measured in 78 pediatric SCD patients receiving cefotaxime intravenously at a daily dose of 200 mg/kg of body weight in three or four divided doses over 30 min. A total of 107 concentrations were available for pharmacokinetic analysis. A population pharmacokinetic model was developed with NONMEM software and used for Monte Carlo simulations. Cefotaxime concentrations ranged from 0.05 to 103.7 mg/liter. Cefotaxime pharmacokinetics were best described by a one-compartment model: the median estimated weight-normalized volume of distribution and clearance were 0.42 liter/kg (range, 0.2 to 1.1 liter/kg) and 0.38 liter/h/kg (range, 0.1 to 1.2 liter/h/kg). Cefotaxime clearance increased by 22% in patients with acute chest syndrome. Dosing optimization, performed using EUCAST MIC susceptibility breakpoints, showed that a dose of 100 mg/kg/6 h should be used, depending on the patient's characteristics and clinical presentation, in order to reach a value of the percentage of time that the drug concentration exceeded the MIC under steady-state pharmacokinetic conditions of 80% in 80% of the patients when targeting sensitive Gram-positive cocci and Gram-negative bacilli with MICs of 1 mg/liter or below.
Collapse
|
26
|
Wiyeh AB, Abdullahi LH, Wonkam A, Wiysonge CS, Kaba M. Effects of vaccines in patients with sickle cell disease: a systematic review protocol. BMJ Open 2018; 8:e021140. [PMID: 29581211 PMCID: PMC5875604 DOI: 10.1136/bmjopen-2017-021140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited haematological disorder caused by a single point mutation (Glub6Val) that promotes polymerisation of haemoglobin S and sickling of erythrocytes. Inflammation, haemolysis, microvascular obstruction and organ damage characterise the highly variable clinical expression of SCD. People with SCD are at increased risk of severe infections, hence the need for vaccination against common disease-causing organisms in this population. We aim to review the evidence on the efficacy and safety of vaccines in people with SCD. METHODS AND ANALYSIS The present systematic review will examine the current data as indexed in PubMed, CENTRAL, EMBASE and EBSCOHost. We will consult Strategic Advisory Group of Experts practice statements, conference abstracts, reference lists of relevant articles, WHO ICTRP trial registry and experts in the field. Two authors will independently screen search outputs, select studies, extract data and assess risk of bias; resolving discrepancies by discussion and consensus between the two authors or arbitration by a third author when necessary. We will perform a meta-analysis for clinically homogenous studies. Evidence from clinically diverse studies will be aggregated using narrative synthesis of the findings. In either case, we will use the GRADE approach to assess the strength of the available evidence. ETHICS AND DISSEMINATION The study draws on data that are readily available in the public domain, hence no formal ethical review and approval is required. The findings of this review will be disseminated through conference presentations and a publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018084051.
Collapse
Affiliation(s)
- Alison Beriliy Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Leila Hussein Abdullahi
- Save the Children International (SCI), Somalia/Somaliland Country Office, Nairobi, Kenya
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Mamadou Kaba
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
27
|
Abstract
Pantoea agglomerans has been classically associated with cellulitis or synovitis secondary to penetrating trauma by vegetation. It is an infrequent cause of systemic infections. We describe the case of a 5-year-old girl with sickle cell disease with P. agglomerans bacteremia and review its potential causes.
Collapse
|
28
|
Droz N, De Lauzanne A, Holvoet L, Missud F, Benkerrou M, Brousse V, Odièvre MH, Faye A, Koehl B. Tuberculosis in children with sickle cell anaemia: a retrospective study in French tertiary care centres. Eur J Pediatr 2017; 176:723-729. [PMID: 28401342 DOI: 10.1007/s00431-017-2905-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/28/2017] [Accepted: 04/03/2017] [Indexed: 01/17/2023]
Abstract
UNLABELLED Tuberculosis (TB) and sickle cell anaemia (SCA) may affect the same population of patients, particularly in Africa but also in high-TB incidence areas in developed countries. However, few data are available from children with SCA who develop TB. The aim of this study was to describe the clinical features and outcome of TB diagnosed in children with SCA. We conducted a retrospective, descriptive study in three referral centre of Sickle Cell Disease in Paris, France. We included 11 patients with SCA who develop TB. The median age at TB diagnosis was 11 years [7.5-14.5]. Two patients were asymptomatic and nine patients were symptomatic. Six patients had pulmonary TB (pulmonary, pleural and mediastinal lesions). Five patients had extrapulmonary TB (osteoarticular TB, hepatic TB, cervical and mediastinal TB). Mycobacterium tuberculosis was isolated in four of the 11 cases. All patients recovered after a median of 6 months of anti-TB treatment. The localisation of TB and outcome after treatment in our SCA patients were similar to the one observed in an age-and sex-matched control group of non-SCA patient with TB. CONCLUSION despite the low number of patients included in our study, SCA does not seem to be a risk factor for severe TB. What is Known: • Tuberculosis (TB) remains a global health problem particularly in developing countries, and Sickle cell anaemia (SCA) is currently one of the most common genetic diseases in the world that mainly affects African populations. • Very few data are available on TB in SCA patients. What is New: • The features of TB in children with SCA seem to be comparable to those expected in general population, with favourable outcomes in response to standard treatment. • Monitoring the dosage of anti-TB treatments could be of interest because of the possible impact of SCA on drug metabolism.
