Increased incidence of bacteremia in Haitian children with sickle cell anemia.

Children with sickle cell anemia who were less than 5 years old were observed over a three-year period. Those born to recent Haitian immigrants accounted for 108.4 patient-years. They had seven episodes of Streptococcus pneumoniae bacteremia and five due to Haemophilus influenzae for rates of 6.5 and 4.6 episodes per 100 patient-years, respectively. Children born to American parents were observed for 131.3 patient-years and had three episodes and one episode, respectively, for rates of 2.3 and 0.76 episodes per 100 patient-years. The differences in the overall rate of bacteremia were significant (P less than .015). Leukocyte counts and percentage of erythrocytes with pits, indicating decreased splenic function, were similar for the two groups. The Haitian families had lower annual incomes, but values for both groups were so low that their difference is unlikely to be related to the increased infection rate. Although no cause for the higher rate of bacteremia could be found, the approach to febrile illness in Haitian children with sickle cell anemia should be even more aggressive than usual. In addition to Haemophilus influenzae immunization, antibiotics effective against penicillin-resistant species should be used in the initial antibiotic coverage of their febrile illnesses.