ACS in children with sickle cell anaemia in Uganda: prevalence, presentation and aetiology

Abstract

ACS (ACS) is a serious complication of sickle cell anaemia (SCA). We set out to describe the burden, presentation and organisms associated with ACS amongst children with SCA attending Mulago Hospital, Kampala, Uganda. In a cross-sectional study, 256 children with SCA and fever attending Mulago Hospital were recruited. Chest X-rays, blood cultures, complete blood count and sputum induction were performed. Sputum samples were investigated by Ziehl-Nielsen staining, culture and DNA polymerase chain reaction (PCR) for Chlamydia pneumoniae. Of the 256 children, 22·7% had ACS. Clinical and laboratory findings were not significantly different between children with ACS and those without, besides cough and abnormal signs on auscultation. Among the 83 sputum cultures Streptococcus pneumoniae (12%) and Moraxella spp (8%), were the commonest. Of the 59 sputa examined with DNA PCR, 59·3% were positive for Chlamydia pneumoniae. Mycobacterium tuberculosis was isolated in 6/83 sputa. These results show that one in 5 SCA febrile children had ACS. There were no clinical and laboratory characteristics of ACS, but cough and abnormalities on auscultation were associated with ACS. The high prevalence of Chlamydia pneumoniae in children with ACS in this setting warrants the addition of macrolides to treatment, and M. tuberculosis should be differential in sub-Saharan children with ACS.

Acute chest syndrome in pediatric sickle cell disease: A 19-year tertiary center experience

“…'s study, which reported a median WBC count of 24.9 k/μL (IQR, 18.1–29.8 k/μL). [ 20 ] Besides, Jaiyesimi and Kasem reported a mean value of WBC at ACS of 15.37 ± 8.39 k/μL (compared to 10.73 ± 3.00 k/μL at steady-state), and Al-Dabbous reported a mean WBC count of 17.8 k/μL at the time of ACS (compared to 11.4 k/μL at baseline). [ 13 ] The observed elevated level of WBC count can be attributed to infections being the common causes of ACS, especially among children.…”