Septicemia caused by Salmonella infection: an overlooked complication of sickle cell disease.

OBJECTIVES

To describe the characteristics of salmonella infections in sickle cell disease and to compare the features of osteomyelitis and those with bacteremia/septicemia without obvious bone changes. To search for risk factors for osteomyelitis, and to draw attention to the frequency and significance of salmonella bacteremia/septicemia.

STUDY DESIGN

A retrospective review of all salmonella isolations from the blood, pus, or aspirates during a 22-year period.

SETTING

The sickle cell clinic at the University Hospital of the West Indies, Kingston, Jamaica.

SUBJECTS

Patients with all genotypes of sickle cell disease. Incidence data and the frequency of associated cholelithiasis were derived from the cohort study based on follow-up of all children detected by neonatal screening.

MAIN OUTCOME MEASURES

Osteomyelitis and bacteremia/septicemia.

RESULTS

Of 55 patients with salmonella infections, 25 initially had osteomyelitis and 27 had bacteremia/septicemia. Three of the first group later had bacteremias for a total of 30 episodes of bacteremia/septicemia, and 4 of the second group later had osteomyelitis for a total of 32 episodes of osteomyelitis. The incidence of salmonella infection was 8.6% by 15 years, and 96% of infections occurred before the age of 10 years. Preceding episodes of avascular necrosis of bone were more frequent (p < 0.006) in patients with osteomyelitis. Patients with osteomyelitis were not more prone to gallstones. High fever (temperature > or = 40 degrees C or 104 degrees F) occurred in 41%, and occasionally marked bone marrow suppression mimicked the aplastic crisis. Twenty Salmonella serotypes were isolated; Salmonella enteritidis accounted for 36% of infections, but no serotype difference occurred between those with osteomyelitis and those with bacteremia/septicemia. There were no deaths in the 32 patients with osteomyelitis, but 7 (23%) of 30 patients with septicemia died.

CONCLUSIONS

Anti-salmonella prophylaxis requires assessment in the management of bone necrosis. Anti-salmonella agents may be indicated in undiagnosed septic conditions in sickle cell disease pending culture results.