Pattern of bacterial infections in homozygous sickle cell disease. A report from Saudi Arabia.

Streptococcus pneumoniae is the leading pathogen in children with sickle cell disease. Forty children younger than 20 years of age who had sickle cell disease and septicemia, meningitis, or osteomyelitis/septic arthritis were identified. The causes included Streptococcus pneumoniae (20%) and gram-negative organisms (mainly Salmonella) (70%). The gram-negative infections occurred in the first decade of life in 45% of our patients. We believe that this pattern of infection is different and related to the mild nature of sickle cell disease in our patients and to their persistent splenic function. The administration of pneumococcal vaccination may also have played a role. Microinfarcts of the intestinal wall allow the access of gram-negative organisms to the circulation. In places where gastrointestinal tract infections, especially Salmonella, are common, antibiotic therapy effective against these organisms is recommended initially with adjustment after identification and sensitivities are known.