Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination

2003 ◽  
Vol 143 (4) ◽  
pp. 438-444 ◽  
Author(s):  
Thomas V Adamkiewicz ◽  
Sharada Sarnaik ◽  
George R Buchanan ◽  
Rathi V Iyer ◽  
Scott T Miller ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Pneumococcal Infections ◽  
Penicillin Prophylaxis

scholarly journals Prevalence of Severe Bacterial Infection in Febrile Children with Sickle CELL Disease in the Era of Pneumococcal Conjugate Vaccine 13

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3665-3665
Author(s):  
Gloria Contreras-Yametti ◽  
Custodio Haidee ◽  
Hamayun Imran
Keyword(s):  
Sickle Cell Disease ◽  
Conjugate Vaccine ◽  
Sickle Cell ◽  
Pneumococcal Conjugate Vaccine ◽  
Univariate Analysis ◽  
Cell Disease ◽  
Pneumococcal Infections ◽  
Patient Disposition ◽  
Penicillin Prophylaxis ◽  
Febrile Events

Abstract Introduction The incidence of invasive pneumococcal infections in patients with sickle cell disease (SCD) decreased after introduction of penicillin prophylaxis and pneumococcal conjugate vaccine (PCV). However, the decrease in pneumococcal infections alone may not necessarily mean an overall decrease in severe bacterial infections (SBI). In a previous publication, we reported a 0.4 % prevalence of pneumococcal bacteremia following introduction of PCV 13. In the current study, we aimed to define the prevalence of SBI and hospitalization in febrile patients in the same cohort in the later years. Methods We performed a retrospective study of patients with SCD <18 years old presenting with fever to University of South Alabama Children's and Women's Hospital from January 2014 to June 2017. SBI was defined as: bacteremia, pneumonia, pyelonephritis, meningitis, osteomyelitis and abscess (superficial and deep). Univariate analysis and multivariate logistic regression were used to determine factors associated with patient disposition as well as presence of SBI. Results There were 258 febrile events in 120 patients resulting in 187 (72%) admissions (figure 1). SBI was seen in 12% of admissions with uncomplicated community acquired pneumonia being the most common. The prevalence of bacteremia was 1.6% with single cases of pneumococcus, E. coli, and H. influenzae bacteremia. Younger age, high fever, and splenectomy were associated with hospitalization (p<0.05). However, only C reactive protein was associated with SBI (p<0.02). Viral infection was diagnosed in 80% of outpatients but 87% were given antibiotics. Among inpatients, all received parenteral antibiotics, and 67% were assessed to have viral illness, although only 23% had a virus identified. Pneumococcal vaccination status was satisfactory in 77% of our sample while compliance rate with penicillin prophylaxis was >85% in both inpatient and outpatient groups. Conclusion Although majority of febrile events were due to viral infections, 3 of four febrile episodes in our cohort resulted in hospitalization. A small proportion of patients had SBI and a much smaller proportion had bacteremia. These findings support early virus identification which can have implications on patient discharge disposition and antibiotic use. Further studies looking at risk stratification of febrile patients with SCD are needed to encourage outpatient management without compromising safety. Figure 1. Figure 1. Disclosures Imran: Novo Nordask: Speakers Bureau.

Pneumococcal infections and sickle cell disease

JAMA ◽  
1982 ◽  
Vol 247 (20) ◽  
pp. 2782b-2782
Author(s):  
J. M. Eustatia
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Pneumococcal Infections

scholarly journals Penicillin prophylaxis in children with sickle cell disease in Brent.