Collapse
Affiliation(s)
- Nina Droz
- Robert Debré Hospital, F-75019, Paris, France. .,Pediatric Emergency Department, Louis Mourier Hospital, 178 rue des Renouillet, 92700, Colombes, France.
| | | | - Laurent Holvoet
- Assistance Publique-Hôpitaux de Paris, Hematology Unit, Robert Debré Hospital, F-75019, Paris, France.,Assistance Publique-Hôpitaux de Paris, Reference Centre of Sickle Cell Disease, Robert Debré Hospital, F-75019, Paris, France
| | - Florence Missud
- Assistance Publique-Hôpitaux de Paris, Hematology Unit, Robert Debré Hospital, F-75019, Paris, France.,Assistance Publique-Hôpitaux de Paris, Reference Centre of Sickle Cell Disease, Robert Debré Hospital, F-75019, Paris, France
| | - Malika Benkerrou
- Assistance Publique-Hôpitaux de Paris, Hematology Unit, Robert Debré Hospital, F-75019, Paris, France.,Assistance Publique-Hôpitaux de Paris, Reference Centre of Sickle Cell Disease, Robert Debré Hospital, F-75019, Paris, France.,INSERM UMR 1123, ECEVE, Paris, France
| | - Valentine Brousse
- Assistance Publique-Hôpitaux de Paris, Reference Centre of Sickle Cell Disease, Necker Hospital, Paris, France
| | - Marie-Hélène Odièvre
- Assistance Publique-Hôpitaux de Paris, Pediatric Unit, Louis Mourier Hospital, Colombes, France
| | - Albert Faye
- Robert Debré Hospital, F-75019, Paris, France.,INSERM UMR 1123, ECEVE, Paris, France.,Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
| | - Berengere Koehl
- Robert Debré Hospital, F-75019, Paris, France.,Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
| |
Collapse
|
29
|
Immunogenicity and Safety of 10-valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) Administered to Children With Sickle Cell Disease Between 8 Weeks and 2 Years of Age: A Phase III, Open, Controlled Study. Pediatr Infect Dis J 2017; 36:e136-e150. [PMID: 28403055 DOI: 10.1097/inf.0000000000001518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunogenicity, safety and reactogenicity of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) were evaluated in children with sickle cell disease (SCD), who are at increased risk for infections. METHODS In this phase III, open-label, single-center, controlled study in Burkina Faso (NCT01175083), children with SCD (S) or without SCD (NS) were assigned to 6 groups (N = 300): children 8-11 weeks of age (<6 months; <6S and <6NS groups) received 3 primary doses and a booster dose of PHiD-CV coadministered with routine childhood vaccines; children 7-11 months of age (7-11S and 7-11NS groups) received 2 primary doses and a booster dose of PHiD-CV; children 12-23 months of age (12-23S and 12-23NS groups) received 2 catch-up doses of PHiD-CV. Pneumococcal antibody responses were measured using 22F-inhibition enzyme-linked immunosorbent assay and functional opsonophagocytic activity. Responses to other antigens were measured by enzyme-linked immunosorbent assay. Adverse events were recorded. RESULTS One month postprimary vaccination, for each vaccine serotype ≥98% of infants in the <6S and <6NS groups had antibody concentrations ≥0.2 µg/mL, except for 6B (≥85%) and 23F (≥89%). Immune responses to PHiD-CV after age-appropriate vaccination in children <2 years did not appear influenced by SCD. All infants were seroprotected/seropositive for diphtheria, tetanus and Bordetella pertussis antigens postprimary and booster vaccination. Safety and reactogenicity profiles were similar in children with or without SCD. CONCLUSIONS PHiD-CV was immunogenic with an acceptable safety profile in children with and without SCD starting vaccination at 8 weeks to 23 months of age.
