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 OJPed  Vol.4 No.4 , December 2014
Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon
Abstract: Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clinical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Complete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.
Cite this paper: Koko, J. , Gahouma, D. , Ategbo, S. , Seilhan, C. , Pambou, A. and Moussavou, A. (2014) Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon. Open Journal of Pediatrics, 4, 262-268. doi: 10.4236/ojped.2014.44036.
References

[1]   Modell, B. and Darlison, M. (2008) Global Epidemiology of Haemoglobin Disorders and Derived Service Indicators. Bulletin of the World Health Organization, 86, 480-487.
http://dx.doi.org/10.2471/BLT.06.036673

[2]   Labie, D. and Elion, J. (2010) La drépanocytose: Problème de l’Afrique. Médecine Tropicale, 70, 449-453.

[3]   Diagne, I., Diagne-Gueye, N.D.R., Signate-Sy, H., et al. (2003) Prise en charge de la drépanocytose chez l’enfant en Afrique: expérience de la cohorte de l’h?pital d’enfants Albert Royer de Dakar. Médecine Tropicale, 63, 513-520.

[4]   Grosse, S.D., Odame, I., Atrash, H.K., Amendah, D.D., Piel, F.B. and Williams, T.N. (2011) Sickle Cell Disease in Africa. A Neglected Cause of Early Childhood Mortality. American Journal of Preventive Medicine, 41, S398-S405.

[5]   Gendrel, D., Nardou, M. and Gendrel, C. (1991) Le poids de la drépanocytose dans un service de pédiatrie africain. In: Galactéros, F. and Dormont, S., Eds., Drépanocytose et santé publique, Inserm/Centre international de l’enfance, Paris, 153-154.

[6]   Thuillez, V., Ditsambou, V., Mba, J.R. Mba Meyo, S. and Kitengue, J. (1996) Aspects actuels de la drépanocytose chez l’enfant au Gabon. Archives de Pédiatrie, 3, 668-674.
http://dx.doi.org/10.1016/0929-693X(96)87087-4

[7]   Bégué, P. and Castello-Herbreteau, B. (2001) Infections graves chez l’enfant drépanocytaire: Aspects cliniques et prévention. Archives de Pédiatrie, 8, 732S-741S.
http://dx.doi.org/10.1016/S0929-693X(01)80189-5

[8]   Koko, J., Kani, F., Reymond-Yéni, A., Onewin-Andjanga, G., Moussavou, A. and Gahouma, D. (1999) Infections bactériennes chez l’enfant drépanocytaire à Libreville. Archives de Pédiatrie, 6, 1131-1132. http://dx.doi.org/10.1016/S0929-693X(00)86994-8

[9]   Koko, J., Dufillot, D., M’ba-Meyo, J., Gahouma, D. and Kani, F. (1998) Mortalité des enfants drépanocytaires dans un service de pédiatrie en Afrique Centrale. Archives de Pédiatrie, 5, 965-969. http://dx.doi.org/10.1016/S0929-693X(98)80003-1

[10]   Wethers, D.L. (2000) Sickle Cell Disease in Childhood: Part II. Diagnosis and Treatment of Major Complications and Recent Advances in Treatment. American Family Physician, 62, 1309-1314.

[11]   Ramakrishnan, M., Moisi, J.C., Klugman, K.P., Iglesias, J.M., Grant, L.R., Mpoudi-Etame, M. and Levine, O.S. (2010) Increased Risk of Invasive Bacterial Infections in African People with Sickle-Cell Disease: A Systematic Review and Meta-Analysis. Lancet Infectious Diseases, 10, 329-337.
http://dx.doi.org/10.1016/S1473-3099(10)70055-4

[12]   Di Nuzzo, D.V.P. and Fonseca, S.F. (2004) Sickle Cell Disease and Infection. Jornal de Pediatria (Rio de Janeiro), 80, 347-354. http://dx.doi.org/10.2223/JPED.1218

[13]   Chakravorty, S. and Williams, T.N. (2014) Sickle Cell Disease: A Neglected Chronic Disease of Increasing Global Health Importance. Archives of Disease in Childhood, Published Online.

