Salmonella septicaemia in sickle-cell disease - abstract

ABSTRACT

The association of Salmonella osteomyelitis with sickle-cell disease is well described. There are few data on the frequency, morbidity or mortality of the salmonella septicaemia which precedes the development of focal bone infection. We have reviewed 34 cases (19 male, 15 female, 29 SS, 3 SB thalassaemia, 1 SC, 1 SO Arab) of salmonella septicaemia without clinical evidence of osteomyelitis. Clinical presentation 44 percent occurred in children between 4 and 7 years old; 17 had fever > 38.5§C associated with painful crisis, 8 had increased jaundice and hepatomegaly, 6 hepatomegaly alone, 3 increased jaundice alone, 6 acute chest syndrome, 6 a diarrhoeal illness and 4 splenic enlargement. Laboratory findings:- 16 had leucocytosis and neutrophilia, 8 erythroid hypoplasia and 3 erythroid aplasia. A variety of salmonella species were isolated. Outcome:- 18 recovered without sequelae. Osteomyelitis developed in 11 (between 5 days and 2 months from positive blood culture). There were 5 fatalities, their illness being characterised by its rapid onset and overwhelming nature. There was no predominant organism responsible for progression to osteomyelitis or death. A review of positive blood culture results (1973 to date) in this clinic shows salmonella species present in 22 percent (this figure excludes patients with salmonella osteomyelitis who subsequently had a positive blood culture). Salmonella septicaemia without progression to osteomyelitis seems more common than previously assumed and we suggest that in dealing with the febrile sick child, in whom blood culture results are not yet available, this association should be borne in mind when selecting antimicrobial therapy (AU)