SALMONELLA OSTEOARTICULAR INFECTION IN SICKLE CELL DISEASE CHILDREN IN PARIS AND ILE-DE-FRANCE, A 12 YEARS RETROSPECTIVE MULTICENTER STUDY.
Dr. Sophie Dugué
9 slide(s) – English – 2011-06-07
Background and aims: Salmonella osteoarticular infection (OAI) is a severe condition in sickle cell disease (SCD) patients.
Methods: Retrospective analysis of SCD children hospitalized for Salmonella OAI between 1997 and 2009 in 6 hospital of Paris and Ile de France. Salmonella sp. was isolated from the blood, pus or articular aspirates.
Results: 24 cases were analyzed. The median age was 35 months (SD ±59.5, range 8 months to 15 years). Before admission, the most common symptoms were pain (92%), fever (67%) and gastro-intestinal symptoms (46%). At admission, 16 patients (67%) had a single site of osteoarticular infection, 8 patients (33 %) had several concomitant sites of IOA. Arm was involved in 79% of children and the humerus was the most affected bone (50% of children). The initial median CRP was high (124 mg/L, SD ± 88.1, range: 0-275 mg/l). 76% of patients (n=16/21) had positive blood culture, and for 62% of them (n=15/24), osteoarticular samples grew Salmonella sp despite initiation of antibiotic therapy (from 1 to 102 days). Intravenous antibiotics with a third generation cephalosporin and ciprofloxacin were given in all cases during a long period (mean: 96 days, SD±17, range 7 to 81 days). 79% of the patients needed surgical drainage. 50% of patients needed more than one surgical drainage for subsequent arthritis, osteomyelitis or sub periostal abscess.
Conclusions: Salmonella osteoarticular infections in SCD remain a severe disease and require long time treatment and subsequent surgical drainage. Local extension of infection must be closely monitored.