[14]   Rahimy, M.C., Gangbo, A., Ahouignan, G., Anagonou, S., Boco, V. and Alihonou, E. (1999) Outpatient Management of Fever in Children with Sickle Cell Disease (SCD) in an African Setting. American Journal of Hematology, 62, 1-6. http://dx.doi.org/10.1002/(SICI)1096-8652(199909)62:1<1::AID-AJH1>3.0.CO;2-C

[15]   Tshilolo, L., Aissi, L.M., Lukusa, D., Kinsiama, C., Wembonyama, S., Gulbis, B. and Vertongen, F. (2009) Neonatal Screening for Sickle Cell Anaemia in the Democratic Republic of the Congo: Experience from a Pioneer Project on 31 204 Newborns. Journal of Clinical Pathology, 62, 35-38. http://dx.doi.org/10.1136/jcp.2008.058958

[16]   McIntosh, S., Rooks, Y., Ritchey, A.K. and Pearson, H.A. (1980) Fever in Young Children with Sickle Cell Disease. The Journal of Pediatrics, 96, 199-204.
http://dx.doi.org/10.1016/S0022-3476(80)80802-X

[17]   Wierenga, K.J.J., Hambleton, I.R., Wilson, R.M., Alexander, H., Serjeant, B.E. and Serjeant, G.R. (2001) Significance of Fever in Jamaican Patients with Homozygous Sickle Cell Disease. Archives of Disease in Childhood, 84, 156-159. http://dx.doi.org/10.1136/adc.84.2.156

[18]   Narang, S., Fernandez, I.D., Chin, N., Lerner, N. and Weinberger, G.A. (2012) Bacteremia in Children with Sickle Hemoglobinopathies. Journal of Pediatric Hematology/Oncology, 34, 13-16.
http://dx.doi.org/10.1097/MPH.0b013e318240d50d

[19]   Bansil, N.H., Kim, T.Y., Tieu, L. and Barcega, B. (2013) Incidence of Serious Bacterial Infections in Febrile Children with Sickle Cell Disease. Clinical Pediatrics (Philadelphia), 52, 661-666.
http://dx.doi.org/10.1177/0009922813488645

[20]   Shihabuddin, B.S. and Scarfi, C.A. (2014) Fever in Children with Sickle Cell Disease: Are All Fevers Equal? Journal of Emergency Medicine, 47, 395-400.
http://dx.doi.org/10.1016/j.jemermed.2014.06.025

[21]   Gendrel, D., Kombila, M., Nardou, M., Gendrel, C., Djouba, F. and Richard-Lenoble, D. (1991) Protection against Plasmodium falciparum Infection in Children with Hemoglobin S. The Pediatric Infectious Disease Journal, 10, 620-621. http://dx.doi.org/10.1097/00006454-199108000-00013

[22]   Williams, T.N., Mwangi, T.W., Wambua, S., Alexander, N.D., Kortok, M., Snow, R.W. and Marsh, K. (2005) Sickle Cell Trait and the Risk of Plasmodium falciparum Malaria and Other Childhood Diseases. The Journal of Infectious Diseases, 192, 178-186. http://dx.doi.org/10.1086/430744

[23]   Aloni, M.N., Tshimanga, B.K., Ekulu, P.M., Ehungu, J.L.G. and Ngiyulu, R.M. (2013) Malaria, Clinical Features and Acute Crisis in Children Suffering from Sickle Cell Disease in Resource-Limited Settings: A Retrospective Description of 90 Cases. Pathogens and Global Health, 107, 198-201.
http://dx.doi.org/10.1179/2047773213Y.0000000089

[24]   McAuley, C.F., Webb, C., Makani, J., Macharia, A., Uyoga, S., Opi, D.H., et al. (2010) High Mortality from Plasmodium falciparum Malaria in Children Living with Sickle Cell Anemia on the Coast of Kenya. Blood, 116, 1663-1668. http://dx.doi.org/10.1182/blood-2010-01-265249

[25]   Williams, T.N., Uyoga, S., Macharia, A., Ndila, C., McAuley, C.F., Opi, D.H., et al. (2009) Bacteraemia in Kenyan Children with Sickle-Cell Anaemia: A Retrospective Cohort and Case-Control Study. The Lancet, 374, 1364-1370. http://dx.doi.org/10.1016/S0140-6736(09)61374-X

[26]   Baskin, M.N., Goh, X.L., Heeney, M.M. and Harper, M.B. (2013) Bacteremia Risk and Outpatient Management of Febrile Patients with Sickle Cell Disease. Pediatrics, 131, 1035-1041.
http://dx.doi.org/10.1542/peds.2012-2139

[27]   De Montalembert, M. and Tshilolo, L. (2007) Les progrès thérapeutiques dans la prise en charge de la drépanocytose sont-ils applicables en Afrique subsaharienne? Médecine Tropicale, 67, 612-616.

[28]   Quinn, C.T., Rogers, Z.R. and Buchanan, G.R. (2004) Survival of Children with Sickle Cell Disease. Blood, 103, 4023-4027. http://dx.doi.org/10.1182/blood-2003-11-3758

[29]   Ware, R.E. (2013) Is Sickle Cell Anemia a Neglected Tropical Disease? PloS Neglected Tropical Diseases, 7, e2120. http://dx.doi.org/10.1371/journal.pntd.0002120

 
 
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