Collapse
|
30
|
Martí-Carvajal AJ, Conterno LO. Antibiotics for treating community-acquired pneumonia in people with sickle cell disease. Cochrane Database Syst Rev 2016; 11:CD005598. [PMID: 27841444 PMCID: PMC6530651 DOI: 10.1002/14651858.cd005598.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND As a consequence of their condition, people with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community-acquired pneumonia. Many different bacteria can cause this infection and antibiotic treatment is generally needed to resolve it. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. This is an update of a previously published Cochrane Review. OBJECTIVES To determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with sickle cell disease suffering from community-acquired pneumonia. SEARCH METHODS We searched The Group's Haemoglobinopathies Trials Register (01 September 2016), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched LILACS (1982 to 01 September 2016), African Index Medicus (1982 to 20 October 2016) and WHO ICT Registry (20 October 2016). SELECTION CRITERIA We searched for published or unpublished randomized controlled trials. DATA COLLECTION AND ANALYSIS We intended to summarise data by standard Cochrane methodologies, but no eligible randomized controlled trials were identified. MAIN RESULTS We were unable to find any randomized controlled trials on antibiotic treatment approaches for community-acquired pneumonia in people with sickle cell disease. AUTHORS' CONCLUSIONS The updated review was unable to identify randomized controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. Randomized controlled trials are needed to establish the optimum antibiotic treatment for this condition. The trials regarding this issue should be structured and reported according to the CONSORT statement for improving the quality of reporting of efficacy and improved reports of harms in clinical research. Triallists should consider including the following outcomes in new trials: number of days to become afebrile; mortality; onset of pain crisis or complications of sickle cell disease following community-acquired pneumonia; diagnosis; hospitalization (admission rate and length of hospital stay); respiratory failure rate; and number of participants receiving a blood transfusion.There are no trials included in the review and we have not identified any relevant trials up to September 2016. We therefore do not plan to update this review until new trials are published.
Collapse
|
31
|
Souza AR, Maruyama CM, Sáfadi MAP, Lopes MH, Azevedo RS, Findlow H, Bai X, Borrow R, Weckx LY. Antibody persistence after serogroup C meningococcal conjugate vaccine in children with sickle cell disease. Vaccine 2016; 34:4327-34. [PMID: 27395566 DOI: 10.1016/j.vaccine.2016.06.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND A decline of protective antibody titers after MCC vaccine has been demonstrated in healthy children, this may be an issue of concern for risk groups. The aim of this study was to evaluate the persistence of bactericidal antibodies after MCC vaccine in sickle cell disease (SCD) patients. The type of vaccine used and booster response were also analyzed. METHODS SCD patients (n=141) previously immunized with MCC vaccines had blood drawn 2-8 years after the last priming dose. They were distributed according to age at primary immunization into groups: <2 years and 2-13 years and evaluated by years since vaccination (2-3, 4-5 and 6-8). Serum bactericidal antibodies with baby rabbit complement (rSBA) and serogroup C-specific IgG concentrations were measured. The correlate of protection was rSBA titer ⩾8. Subjects with rSBA <8 received a booster dose and antibody levels re-evaluated after 4-6 weeks. RESULTS For children primed under 2years of age rSBA titer ⩾8 was demonstrated in 53.3%, 21.7% and 35.0%, 2-3, 4-5, 6-8years, respectively, after vaccination, compared with 70.0%, 45.0% and 53.5%, respectively, for individuals primed at ages 2-13years. rSBA median titers and IgG median levels were higher in the older group. Six to eight years after vaccination the percentage of patients with rSBA titers ⩾8 was significantly higher in the group primed with MCC-TT (78.5%) compared with those primed with MCC-CRM197 [Menjugate® (33.3%) or Meningitec® (35.7%)] (p=0.033). After a booster, 98% achieved rSBA titer ⩾8. CONCLUSION Immunity to meningococcal serogroup C in SCD children declines rapidly after vaccination and is dependent on the age at priming. Booster doses are needed to maintain protection in SCD patients. Persistence of antibodies seems to be longer in individuals primed with MCC-TT vaccine comparing to those immunized with MCC-CRM197.
Collapse
Affiliation(s)
- Alessandra R Souza
- Pediatric Infectious Disease Discipline, Department of Pediatrics, Universidade Federal de São Paulo, SP, Brazil
| | - Claudia M Maruyama
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, SP, Brazil
| | - Marco Aurélio P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, SP, Brazil
| | - Marta H Lopes
- Infectious Disease Department of the School of Medicine, Universidade de São Paulo, SP, Brazil
| | - Raymundo S Azevedo
- Pathology Department of the School of Medicine, Universidade de São Paulo, SP, Brazil
| | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Xilian Bai
- Vaccine Evaluation Unit, Public Health England, Manchester Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Lily Y Weckx
- Pediatric Infectious Disease Discipline, Department of Pediatrics, Universidade Federal de São Paulo, SP, Brazil.
