Abstract

Bacterial infections constitute a major cause of morbidity and mortality in children with
sickle cell anaemia (SCA). The children with SCA are shown to have increased
susceptibility to certain bacterial infections, the pattern of which vary from place to place
and also overtime in the same place. The knowledge of the local pattern will facilitate
empirical management of acutely ill children with SCA. This study therefore aimed to
determine the prevalence and pattern of bacterial isolates and the in vitro antibiotic
sensitivities in children with SCA at Ahmadu Bello University Teaching Hospital
(ABUTH), Zaria.
Children with sickle cell anaemia (SCA) aged between 6 months and 15 years who
presented with axillary temperature of 37.5oC and above were investigated for bacterial
infection. Age-matched children who were also febrile and confirmed by haemoglobin
electrophoresis to have haemoglobin genotype of HbAA were studied as controls. Blood
and urine cultures were obtained and analyzed in all the SCA patients and the controls.
Other cultures were performed as determined by the patients’ clinical presentation. A
total of 232 patients with SCA and another 232 controls with confirmed haemoglobin
electrophoresis of HbAA were studied. Temperature ranged between 37.6oC and 40.0oC,
and 37.5oC and 40.9oC in patients and controls respectively.
Bacterial culture was positive in 34 (14.7%) of children with SCA and 40 (17.2%) of the
controls. Although a lower proportion of patients than controls had bacterial isolates, the
difference was not statistically significant (χ2 = 0.58, df = 1, p = 0.45). Gram-negative
bacteria were the predominant organisms isolated and accounted for 22 (64.7%) of the
cases and 23 (57.5%) in controls. The commonest organisms isolated in SCA patients
were Escherichia coli, Staphylococcus aureus and Klebsiella species accounting for 8
(23.5%), 8 (23.5%) and 5 (14.7%) respectively. Staphylococcus aureus, E. coli,
Klebsiella species and Streptococcus pneumoniae accounted for 10 (25.0%), 8 (20.0%), 7
(17.5%) and 7 (17.5%) in the controls respectively. Bacterial infection was significantly
commoner, isolated from 30 (17.8%) of children less than 5 years, as compared to 4
(6.3%) of those 5 years and older among patients with SCA (χ2 = 3.98, df = 1, p = 0.046).
Pneumonia was the commonest bacterial infection followed by osteomyelitis and then
UTI among patients with SCA with positive bacterial isolates while pneumonia followed
by septicaemia and UTI were the common infections among the controls.
There was prophylactic use of penicillin in 20 (8.6%) children with SCA and none had
positive bacterial culture. The presence of HbF did not affect the rate of bacterial
infection in children with SCA.
This study showed that the aetiological agents of bacterial infection in SCA were similar
to that in children without SCA and that the predominant organisms isolated were most
sensitive to third generation Cephalosporins and Gentamicin.