BMJ ◽  
1991 ◽  
Vol 302 (6783) ◽  
pp. 989-990 ◽  
Author(s):  
D Cummins ◽  
R Heuschkel ◽  
S C Davies
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Penicillin Prophylaxis

scholarly journals Serum Opsonic Activity in Infants with Sickle-Cell Disease Immunized with Pneumococcal Polysaccharide Protein Conjugate Vaccine

2000 ◽  
Vol 7 (5) ◽  
pp. 788-793 ◽  
Author(s):  
Anna Nowak-Wegrzyn ◽  
Jerry A. Winkelstein ◽  
Andrea J. Swift ◽  
Howard M. Lederman
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Booster Dose ◽  
Cell Disease ◽  
Pneumococcal Infections ◽  
Opsonic Activity ◽  
Protein Conjugate ◽  
Healthy Infants ◽  
Antibody Levels ◽  
Biologic Function

ABSTRACT Pneumococcal infections are an important cause of morbidity and mortality in children with sickle-cell disease (SCD). Pneumococcal conjugate vaccines (PCVs) are immunogenic in healthy infants <2 years of age but have not been evaluated in young children with SCD. Infants with SCD were immunized with a 7-valent PCV (Wyeth-Lederle Vaccines & Pediatrics) at 2, 4, and 6 months of age. A booster dose of 23-valent pneumococcal polysaccharide vaccine (PPV; Pnu-Immune) was administered at 24 months of age. Antipneumococcal type 6B and 14 serum opsonic activity was measured to assess the biologic function of the antibody. Following the administration of three doses of PCV, opsonic activity against serotype 6B increased from 4.8% at 2 months to 33.5% at 7 months, with a subsequent decline to 8.1% at 12 months and 7.5% at 24 months and with an increase to 30.7% at 25 months after administration of a booster dose of PPV. Similar trends were seen with serotype 14 (opsonic activities were 9.4% at 2 months, 24.9% at 7 months, 16.5% at 12 months, and 12.6% at 24 months, and the opsonic activity was 27.3% 1 month after the administration of PPV). Serum opsonic activity correlated with antibody levels for both serotypes. PCV induces serum opsonic activity in infants with SCD. Antipneumococcal serum opsonic activity correlates with antibody levels.

scholarly journals Sickle cell disease: a comprehensive program of care from birth

Hematology ◽  
2019 ◽  
Vol 2019 (1) ◽  
pp. 490-495
Author(s):  
Mariane de Montalembert ◽  
Léon Tshilolo ◽  
Slimane Allali
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Health Care Professionals ◽  
Improve Patient Care ◽  
The United States ◽  
Cell Disease ◽  
Pneumococcal Infections ◽  
African Countries ◽  
Early Management ◽  
High Resource

Abstract As more children are appropriately being diagnosed, the burden of sickle cell disease is increasing greatly in Africa and in high-resource countries such as the United States and Europe. Early management is mandatory, but newborn screening is not implemented everywhere. Point-of-care testing devices are increasingly being used in low-resource countries, showing good sensitivity and specificity. Because the diagnosis is often traumatic for the families, the announcement should be made by an experienced person. The development of care networks is urgently required to facilitate daily life by defining the respective functions of nearby and highly specialized health care professionals, who should work in close collaboration. Comprehensive programs targeting the prevention of pneumococcal infections, malaria in infested zones, and stroke may substantially improve patient care. Hydroxyurea is increasingly being used, but whether it should be systematically prescribed in all children is debated, and its access is still limited in many African countries. Yearly checkups should be organized early in life in order to screen and then treat any organ impairment. Enhancing parents’ and patients’ knowledge and skills is mandatory.

scholarly journals Outcomes of Splenectomy in Children with Sickle Cell Disease

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1382-1382
Author(s):  
Peter B. Soh ◽  
Abdul H. Siddiqui
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Doppler Ultrasonography ◽  
Beta Thalassemia ◽  
Blood Transfusions ◽  
Cell Disease ◽  
Splenic Sequestration ◽  
Operative Complications ◽  
The Mean ◽  
Penicillin Prophylaxis