| |
Collapse
|
32
|
Obaro SK, Iroh Tam PY. Preventing Infections in Sickle Cell Disease: The Unfinished Business. Pediatr Blood Cancer 2016; 63:781-5. [PMID: 26840500 DOI: 10.1002/pbc.25911] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/26/2015] [Accepted: 12/28/2015] [Indexed: 11/08/2022]
Abstract
While encapsulated bacterial agents, particularly Streptococcus pneumoniae, are recognized as important microbes that are associated with serious illness in hosts with sickle cell disease (SCD), multiple pathogens are implicated in infectious manifestations of SCD. Variations in clinical practice have been an obstacle to the universal implementation of infection preventive management through active, targeted vaccination of these individuals and routine usage of antibiotic prophylaxis. Paradoxically, in low-income settings, there is evidence that SCD also increases the risk for several other infections that warrant additional infection preventive measures. The infection preventive care among patients with SCD in developed countries does not easily translate to the adoption of these recommendations globally, which must take into account the local epidemiology of infections, available vaccines and population-specific vaccine efficacy, environment, health care behaviors, and cultural beliefs, as these are all factors that play a complex role in the manifestation of SCD and the prevention of infectious disease morbidity.
Collapse
Affiliation(s)
- Stephen K Obaro
- Department of pediatrics, Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska.,International Foundation Against Infectious Diseases in Nigeria (IFAIN), Millennium Plaza, Central Business Area, Abuja, Nigeria.,Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - P Y Iroh Tam
- Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
33
|
Bundy DG, Muschelli J, Clemens GD, Strouse JJ, Thompson RE, Casella JF, Miller MR. Preventive Care Delivery to Young Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2016; 38:294-300. [PMID: 26950087 PMCID: PMC4842129 DOI: 10.1097/mph.0000000000000537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children aged 2 to 5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting the inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% vs. 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in 20 children received all 3 preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential.
Collapse
Affiliation(s)
- David G. Bundy
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gwendolyn D. Clemens
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John J. Strouse
- Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard E. Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - James F. Casella
- Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marlene R. Miller
- Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
34
|
Noubouossie D, Tayou Tagny C, Chetcha B, Ngo Balogog P, Mbanya DN. Sickle-cell disease in sub-Saharan Africa. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- D. Noubouossie
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
| | - C. Tayou Tagny
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé University Teaching Hospital; Yaoundé Cameroon
| | - B. Chetcha
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé Central Hospital; Yaoundé Cameroon
| | | | - D. N. Mbanya
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé University Teaching Hospital; Yaoundé Cameroon
| |
Collapse
|
35
|
Fletcher MA, Balmer P, Bonnet E, Dartois N. PCVs in individuals at increased risk of pneumococcal disease: a literature review. Expert Rev Vaccines 2015; 14:975-1030. [DOI: 10.1586/14760584.2015.1037743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
36
|
Carter R, Wolf J, van Opijnen T, Muller M, Obert C, Burnham C, Mann B, Li Y, Hayden RT, Pestina T, Persons D, Camilli A, Flynn PM, Tuomanen EI, Rosch JW. Genomic analyses of pneumococci from children with sickle cell disease expose host-specific bacterial adaptations and deficits in current interventions. Cell Host Microbe 2015; 15:587-599. [PMID: 24832453 DOI: 10.1016/j.chom.2014.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/10/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
Sickle cell disease (SCD) patients are at high risk of contracting pneumococcal infection. To address this risk, they receive pneumococcal vaccines, and antibiotic prophylaxis and treatment. To assess the impact of SCD and these interventions on pneumococcal genetic architecture, we examined the genomes of more than 300 pneumococcal isolates from SCD patients over 20 years. Modern SCD strains retained invasive capacity but shifted away from the serotypes used in vaccines. These strains had specific genetic changes related to antibiotic resistance, capsule biosynthesis, metabolism, and metal transport. A murine SCD model coupled with Tn-seq mutagenesis identified 60 noncapsular pneumococcal genes under differential selective pressure in SCD, which correlated with aspects of SCD pathophysiology. Further, virulence determinants in the SCD context were distinct from the general population, and protective capacity of potential antigens was lost over time in SCD. This highlights the importance of understanding bacterial pathogenesis in the context of high-risk individuals.
