Splenic abscess and sickle cell disease.

This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease (SCD). All presented with fever and abdominal pain and were found to have a tender enlarged spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation. Although both ultrasound and CT-scan of the abdomen were of diagnostic value, we found CT-scan more accurate and reliable in the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be used routinely in the evaluation of SCD patients who present with fever and abdominal pain, especially if they have a tender enlarged spleen. Diagnostic aspiration under CT-scan or ultrasound guidance should be used in doubtful cases to differentiate between splenic abscess and a large splenic infarct. All our patients were managed by peri operative antibiotics and splenectomy with no mortality. Salmonella was the commonest causative organism. Although CT-guided aspiration of splenic abscess is being advocated recently, we feel splenectomy should be the treatment of choice in patients with SCD as there is no point in preserving a non-functioning spleen that is present in the majority of patients. CT-guided aspiration may be employed as a temporary measure for those patients who are at high surgical risk with unilocular abscess.

The patterns of oropharyngeal microflora in patients with homozygous sickle cell disease.

A controlled prospective study was carried out between 16 July 1991 and 31 January 1992 to evaluate the oropharyngeal flora in homozygous sickle cell disease (SS). Throat swabs for cultures were taken from 163 asymptomatic SS patients attending sickle cell clinics (90 children and 73 adults). Throat swabs were also taken from 84 asymptomatic healthy individuals as a control group (44 children and 40 adults). Group A beta hemolytic Streptococci were isolated from 16.6% of children with SS compared to 4.5% of children without SS (P<0.05). Staphylococcus aureus was isolated from 16.4% of adults with SS compared to 0% of adults without SS (P<0.0001). Group G beta hemolytic Streptococci and nongroupable Streptococci were also isolated from 11% and 13.7% of adults with SS compared to 0% and 2.5% of adults without SS respectively. Several other organisms were isolated only from SS patients. We conclude that the oropharyngeal flora of patients with SS is disturbed. This disturbance may contribute to morbidity of these patients.

Bacteriuria, incidence, causative microorganism, and susceptibility pattern at Qatif Central Hospital.

From August 1988 to January 1990, a total of 13,193 urine specimens were collected from inpatients and outpatients of Qatif Central Hospital, located in the Eastern Province of Saudi Arabia, to determine the incidence of significant bacteriuria, causative microorganisms, and antimicrobial susceptibility. Among these, 1004 specimens (7.6%) showed significant bacteriuria. In community-acquired cases of bacteriuria, the prevalence was greater in female than in male patients. The most common organisms isolated were Escherichia coli and Klebsiella-Enterobacter species. Antimicrobial susceptibility showed high resistance to ampicillin, and therefore we suggest that norfloxacin be considered in empherical therapy, particularly in suspected cases of Pseudomonas urinary tract infections. For patients with an indwelling catheter, it is important to differentiate between colonization and infection before initiating antimicrobial therapy. The difficulties in treating urinary tract infections in patients with an indwelling catheter emphasize the importance of preventive measures.

Incidence of major infection in sickle cell pediatric patients at Qatif Central Hospital.

During the two-year period, 20 Jumada I 1408 (January 9, 1989) to 20 Jumada I 1410 (December 18, 1989), a total of 450 pediatric patients with sickle-cell anemia were admitted to the pediatric ward of Qatif Central Hospital. Thirty-nine patients had a major infection (septicemia, meningitis, or osteomyelitis), with an incidence of 8.6%. During the same period, 3700 non-sickle pediatric patients were admitted and 38 of them had a major infection, with an incidence of 1% (P<0.001). Three patients died in the sickle cell groups, for a case fatality rate of 7.6%, while only one patient in the control group died, for a case fatality rate of 2.6% (P<0.002). Salmonella species were responsible for 12 cases of septicemia and three episodes of osteomyelitis, and Streptococcus pneumoniae was the source in eight cases of septicemia and one case of meningitis in sicklers. Meningitis was caused by different organisms, such as Streptococcus pneumoniae, Salmonella, and Meningococcus. Antibiotics that cover both Salmonella and Streptococcus pneumoniae must be considered in all children with sickle cell anemia who have a febrile illness.