Significance of fever in Jamaican patients with homozygous sickle cell disease.
OBJECTIVE
To investigate the cause and outcome of high fever in Jamaican children with homozygous sickle cell disease.


METHODS
Retrospective review of febrile episodes in a three year period (1 September 1993 to 31 August 1996).


METHODS
Sickle cell clinic, an outpatient clinic in Kingston run by the Medical Research Council Laboratories (Jamaica).


METHODS
Patients with homozygous sickle cell disease under 17 years of age presenting with an axillary temperature >/= 39.0 degrees C (102.4 degrees F).


METHODS
Diagnosis, death.


RESULTS
There were 165 events in 144 patients (66 (45.8%) boys) with a median age of 6.1 years. Bacteraemia was found in 10 (6.1%) events (three Streptococcus pneumoniae, two Haemophilus influenzae type b, two Salmonella sp, one Escherichia coli, one Enterobacter sp, and one Acinetobacter sp), and urinary tract infections in four (2.4%). All cultures of cerebrospinal fluid were sterile. Acute chest syndrome occurred in 36 (21.8%) events. A painful crisis was associated with 45 (27.3%) events and was the only pathology identified in 20 events (12.1%). Hospital admission was necessary in 66 cases including all those with bacteraemia and 31 with acute chest syndrome. There were two deaths: a 5 year old boy with septic shock associated with H influenzae septicaemia, and a 3 year old boy with the acute chest syndrome.


CONCLUSIONS
Painful crisis and acute chest syndrome were the most common complications associated with high fever, but other important associated features included bacteraemia and urinary tract infection. Enteric Gram negative organisms accounted for 50% of positive blood cultures.
Wierenga
K J
KJ
Sickle Cell Unit, formerly MRC Laboratories (Jamaica), University of the West Indies, Mona, Kingston, Jamaica, West Indies. kjwien@uwimona.edu.jm
Hambleton
I R
IR
Wilson
R M
RM
Alexander
H
H
Serjeant
B E
BE
Serjeant
G R
GR
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000235:genetics; D016470:Bacteremia / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006720:Homozygote; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D010146:Pain / Q000209:etiology; D012044:Regression Analysis; D012189:Retrospective Studies; D013577:Syndrome; D014552:Urinary Tract Infections / Q000209:etiology