The painful crisis of homozygous sickle cell disease: a study of the risk factors

Some epidemiologic features of the painful crisis in homozygous sickle cell disease were examined in a retrospective study of 995 painful crises. Previously reported associations with cold weather and pregnancy were confirmed. There was a striking increase in painful crises in male patients between the ages of 15 and 25 years, whereas female patients showed little age-related change. The frequency of painful crises correlated positively with hemoglobin levels and reticulocyte counts in female patients. There was a striking increase in painful crises in male patients with hemoglobin levels above 8.5 g/dL (>85 g/L). High hemoglobin levels appear to be an important risk factor for painful crises.(AU)

Topical antibiotics in chronic sickle cell leg ulcers - abstract

Previous studies have indicated that chronic leg ulcers in homozygous sickle-cell (SS) disease usually contain at least one of the common skin pathogens, Staphylococcus aureus, Pseudomonas aeruginosa or Beta haemolytic streptococci. These organisms are usually sensitve t a mixture of neomycin, bacitracin, and polymyxin B, and a randomised controlled crossover trial of these topical antibiotics has been performed in 30 patients with chronic leg ulcers and SS disease. During the first 8 weeks, the mean ulcer area decreased to 51 percent (SD 34 percent) of initial ulcer size in the treatment group compared to 75 percent (SD 37 percent) in the control group, the difference being significant at the 5 percent level. On crossover, accelerated healing was noted in the group previously receiving control therapy, comparison of the healing rates in the two phases showing a highly significant difference (p<0.005). The results suggest that these topical antibiotics may have a place in the therapy of chronic leg ulceration associated with sickle-cell disease (AU)

Bacteriology of sickle cell leg ulcers

The bacteria isolated on aerobic and anaerobic culture were compared in 80 unilateral ulcers in patients with homozygous sickle cell (SS) disease, 62 superficial skin lesions and in 30 diabetic ulcers. In SS disaese the bacterial flora was predominantly aerobic and polymicrobial with Staphylococcus aureus, Psuedomonas aeruginosa and beta haemolytic streptococci being the major isolates. Repeat sampling of 26 ulcers over a period of 23 weeks indicated the persistence of these organisms, either singly or in combination in 21 ulcers.Although a variety of Enterobacteriaceae were recovered no single genus predominated and these organisms did not normally persist on follow up. Simultaneous swabs from bilateral ulcers revealed similar if not identical flora in most cases, indicating good predictive value of a single swab in patients with multiple ulcers. Corynebacterium diphtheriae was recovered from 8 ulcers and 4 of these strains were toxigenic. By contrast the superficial skin lesions grew mainly S. aureus and beta haemolytic streptococci, and the diabetic ulcers yielded a mixed growth of streptococci, Enterobacteriaceae and anaerobes. The recovery of known skin pathogens from most sickle cell leg ulcers, the persistence of these organisms, and the presence of associated lymphadenopathy, indicates that infection may be a significant factor in the pathology of these lesions

Corynebacterium diptheriae in sickle cell leg ulcers in Jamaica

Bacterial cultures of leg ulcers from 90 patients with SS disease demonstrated 9 with Corynebacterium diptheriae. Follow-up swabs revealed a further 4 cases. All strains were of the gravis variety and 9 of the 13 isolates were toxigenic. The affected ulcers were not remarkable in appearance and no patient was clinically toxic. A variety of other organisms were isolated from the wound, most commonly Pseudomonas aeruginosa. Carriage of C. diptheriae tended to be brief. The significance and therapy of cutaneous diptheria are reviewed (AU)

Bacteriology of sickle cell leg ulcers - abstract

Leg ulceration affects nearly 75 percent of Jamaican adults with homozygous sickle cell (SS) disease. Secondary infection is common but little information on the bacterial flora is available in the literature. The present study was designed to collect information and to define a possible role for antimicrobial therapy in such ulcers. During the period 29.10.82 to 21.1.83 all patients with leg ulcers attending the sickle cell clinic of the University of the west Indies had swabs taken for bacterial studies. There were 50 patients (45 SS; 1 SC) in whom single swabs were taken in 33 and repeat swabs 1 - 11 weeks later in 17. Of the initial swabs, one yielded no bacterial growth and the remainder a median of two organisms per swab. These organisms included Pseudomonas aeruguinosa in 28 (56 percent), Staphylococcus aureus in 27 (54 percent), á haemolytic Streptococcus in 21 (42 percent), Proteus species in 9 (18 percent) and other gram negative bacilli in 14 (28 percent). Of the haemolytic streptococci, 8 were Lancefield group A, 7 Group G and 6 Group C. Of the Proteus organisms, 6 were Proteus mirablis and 3 Proteus vulgaris. Three swabs (6 percent) grew corynebacterium diphtheriae gravis, two of which were toxogenic strains. Notable by their infrequency were E Coli (no isolates), Klebsiella (one isolate), Salmonella species (no isolates), and anaerobes (no isolates). Repeat swabs showed the persistence of the same skin pathogen in 16 cases. The high incidence of known skin pathogens with 98 percent swabs yielding one or more of Staphylococcus aureus, Pseudomonas aeruginosa, beta haemolytic streptococci or Corynebacterium diphtheriae raises the possibility of a bacterial role in prevention of healing of sickle cell leg ulcers (AU)