Collapse
Affiliation(s)
- Robert Carter
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Tim van Opijnen
- Tufts University School of Medicine, Department of Molecular Biology and Microbiology, 136 Harrison Avenue, Boston, MA 02111-1817 USA
| | - Martha Muller
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Caroline Obert
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Corinna Burnham
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Beth Mann
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Randall T Hayden
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Tamara Pestina
- Department of Experimental Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Derek Persons
- Department of Experimental Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Andrew Camilli
- Tufts University School of Medicine, Department of Molecular Biology and Microbiology, 136 Harrison Avenue, Boston, MA 02111-1817 USA.,Howard Hughes Medical Institute, Department of Molecular Biology and Microbiology, 136 Harrison Avenue, Boston, MA 02111-1817 USA
| | - Patricia M Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Elaine I Tuomanen
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Jason W Rosch
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| |
Collapse
|
37
|
Mulumba LL, Wilson L. Sickle cell disease among children in Africa: An integrative literature review and global recommendations. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2015. [DOI: 10.1016/j.ijans.2015.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
38
|
Oral microbial colonization in children with sickle cell anaemia under long-term prophylaxis with penicillin. Arch Oral Biol 2014; 59:1042-7. [DOI: 10.1016/j.archoralbio.2014.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 02/12/2014] [Accepted: 05/06/2014] [Indexed: 11/18/2022]
|
39
|
Willen SM, Thornburg CD, Lantos PM. Travelers with sickle cell disease. J Travel Med 2014; 21:332-9. [PMID: 24947546 PMCID: PMC4146746 DOI: 10.1111/jtm.12142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/06/2014] [Accepted: 04/22/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background to SCD and reviews many important aspects of travel preparation in this population. METHODS The medical literature was searched for studies on travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness. RESULTS There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler is uncertain. Combining these sources of data and the broader medical literature, we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel. CONCLUSIONS Travelers with SCD face considerable medical risks when traveling to developing tropical countries, including malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. For individuals with SCD, frank counseling about the risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary aspects of the pre-travel visit.
Collapse
Affiliation(s)
- Shaina M. Willen
- Department of Pediatrics, Duke University Medical Center; Durham, NC, USA
| | - Courtney D. Thornburg
- Division of Pediatric Hematology/Oncology, University of San Diego Medical Center; San Diego, CA, USA
| | - Paul M. Lantos
- Divisions of Pediatric Infectious Disease and General Internal Medicine, Duke University Medical Center; Durham, NC, USA
| |
Collapse
|
40
|
Fever in children with sickle cell disease: are all fevers equal? J Emerg Med 2014; 47:395-400. [PMID: 25161094 DOI: 10.1016/j.jemermed.2014.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/18/2014] [Accepted: 06/30/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sepsis is the most common cause of mortality in sickle cell disease (SCD). Empiric antibiotic administration after obtaining blood cultures in febrile children with SCD has been a standard practice parameter. OBJECTIVE Our primary objective was to calculate the rate of bacteremia in febrile pediatric patients with SCD. Our secondary objective was to establish whether vital signs or diagnostics predict bacteremia in these patients. METHODS We conducted a retrospective chart review of patients with SCD who presented to an urban pediatric emergency department in Newark, NJ between January 1, 2001 and June 30, 2011 with the chief complaint of fever. Patients between the ages of 0 and 20 years with SCD who presented with the chief complaint of fever and who had a blood culture performed were included. Descriptive data, visit-specific data, and diagnostic data were collected. RESULTS Charts of 307 patients were included. Six patients had a positive blood culture, one of which was considered a true pathogen (Streptococcus pneumoniae) (0.33%; 95% confidence interval 0.06%-1.86%). There was no statistical significance between the means of visit-specific and diagnostic data of patients with positive blood cultures and those with negative blood cultures. CONCLUSIONS The incidence of bacteremia in febrile children with SCD presenting to the emergency department is low. Close follow-up within 24 hours and delayed antibiotic administration can be a plausible alternative treatment option in this population.
Collapse
|
41
|
Conklin L, Loo JD, Kirk J, Fleming-Dutra KE, Deloria Knoll M, Park DE, Goldblatt D, O'Brien KL, Whitney CG. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type invasive pneumococcal disease among young children. Pediatr Infect Dis J 2014; 33 Suppl 2:S109-18. [PMID: 24336053 PMCID: PMC3944481 DOI: 10.1097/inf.0000000000000078] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) are being implemented globally using a variety of different schedules. The optimal schedule to maximize protection of vaccinated children against vaccine-type invasive pneumococcal disease (VT-IPD) is not known. METHODS To assess the relative benefit of various PCV dosing schedules, we conducted a systematic review of studies published in English from 1994 to 2010 (supplemented post hoc with studies from 2011) on PCV effectiveness against VT-IPD among children targeted to receive vaccine. Data on 2-dose and 3-dose primary series, both with and without a booster ("2+0," "2+1," "3+0" and "3+1"), were included. For observational studies using surveillance data or case counts, we calculated percentage reduction in VT-IPD before and after PCV introduction. RESULTS Of 4 randomized controlled trials and 31 observational studies reporting VT-IPD among young children, none evaluated a 2+0 complete series, 7 (19%) evaluated 2+1, 4 (11%) 3+0 and 27 (75%) 3+1. Most (86%) studies were from North America or Europe. Only 1 study (observational) directly compared 2 schedules (3+0 vs. 3+1); results supported the use of a booster dose. In clinical trials, vaccine efficacy ranged from 65% to 71% with 3+0 and 83% to 94% with 3+1. Surveillance data and case counts demonstrate reductions in VT-IPD of up to 100% with 2+1 (6 studies) or 3+1 (17 studies) schedules and up to 90% with 3+0 (2 studies). Reductions were observed as early as 1 year after PCV introduction. CONCLUSIONS These data support the use of 2+1, 3+0 and 3+1 schedules, although most data of PCV impact on VT-IPD among young children are from high-income countries using 3+1. Differences between schedules for impact on VT-IPD are difficult to discern based on available data.
