RESUMO
Salmonella infections remain a significant cause of morbidity and mortality in patients with sickle cell disease. In Jamaica, 16 episodes of systemic Salmonella infection were recognised in 308 children with sickle cell disease followed prospectively in a cohort study from birth. There were eight cases with osteomyelitis, seven with septicaemia, and one with meningitis. Salmonella dactylitis and dactylitis owing to avascular bone necrosis showed that children with osteomyelitis had significantly higher fever, prolonged history and fluctuant swelling. Fever above 38.5§C occurred in four of five children with Salmonella dactylitis, but in only one of 59 with uncomplicated dactylitis (P=0.01). Chloramphenicol and co-trimoxazole were both effective for systemic infection, and ampicillin alone was inadequate. Three deaths occurred, two from septicaemia and one from meningitis. (AU)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Masculino , Feminino , Anemia Falciforme/complicações , Infecções por Salmonella/etiologia , Jamaica , Meningite/etiologia , Osteomielite/etiologia , Estudos Prospectivos , Sepse/etiologiaRESUMO
Gallstones were detected by ultrasonography in 30/226 (13 per cent) children with SS disease, aged 5-13 years, participating in a cohort study from birth. Children with gallstones had significantly lower total haemoglobin and foetal haemoglobin and higher bilirubin levels. Further analysis revealed that the apparent effects of Hb and HbF were secondary to their relationship with bilirubin levels. Abdominal pain crises were significantly associated with gallstones but both factors appeared to reflect an increased clinical severity and were probably not casually related. No patient had symptoms specific for gallstones. An association with abdominal pain crisis should not, of itself, be considered an indication for surgery (AU)
Assuntos
Humanos , Criança , Anemia Falciforme , Colelitíase/diagnóstico por imagem , Dor Abdominal , BilirrubinaRESUMO
The aplastic crisis is a temporary self-limited erythropietic maturation arrest which, because of the short red cell survival in homozygous sickle-cell (SS) disease, results in rapid fall in haemoglobin level. These aplastic crises occur in epidemics, predominantly affect children, frequently involve siblings simultaneously, and often follow an upper respiratory tract type of infection. Recent evidence suggests that these events may follow human parvovirus (HPV) infection and the role of HPV infection has been examined in the last three epidemics of aplastic crises observed among SS patients in Jamaica. Eighteen patients were affected in the 1973-1975 epidemics, 45 in the 1979-1981 epidemic, and 41 so far in an epidemic in 1984-1985. Serological studies have been possible in 73 patients and in 69 (95 percent) there was evidence consistent with recent HPV infections. This infection appears to confer long-lasting immunity, and recurrent attacks of aplastic crisis have never been described. These data suggest that a parvovirus vaccine may be beneficial in the prevention of aplastic crises (AU)