Abstract Background Children with splenic sequestration, related to sickle cell disease, are managed acutely with blood transfusions followed by an elective splenectomy to prevent recurrent episodes. The objective of this study was to review the outcomes of splenectomy in children with sickle cell disease as a single center experience. Methods A retrospective chart review of children with sickle cell disease who had splenectomy between 1999 and 2014 at the University of South Alabama was performed. Data on demographics, sequestration episodes, post-operative complications, bacteremia, transcranial doppler ultrasonography and death were collected. Results A total of 52 patients (36 with Hemoglobin SS, 7 with Hemoglobin SC, 5 with S-Beta Thalassemia Plus, and 4 with S-Beta Thalassemia Zero) received splenectomy during the study period. Mean age at first splenic sequestration event was 39 months. The mean age of splenectomy was 5 years (Minimum: 18 months; Maximum: 18 years). There were 24 males and 28 females. Over 95 percent of patients were on penicillin prophylaxis. In only 73 percent of patients, proof of completed vaccination including pneumococcal polysaccharide, pneumococcal conjugate and meningococcal conjugate vaccines, could be found. Average post-splenectomy follow-up was 7.4 years. The post-operative complications included fever in 4 patients, acute chest syndrome in 4 patients, lobar pneumonia in 2 patients, pleural effusion in 1 patient, atelectasis on chest radiograph in 2 patients and surgical wound abscess in 1 patient. One patient had an intra-abdominal bleed which required reoperation. The average number of hospitalizations for vaso-occlusive pain crises was 3.3 per year prior to splenectomy and 2.2 per year during the 2 years following splenectomy (p=0.04). Mean platelet count before splenectomy was 267/m3 compared to 533/m3 at 1 year after splenectomy (p<0.05). Differences in mean white blood cell and reticulocyte counts before and after splenectomy were not statistically significant. Only 2 of the patients had culture proven bacteremia, but both of them occurred prior to their splenectomy. One of the patients grew Staphylococcus hominis and the other grew Staphylococcus lugdunensis. No true bacteremia were reported in patients after splenectomy. None of the patients developed stroke while four (~8%) patients developed critical transcranial doppler ultrasonography velocities (≥200 cm/s) and were started on chronic blood transfusions. The mean time-average maximum velocity before splenectomy was 127 cm/sec and increased to 151 cm/sec at 2 years after splenectomy (p=0.002). Among the splenectomized patients, 18 (35%) of them had been started on Hydroxyurea. Discussion Our results indicate that with proper vaccination and penicillin prophylaxis, the risk of infection after splenectomy can be controlled. The mean hemoglobin levels did not change after splenectomy but our patients had fewer hospitalizations for pain crises after splenectomy. The cerebral blood flow velocity increased after splenectomy. This might imply that more patients will require chronic blood transfusions for stroke prevention after splenectomy. We conclude that splenectomy is a safe and effective modality for management of life threatening splenic sequestrations in children with sickle cell disease. Disclosures No relevant conflicts of interest to declare.

Penicillin Prophylaxis in Children with Sickle Cell Disease

2010 ◽  
Vol 15 (3) ◽  
pp. 152-159 ◽  
Author(s):  
Mary Petrea Cober ◽  
Stephanie J. Phelps
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pneumococcal Infection ◽  
Cell Disease ◽  
Older Children ◽  
American Academy Of Pediatrics ◽  
Increased Risk ◽  
Potential Problems ◽  
Life Threatening ◽  
Penicillin Prophylaxis

Abstract Children who have sickle cell disease and are under the age of five years are at increased risk of life-threatening pneumococcal infection due to absent or non-functional spleens and a decreased immune response. To prevent pneumococcal infection, the American Academy of Pediatrics recommends the use of penicillin prophylaxis in children with sickle cell disease under the age of five and in older children who have had a previous severe pneumococcal infection or have functional/surgical asplenia. These recommendations are based on two landmark studies, the first evaluating the effectiveness of penicillin prophylaxis and the second evaluating the duration of prophylaxis. Although the mortality rate from infection has been reduced following penicillin prophylaxis, altered immunologic response and penicillin-resistant S. pneumoniae remain a concern. This paper will review the literature that supports the use of penicillin prophylaxis, potential problems associated with prolonged therapy and recommendations for prophylaxis.

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