Collapse
Affiliation(s)
- Laura Conklin
- From the *Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †Westat Inc., Rockville, MD; ‡Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; §International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ¶Institute for Child Health, University College London, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Invasive pneumococcal disease among children with and without sickle cell disease in the United States, 1998 to 2009. Pediatr Infect Dis J 2013; 32:1308-12. [PMID: 23811745 PMCID: PMC4519831 DOI: 10.1097/inf.0b013e3182a11808] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk of illness and death from invasive pneumococcal disease (IPD). The introduction in 2000 of the 7-valent pneumococcal conjugate vaccine and penicillin prophylaxis for children with SCD has greatly reduced the incidence of IPD in this population. However, a recent report suggested an increase in cases of IPD in children with SCD. METHODS Using data from Active Bacterial Core surveillance, we analyzed trends in hospitalizations, mortality and serotype among children with SCD compared with other children. We used neonatal screening data to estimate SCD population denominators for each Active Bacterial Core surveillance site. RESULTS From 1998 to 2009, 3069 cases of IPD occurred among African-American children less than 18 years of age in the Active Bacterial Core surveillance catchment area. Of these, 127 (4.1%) had SCD identified by medical chart review and 185 (6.0%) had 1 or more IPD risk factors, excluding SCD. Rates of IPD among children with SCD declined by 53% (1118 vs. 530 per 100,000) whereas the overall rates among African-American children declined by 74% (54 to 14 per 100,000). For all time periods, children with SCD and IPD were more likely to be hospitalized (84%-92% vs. 31%-56%) and more likely to die (6%-17% vs. 1%-2%) than children with no risk factors. CONCLUSIONS Although the rate of IPD in children with SCD has dropped dramatically since 7-valent pneumococcal conjugate vaccine introduction, the rate of IPD in children with SCD remains higher than that of the general population of African-American children, pointing to the need for more effective prevention efforts to prevent IPD in children with SCD.
Collapse
|
43
|
Santoro JD, Case AE, El-Dahr J, Kanter J. A case of invasive Streptococcus pneumoniae in an afebrile adolescent with sickle cell disease. Clin Pediatr (Phila) 2013; 52:1173-5. [PMID: 23589086 DOI: 10.1177/0009922813485122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jonathan D Santoro
- 1Department of Pediatrics, Division of Hematology-Oncology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | |
Collapse
|
44
|
Cheng LH, Crim SM, Cole CR, Shane AL, Henao OL, Mahon BE. Epidemiology of Infant Salmonellosis in the United States, 1996-2008: A Foodborne Diseases Active Surveillance Network Study. J Pediatric Infect Dis Soc 2013; 2:232-9. [PMID: 26619477 DOI: 10.1093/jpids/pit020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 03/07/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Infants have increased risk for salmonellosis; but epidemiologic information is limited. METHODS We reviewed Foodborne Diseases Active Surveillance Network reports of laboratory-confirmed non-Typhi Salmonella infections in infants from 1996-2008. We calculated incidence, estimated relative risks, and assessed trends over the duration of the study period, using the first 3 years as reference. RESULTS Average annual incidence of salmonellosis per 100 000 infants was 177.8 (95% confidence interval [CI], 152.7-202.8) in blacks, 129.7 (95% CI, 94.8-164.7) in Asians, and 81.1 (95% CI, 70.2-92.0) in whites. Our analysis of ethnicity independent of race showed salmonellosis incidence of 86.7 (95% CI, 74.6-98.9) in Hispanics and 69.4 (95% CI, 54.8-84.1) in non-Hispanics. Salmonellosis was invasive more often in blacks (9.4%) and Asians (6.4%) than whites (3.6%, P <.001 and P = .01, respectively). Asian infants with salmonellosis were older (median, 31 weeks [range, 0-52]) than black (24 weeks [range, 0-52], P < .001) or white infants (23 weeks [range, 0-52], P < .001). Incidence of all salmonellosis remained stable for whites from 1996-1998 through 2008, but blacks had a sustained decrease, with relative risk of 0.48 (95% CI, .37-.63) in 2008 compared with 1996-1998. However, 2008 incidence remained highest among blacks (141.0 of 100 000 vs 113.5 of 100 000 among whites and 109.9 of 100 000 among Asians). CONCLUSION Black infants had a greater risk of salmonellosis and invasive disease than other racial groups, and despite the greatest decrease in incidence over the study period, they continued to have the highest incidence of salmonellosis. The decrease in salmonellosis in black infants suggests that future improvements may be possible for other population subgroups.
