Management of acute chest syndrome in children with sickle cell disease: impact of vaccination and respiratory panels.

INTRODUCTION

Acute chest syndrome (ACS) is a common sickle cell disease (SCD) complication. Infectious pathogens are the most common causes of ACS followed by pulmonary infarction and fat embolism. Infectious pathogens responsible for ACS include viruses, atypical bacteria (Mycoplasma pneumoniae and Chlamydia pneumoniae), and bacteria.

AREAS COVERED: The introduction of conjugate pneumococcal and Hemophilus influenzae b vaccines and implementation of penicillin prophylaxis has significantly reduced, but not eliminated the risk of bacterial infections in this population. However, pneumococcal infections still occur but may further decline with the introduction of expanded conjugate vaccines such as PCV20. The introduction of multiplexed PCR respiratory panels in 2014 has enabled more accurate diagnosis of the infectious pathogens responsible for ACS in children with SCD. Recent studies using these panels have found that the majority of cases of ACS were associated with viral infections. M. pneumoniae and C. pneumoniae infections were uncommon.

EXPERT OPINION: We suggest that empiric antibiotics in children with SCD presenting with ACS be limited to ceftriaxone. Azithromycin should only be used if the respiratory pathogen panel is positive for M. pneumoniae or C. pneumoniae, as azithromycin will remain in the system for over 7-days even if discontinued after one dose.