Abstract

Fever is a common symptom in sickle cell patients, and may be a sign of a bacterial or non-bacterial infection.

Objective: Describe the bacterial aetiologies of fever in Sickle Cell Disease (SCD) children consulted or hospitalized, and the extent of confection with other pathogens in children at “Centre for Sickle Cell Disease Research and Control” (CRLD) in Bamako, Mali.

Patients and methods: From April 2014 to January 2016, a bacteriological study was conducted on nasal swabs, blood cultures, urine cultures and malaria diagnosis by Rapid Diagnosis Test (RDT) and Thick smear. All febrile SCD children aged 0.5-15 years seen at CRLD. All morbidity events related to fever were systematically recorded.

Results: Two hundred and thirty one SCD children were enrolled in this study. Urinary tract infections accounted for 14.28%; they were mainly caused by Escherichia coli, Klebsiella pneumonia, and Enterococcus faecalis. Blood cultures were positive for 10 patients (4.32%), and the isolated bacteria were dominated by Salmonella spp. Streptococcus pneumonia was the cause in 2 cases of pneumopathies confirmed by chest X-ray. Klebsiella pneumonia, isolated in naso-pharyngeal specimens, was the cause in a meningoencephalitis case which was gradually cured with antibiotic therapy. Fever was associated with malaria in 6.92% of the cases. Coinfections were frequent. Hospitalization was required for 62.3% of the children. Clinical progress was favourable in 99.2% of the cases; we noted 2 cases of death associated with HIV infection.

Conclusion: Fever in sickle-cell children in Mali is frequently associated with a urinary or invasive infection due to enterobacteria other than Salmonella. However, malaria and viral infections also play a key role in its occurrence, as well as coinfections. This study calls for exploration of immunological characteristics that contribute to the occurrence of bacterial infections in sickle cell children.

Keywords: Bacterial aetiologies; Fever; Sickle cell children; CRLD; Mali