Collapse
Affiliation(s)
- Lay Har Cheng
- Pediatric Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, and
| | - Stacy M Crim
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Conrad R Cole
- Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Ohio
| | - Andi L Shane
- Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Olga L Henao
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara E Mahon
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
45
|
Meier ER, Byrnes C, Lee YT, Wright EC, Schechter AN, Luban NLC, Miller JL. Increased reticulocytosis during infancy is associated with increased hospitalizations in sickle cell anemia patients during the first three years of life. PLoS One 2013; 8:e70794. [PMID: 23951011 PMCID: PMC3737358 DOI: 10.1371/journal.pone.0070794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Among older children with sickle cell anemia, leukocyte counts, hemoglobin, and reticulocytosis have previously been suggested as disease severity markers. Here we explored whether these blood parameters may be useful to predict early childhood disease severity when tested in early infancy, defined as postnatal ages 60–180 days. Study Design Data from fifty-nine subjects who were followed at Children’s National Medical Center’s Sickle Cell Program for at least three years was retrospectively analyzed. Comparisons were made between white blood cell counts, hemoglobin and reticulocyte levels measured at ages 60–180 days and the clinical course of sickle cell anemia during infancy and childhood. Results A majority of subjects had demonstrable anemia with increased reticulocytosis. Only increased absolute reticulocyte levels during early infancy were associated with a significant increase in hospitalization during the first three years of life. Higher absolute reticulocyte counts were also associated with a markedly shorter time to first hospitalizations and a four-fold higher cumulative frequency of clinical manifestations over the first three years of life. No significant increase in white blood cell counts was identified among the infant subjects. Conclusions These data suggest that during early infancy, increased reticulocytosis among asymptomatic SCA subjects is associated with increased severity of disease in childhood.
Collapse
Affiliation(s)
- Emily Riehm Meier
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, District of Columbia, United States of America
- Department of Pediatrics, The George Washington University Medical Center, Washington, District of Columbia, United States of America
| | - Colleen Byrnes
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Y. Terry Lee
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth C. Wright
- Office of the Director, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan N. Schechter
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Naomi L. C. Luban
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, District of Columbia, United States of America
- Department of Pediatrics, The George Washington University Medical Center, Washington, District of Columbia, United States of America
| | - Jeffery L. Miller
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| |
Collapse
|
46
|
Chinen J, Shearer WT. External factors inducing immune deficiency. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
47
|
Martí-Carvajal AJ, Conterno LO. Antibiotics for treating community acquired pneumonia in people with sickle cell disease. Cochrane Database Syst Rev 2012; 10:CD005598. [PMID: 23076916 DOI: 10.1002/14651858.cd005598.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND As a consequence of their condition, people with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community-acquired pneumonia. Many different bacteria can cause this infection and antibiotic treatment is generally needed to resolve it. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. OBJECTIVES To determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with sickle cell disease suffering from community-acquired pneumonia. SEARCH METHODS We searched The Group's Haemoglobinopathies Trials Register (25 May 2012), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched LILACS (1982 to 27 April 2012), African Index Medicus (1982 to 27 April 2012) and WHO ICT Registry (27 April 2012). SELECTION CRITERIA We searched for published or unpublished randomized controlled trials. DATA COLLECTION AND ANALYSIS We intended to summarise data by standard Cochrane Collaboration methodologies, but no eligible randomized controlled trials were identified. MAIN RESULTS We were unable to find any randomized controlled trials on antibiotic treatment approaches for community-acquired pneumonia in people with sickle cell disease. AUTHORS' CONCLUSIONS The updated review was unable to identify randomized controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. Randomized controlled trials are needed to establish the optimum antibiotic treatment for this condition. The trials regarding this issue should be structured and reported according to the CONSORT statement for improving the quality of reporting of efficacy and improved reports of harms in clinical research. Triallists should consider including the following outcomes in new trials: number of days to become afebrile; mortality; onset of pain crisis or complications of SCD following CAP; diagnosis; hospitalisation (admission rate and length of hospital stay); respiratory failure rate; and number of participants receiving a blood transfusion.There are no trials included in the review and we have not identified any relevant trials up to May 2012. We therefore do not plan to update this review until new trials are published.
