Navalkele Pournima, Özgönenel Bülent, McGrath Eric, Lephart Paul, Sarnaik Sharada
*The Carman and Ann Adams Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit †Pediatric Hematology and Oncology §Pediatric Infectious Diseases, Detroit ∥Department of Microbiology, Detroit Medical Center University Laboratories, Detroit, MI ‡Department of Pediatrics, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, MO.
J Pediatr Hematol Oncol. 2017 Jul;39(5):341-344. doi: 10.1097/MPH.0000000000000858.
Patients with sickle cell disease (SCD) are at risk of fatal sepsis with encapsulated bacteria, such as Streptococcus pneumoniae, because of the inherent autosplenectomy that occurs in SCD. This risk is thwarted with oral penicillin prophylaxis during the first 5 years of life, and with stringent vaccination against S. pneumoniae alongside routine childhood immunization. But compared with the general African American pediatric population, the rate of invasive pneumococcal disease (IPD) in patients with SCD still remains high, resulting in hospitalization and fatality.
Patients with SCD who developed IPD from 2004 up to 2013 were identified using microbiology records. Descriptive analysis of presence of risk factors for IPD, type of SCD, pneumococcal vaccination and prophylaxis status, clinical presentation, microbiological data, and the outcome of IPD was performed.
Eight patients with SCD developed IPD (7 bacteremia and 1 respiratory tract infection). Three of the 8 isolates underwent serotype analysis (15 C in 2 and 15A in 1), none covered with the current vaccination program. One patient had fatal outcome (15A).
Breakthrough cases of IPD may involve nonvaccine isolates, and seem to occur after 5 years of age when oral penicillin prophylaxis has been terminated.
镰状细胞病（SCD）患者由于SCD中发生的固有脾切除，有感染包膜细菌（如肺炎链球菌）导致致命性败血症的风险。在生命的前5年通过口服青霉素预防，以及在常规儿童免疫接种的同时严格接种肺炎链球菌疫苗，可降低这种风险。但与一般非裔美国儿科人群相比，SCD患者的侵袭性肺炎球菌疾病（IPD）发生率仍然很高，导致住院和死亡。
利用微生物学记录确定2004年至2013年期间发生IPD的SCD患者。对IPD危险因素的存在情况、SCD类型、肺炎球菌疫苗接种和预防状况、临床表现、微生物学数据以及IPD的结局进行描述性分析。
8例SCD患者发生IPD（7例菌血症和1例呼吸道感染）。8株分离株中的3株进行了血清型分析（2株为15C，1株为15A），均未被当前疫苗接种计划覆盖。1例患者死亡（血清型15A）。
IPD的突破性病例可能涉及非疫苗分离株，且似乎发生在5岁以后口服青霉素预防终止时。
