儿童镰状细胞 trait 患者血源性骨关节感染：西非一家三级中心的现实。

Haematogenous osteoarticular infections in paediatric sickle cell trait patients: A reality in a tertiary centre in West Africa.

机构信息

Department of Pediatric Surgery, CHU Yopougon, Abidjan, Côte d'Ivoire.

出版信息

Afr J Paediatr Surg. 2021 Jan-Mar;18(1):62-66. doi: 10.4103/ajps.AJPS_114_20.

DOI:10.4103/ajps.AJPS_114_20

PMID:33595545

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8109757/

Abstract

BACKGROUND

Sickle cell trait (SCT) affects at least 5.2% of the world population, and it is considered asymptomatic by medical practitioners. There is a paucity of data regarding SCT paediatric patients and haematogenous osteoarticular infections (HOAIs). In our practice, some children with SCT presented HOAIs. This study aims to describe the pattern of HOAIs in children with SCT admitted in our unit.

MATERIALS AND METHODS

A single-centre retrospective study of medical records of SCT paediatric patients treated for HOAIs between January 2012 and June 2019 was performed. The data extracted were epidemiologic (gender, age at diagnosis, history of haemoglobinopathy and ethnic group), diagnostic (time to diagnosis, type of infection and fraction of haemoglobin S [HbS] at standard electrophoresis of Hb), germs and complications.

RESULTS

Among 149 patients with haemoglobinopathy treated for HOAIs, 52 have SCT. The prevalence of SCT patients was 34.9%. Thirty-nine (n = 39) records were retained for the study. The average age at diagnosis was 7.18 ± 4.59 years (7 months-15 years). The Malinké ethnic group was found in 22 (56.4%) cases. The mean HbS fraction was 37.2% ± 4.3% (30%-46%). Septic arthritis and osteoarthritis involved the hip in 11 cases, the shoulder in 4 and the knee in 2. Osteomyelitis was acute in 5 cases (11.1%) and chronic in 16 (35.5%). None of the patients has multifocal involvements. Bacterial identification was positive in 17 cases (37.8%). Staphylococcus aureus was involved in 9 cases (52.9%), and in one case, it was Mycobacterium tuberculosis. This patient has abscess of the psoas. No patient was infected by human immunodeficiency virus. The sequelae were joint destruction (n = 2), epiphysiodesis (n = 5) and retractile scars (n = 2).

CONCLUSION

Relatively infrequent in our daily practice, SCT patients present with HOAIs. These infections had characteristics that are not very different from the series of the literature.

摘要

背景

镰状细胞特质（SCT）影响着全球至少 5.2%的人口，且其在医学上被认为是无症状的。目前，有关小儿 SCT 患者和血源性骨髓炎关节感染（HOAI）的数据很少。在我们的实践中，一些 SCT 患儿出现了 HOAIs。本研究旨在描述我们科室收治的 SCT 患儿 HOAIs 的发病模式。

材料和方法

对 2012 年 1 月至 2019 年 6 月期间因 HOAIs 而接受治疗的小儿 SCT 患者的病历进行了单中心回顾性研究。提取的数据包括流行病学（性别、诊断时的年龄、血红蛋白病史和种族）、诊断（诊断时间、感染类型和血红蛋白电泳标准下 HbS 分数）、病原体和并发症。

结果

在 149 例因 HOAIs 而接受治疗的血红蛋白病患者中，有 52 例为 SCT。SCT 患者的患病率为 34.9%。保留了 39 份（n=39）记录用于研究。诊断时的平均年龄为 7.18±4.59 岁（7 个月-15 岁）。Malinké 族在 22 例（56.4%）中发现。平均 HbS 分数为 37.2%±4.3%（30%-46%）。11 例为化脓性关节炎和骨关节炎，累及髋关节；4 例累及肩关节；2 例累及膝关节。5 例（11.1%）骨髓炎为急性，16 例（35.5%）为慢性。无患者存在多灶性受累。17 例（37.8%）有细菌鉴定阳性。9 例（52.9%）为金黄色葡萄球菌感染，1 例为结核分枝杆菌感染。该患者有腰大肌脓肿。无患者感染人类免疫缺陷病毒。后遗症包括关节破坏（n=2）、骺板融合（n=5）和收缩性瘢痕（n=2）。