Anderson, S

Bah, G

Bolarinde, L

Cunnington, A

Darboe, S

Soothill, G

Haematologica

English

Spiral - Imperial College Digital Repository

Abstract Submission25. Sickle cell diseaseEHA-1148INVASIVE BACTERIAL INFECTIONS IN GAMBIAN PATIENTS WITH SICKLE CELL ANEMIA IN AN ERA OFWIDESPREAD PNEUMOCOCCAL AND HAEMOPHILUS INFLUENZA TYPE B VACCINATIONGermander Soothill* 1, Saffiatou Darboe2, Gibril Bah2, Lawal  Bolarinde2, Aubery Cunnington3, Suzanne Anderson21Royal Free Hospital, London, United Kingdom, 2Medical Research Council Unit Gambia, Fajara, Gambia, 3ImperialCollege London, London, United KingdomPlease indicate all of which apply to the presenting author: Medical TraineeBackground: Bacterial infections cause significant morbidity and mortality in patients with sickle cell anemia, especially inpopulations without reliable access to antimicrobial prophylaxis and treatment. The longstanding use of penicillin prophylaxis andvaccination for Streptococcus pneumoniae and Haemophilus influenzae type b in resource-rich settings has minimised the additionalrisk of invasive bacterial infections associated with sickle cell anemia. However, these interventions are not routinely implemented inmuch of Africa, despite this region having the greatest burden of disease, with over 80% of people with sickle cell anemia born on thecontinent. The Gambia has well established vaccination programmes for pneumococcal and Haemophilus influenzae type b, which israre in the region. There is little data on the identity of bacterial infections in African sickle cell anemia populations, and we believe(until this study) there were no data from countries with comprehensive vaccination programmes against Streptococcus pneumoniae and Haemophilus influenzae type b.Aims: Primary: to determine the predominant pathogens causing invasive bacterial infections in a population of sickle cell anemiapatients admitted to the Medical Research Council Unit Gambia. Secondary: to review the characteristics of this sickle cell anemiapopulation. Methods: A retrospective analysis of the clinical and laboratory records relating to 161 admissions of 126 patients with sickle cellanemia admitted to the Medical Research Council Unit Gambia over a five-year period (between April 2010 and April 2015) whenthere was high coverage of pneumococcal and Haemophilus influenzae type b vaccination.Results: Pathogenic bacteria were cultured from blood in 11 of the 131 admissions which had blood cultures taken (8.4%, 95% CI4.5-14.1%). The most frequent organism isolated was Salmonella typhimurium (6/11; 54.5%), followed by Staphylococcus aureus (2/11; 18.2%) and other enteric Gram-negative pathogens (2/11; 18.2%) and there was one case of Haemophilus influenzae non-typeb bacteremia (1/11; 9.1%). No cases of bacteremia caused by Streptococcus pneumoniae or Haemophilus influenzae type b wereidentified.The most common diagnosis causing the admission was vaso-occlusive crisis (53/161; 32.9%), followed by infective complicationsincluding pneumonia (16/161; 9.9%) and osteomyelitis (12/161; 7.5%). The median length of admission was five days and themedian age of patients was five years (IQR: 2-13 years). A new diagnosis of sickle cell anemia was made during the admission in justunder half of patients. Image/Pictures:Summary/Conclusion: The predominance of non-typhoidal Salmonella and other enteric Gram-negatives as the causative agents ofinvasive bacterial infections in our study is striking. Despite its success in resource-rich settings, penicillin may not be the optimalprophylaxis for sickle cell anemia patients already vaccinated for pneumococcal and Haemophilus influenzae type b in The Gambia.For sickle cell anemia patients with suspected bacterial sepsis, empirical treatment must be effective against both non-typhoidal Salmonella and Staphylococcus aureus, and account for local resistance patterns. As other countries in the regionadopt pneumococcal and Haemophilus influenzae type b vaccination programmes, they may see a change in the spectrum ofpathogens found in sickle cell anemia patient populations. Local research may be needed to determine appropriate antimicrobialtreatment and prophylaxis regimens for patients with sickle cell anemia.Keywords: Infection, Prophylaxis, Sickle cell anemia

Invasive bacterial infections in gambian patients with Sickle Cell Anemia in an era of widespread pneumococcal and haemophilus influenza type B vaccination

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Invasive bacterial infections in gambian patients with Sickle Cell Anemia in an era of widespread pneumococcal and haemophilus influenza type B vaccination

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