Collapse
Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador.
| | | |
Collapse
|
48
|
Szczepanek SM, McNamara JT, Secor ER, Natarajan P, Guernsey LA, Miller LA, Ballesteros E, Jellison E, Thrall RS, Andemariam B. Splenic morphological changes are accompanied by altered baseline immunity in a mouse model of sickle-cell disease. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1725-34. [PMID: 23000264 DOI: 10.1016/j.ajpath.2012.07.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 05/30/2012] [Accepted: 07/17/2012] [Indexed: 11/29/2022]
Abstract
Although functional asplenia from infarctions may be a major contributor to increased infectious mortality in sickle-cell disease (SCD), this relationship has not been fully defined. We used the transgenic Berkeley SCD mouse to define blood and splenic immunophenotypic differences in this model compared with C57BL/6 and hemizygous controls. In the serum of SCD mice, we found increased IgG2a and suppressed IgM, IgG2b, and IgA levels. Serum IL-6 levels in SCD mice were elevated, whereas IL-1α, CXCL10, and CCL5 levels were decreased. The blood of SCD mice had higher white blood cell counts, with an increased percentage of lymphocytes and decreases in other leukocytes. Immunophenotyping of lymphocytes revealed higher percentages of CD8(+) and T-regulatory cells and lower percentages of B cells. SCD mouse spleens exhibited histological disorganization, with reduction of defined lymphoid follicles and expansion of red pulp, a greater than fourfold increase in splenic mononuclear cells, marked expansion of the nucleated red blood cell fraction, and B-cell and CD8(+) T-cell lymphopenia. Within the splenic B-cell population, there was a significant decrease in B-1a B cells, with a corresponding decrease in IgA secreting plasma cells in the gut. Confocal microscopy of spleens demonstrated complete disruption of the normal lymphofollicular structure in the white pulp of SCD mice without distinct B, T, and marginal zones. Our findings suggest that altered SCD splenic morphological characteristics result in an impaired systemic immune response.
Collapse
Affiliation(s)
- Steven M Szczepanek
- Adult Sickle Cell Clinical and Research Center, Farmington, Connecticut, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Drépanocytose et salmonelloses invasives ostéo-articulaires. Arch Pediatr 2012; 19:267-70. [DOI: 10.1016/j.arcped.2011.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/10/2011] [Accepted: 12/16/2011] [Indexed: 11/23/2022]
|
50
|
Kateete DP, Kajumbula H, Kaddu-Mulindwa DH, Ssevviri AK. Nasopharyngeal carriage rate of Streptococcus pneumoniae in Ugandan children with sickle cell disease. BMC Res Notes 2012; 5:28. [PMID: 22243524 PMCID: PMC3283489 DOI: 10.1186/1756-0500-5-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/13/2012] [Indexed: 11/15/2022] Open
Abstract
Background Nasopharyngeal carriage of Streptococcus pneumoniae is a determinant for invasive pneumococcal disease, which often complicates homozygous sickle cell disease. Here, we determined the nasopharyngeal carriage rate of S. pneumoniae in Ugandan children with homozygous sickle cell disease, who attended the outpatient Sickle Cell Clinic at Mulago National Referral hospital in Kampala, Uganda. Results S. pneumoniae occurred in 27 of the 81 children with homozygous sickle cell disease (giving a carriage rate of 33%, 27/81). Twenty three children were previously hospitalized of whom S. pneumoniae occurred in only two (9%, 2/23), while among the 58 who were not previously hospitalized it occurred in 25 (43%, 25/58, χ2 = 8.8, p = 0.003), meaning there is an association between high carriage rate and no hospitalization. Two children previously immunized with the pneumococcal conjugate vaccine did not carry the organism. Prior antimicrobial usage was reported in 53 children (65%, 53/81). There was high resistance of pneumococci to penicillin (100%, 27/27) and trimethoprime-sulfamethoxazole (97%, 26/27), but low resistance to other antimicrobials. Of the 70 children without sickle cell disease, S. pneumoniae occurred in 38 (54%, 38/70) of whom 43 were males and 27 females (53% males, 23/43, and 56% females, 15/27). Conclusion Nasopharyngeal carriage of penicillin resistant pneumococci in Ugandan children with homozygous sickle cell disease is high. While nasopharyngeal carriage of S. pneumoniae is a determinant for invasive pneumococcal disease, pneumococcal bacteremia is reportedly low in Ugandan children with sickle cell disease. Studies on the contribution of high carriage rates to invasive pneumococcal disease in these children will be helpful. This is the first report on pneumococcal carriage rate in Ugandan children with sickle cell disease.
Collapse
Affiliation(s)
- David P Kateete
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Box 7072 Kampala, Uganda.
| | | | | | | |
Collapse
|