Bacterial infections in children with sickle cell disease

Children under 5 years old with sickle-cell disease, appear to be susceptible to some bacterial infections. S. pneumoniae and Salmonella sp. are the 2 leading pathogens. Three main mechanisms account for the pathophysiology of these infections : early functional asplenia, under the age of 2 ; reduced serum opsonic activity against encapsulated bacteria ; macrophage saturation secondary to erythrophagocytosis. Pneumococci are responsible for three clinical pictures : pneumonia, meningitis and septicemia, with a high risk of fulminant sepsis. Salmonellae account for the majority of osteomyelitis cases in sicklers. Prophylactic measures include early diagnosis of hemoglobinopathy, regular medical follow-up, and maternal education ; penicillinotherapy and active immunization reduce the risk of severe pneumococcal sepsis. © 1987.