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J Pediatr ; 130(3): 394-9, Mar. 1997.
Artigo em Inglês | MedCarib | ID: med-2034


OBJECTIVE: To describe the characteristics of salmonella infections in sickle cell disease and to compare the features of osteomyelitis and those with bacteremia/septicemia without obvious bone changes. To search for risk factors for osteomyelitis, and to draw attention to the frequency and significance of salmonella bacteremia/septicemia. STUDY DESIGN:A retrospective review of all salmonella isolations from the blood, pus, or aspirates during a 22-year period. SETTING: The sickle cell clinic at the University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: Patients with all genotypes of sickle cell diseases. Incidence data and the frequency of associated cholelithiasis were derived for the cohort study based on follow-up of all children detected by neonatal screening. MAIN OUTCOME MEASURES: Osteomyelitis and bacteremia/septicemia. RESULTS: Of 55 patients with salmonella infections, 25 initially had osteomyelitis and 27 had bacteremia/septicemia. Three of the first group later had bacteremias for a total of 30 episodes of bacteremia/septicemia, and 4 of the second group later had osteomyelitis for a total of 32 episodes of osteomyelitis. The incidence of salmonella infection was 8.6 percent by 15 years and 96 percent of infections occurred before the age of 10 years. Preceding episodes of avascular necrosis of bone were frequent (p < 0.006) in patients with osteomyelitis. Patients with osteomyelitis were not more prone to gallstones. High fever (temperature > or = 40 degrees C or 104 degrees F) occurred in 41 percent, and occasionally marked bone marrow suppression mimicked the aplastic crisis. Twenty Salmonella serotypes were isolated; Salmonella enteritidis accounted for 36 percent of infections, but no serotype difference occurred between those with osteomyelitis and those with bacteremia/septicemia. There were no deaths in the 32 patients with osteomyelitis, but 7 (23 percent) of 30 patients with septicemia died. CONCLUSIONS: Anti-salmonella prophylaxis requires assessment in the management of bone necrosis. Anti-salmonella agents may be indicated in undiagnosed septic conditions in sickle cell disease pending culture results.(AU)

Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Bacteriemia/microbiologia , Anemia Falciforme/complicações , Osteomielite/microbiologia , Infecções por Salmonella/complicações , Anemia Falciforme/epidemiologia , Bacteriemia/epidemiologia , Colelitíase/complicações , Colelitíase/epidemiologia , Estudos de Coortes , Incidência , Jamaica/epidemiologia , Osteomielite/epidemiologia , Osteonecrose/complicações , Osteonecrose/epidemiologia , Fatores de Risco , Salmonella enteritidis/isolamento & purificação , Infecções por Salmonella/epidemiologia , Esplenectomia
West Indian med. j ; 22(4): 202, Dec. 1973.
Artigo em Inglês | MedCarib | ID: med-6191


The survival of a relatively large group of patients with SS disease beyond the age of 40 years in Jamaica has enabled a number of studies defining the charcteristics of this group. These are important because this group may reflect extremes of pathological change consequent on the long duration of the sickling process. The present paper describes the pattern of bone involvement in patients over the age of 40 years as detected by skeletal surveys of the skull, lumbar spine, pelvis, shoulders, hands, femurs, tibia, fibulae and chest. Radiologial evidence of bone marrow expansion was common and included widening of the marrow cavities, large nutrient foramino, osteoporosis, and coarsencing of the remaining trabecular pattern. Calcified medullary infarction in long bones, which has been considered rare in SS disease, was common in this group. Changes consistent with avascular necrosis of the femoral and humeral heads occurred and were often unsuspected clinically, especially with humeral involvement. Factors leading to these changes are discussed (AU)

Humanos , Pessoa de Meia-Idade , Idoso , Anemia Falciforme , Ossificação Heterotópica , Osteonecrose
J Bone Joint Surg ; 41B(4): 711-8, Nov. 1959.
Artigo em Inglês | MedCarib | ID: med-14477


The bone changes are described in fifty-one cases of sickle cell anaemia, nineteen cases of sickle cell haemoglobin C disease and two cases of sickle cell thalassaemia. Avascular necrosis of the head of the femur has been found in all three types of sickle cell disease. These responded to treatment. The changes found in six cases of Perthes' disease in the negro compared with the changes in avascular necrosis of the head of the femur in sickle cell disease. Hyperplastic bone changes are seen only in true sickle cell anaemia and not in the variants. Secondary osteomyelitis appears to be fairly common in sickle cell anaemia. Organisms of the salmonella group have often been found in these cases (Summary)

Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Anemia Falciforme , Osso e Ossos/anormalidades , Osso e Ossos/diagnóstico por imagem , Doença da Hemoglobina SC , Talassemia , Hiperplasia , Osteonecrose , Infecções , Osteomielite , Salmonella