TITLE:
Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon
AUTHORS:
Jean Koko, Daniel Gahouma, Simon Ategbo, Cathérine Seilhan, Armelle Pambou, André Moussavou
KEYWORDS:
Sickle-Cell Disease, Fever, Malaria, Acute Lower Respiratory Infections (ALRI), Gabon
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.4,
November
13,
2014
ABSTRACT: Sickle-cell disease (SCD) represents a
substantial public health problem in Gabon. Fever is one of the principal
reasons for the hospitalization of children afflicted by major sickle-cell
disorder, since it can be a clinical reflection of severe infections that have
the potential to become life threatening. Objectives: Identification of the main causes of
fever in children with SCD in our clinical setting, with the aim of optimizing
treatments. Patients and Methods: This is a retrospective study of all
the medical files for children with SCD that were admitted to our ward, over a
two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those
files that contained at least the following five fundamental medical
examinations were retained for further evaluation: Complete Blood Count (CBC),
blood smear, blood culture, urine culture and chest X-ray. Out of a total of
118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever.
The medical files of 11 patients were deemed to be unusable. Seventy-six
episodes of fever were observed among 69 children, of which 42 were male and 27
female (sex ratio of 1.5). Among these, seven (10%) were admitted twice.
Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The
most common accompanying symptoms were bone and joint pain (43.4%), asthenia
(22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause
of the fever could not be pinpointed in 29 cases (38.1%). Aside from these
cases, the main causes of fever were malaria (30.3%) and bronchopulmonary
infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections,
43.5% of the cases involving malaria and 55.2% of cases of
fever with unknown cause. Hemoglobin levels were For the majority of fever episodes, the
underlying cause could not be determined. Nonetheless, malaria was identified
as one of the principal identifiable causes of fever among children with SDC in
Libreville. Treatment for malaria upon admission, and the promotion of
preventative measures, therefore seems to be appropriate for our clinical
setting. In light of the large number of unresolved cases, systematic
prescription of broad-spectrum antibiotics may also be called for.