1. Severe, non specific symptoms in non-typhoidal Salmonella infections in adult patients with sickle cell disease: a retrospective multicentre study.
- Author
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Guery R, Habibi A, Arlet JB, Lionnet F, de Lastours V, Decousser JW, Mainardi JL, Razazi K, Baranes L, Bartolucci P, Godeau B, Galacteros F, Michel M, and Mahevas M
- Subjects
- Adolescent, Adult, Bacteremia microbiology, Bacteremia pathology, Bone and Bones diagnostic imaging, Bone and Bones microbiology, Bone and Bones pathology, Female, Hospitalization, Humans, Joints diagnostic imaging, Joints microbiology, Joints pathology, Male, Middle Aged, Retrospective Studies, Salmonella Infections complications, Salmonella Infections microbiology, Salmonella Infections pathology, Serogroup, Tomography, X-Ray Computed, Young Adult, Anemia, Sickle Cell complications, Bacteremia diagnostic imaging, Salmonella isolation & purification, Salmonella Infections diagnostic imaging
- Abstract
Background: Non-typhoidal salmonellosis (NTS) often occurs in children with sickle-cell disease (SCD) and remains a significant cause of mortality in developing countries. However, there is lack of reports on the clinical presentation, outcome and complications of NTS in adults with SCD., Methods: We performed a chart review between 2006 and 2016 of adults SCD diagnosed with NTS in 3 referral centers monitoring approximately 3500 SCD adults., Results: Twenty-three episodes of NTS were diagnosed among 22 SCD adults. Diagnosis was challenging: 65% (n = 15/23) of patients presented with vaso-occlusive crisis (VOC) and 30% had no fever. Isolated serotypes were: ser. Enteritidis (n = 8), ser. Typhimurium (n = 6), others (n = 3). We identified two patterns of infections: (1) bacteremic NTS (n = 15) with (n = 9) or without secondary foci of infections (n = 6); (2) non-bacteremic NTS with extra-intestinal foci of infection (n = 8), including primary bones/joints infections (n = 5). Half of patients with osteo-articular localization (n = 6/13) had a previous history of osteonecrosis (n = 2) or osteomyelitis (n = 4) at the same site. Morbidity was high, 6 patients (26%) were admitted to the intensive care unit, 14 patients (61%) required RBC transfusion for VOC. Half of the episodes (n = 12) required surgery (n = 10) or interventional radiology (n = 2) to control the infection. One patient presented a relapse of NTS bacteraemia one year after the first episode., Conclusions: Besides bloodstream infections, clinical presentation of NTS in adults with SCD is non-specific at admission. A triad including bacteraemia, secondary focis of infection and bone localizations was observed in 30% of cases.
- Published
- 2018
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