title: How we prevent and manage infection in sickle cell disease.
abstract: Sickle cell disease (SCD) affects approximately 100,000 people in the US, 12,500 in the UK, and millions worldwide. SCD is typified by painful vaso-occlusive episodes, haemolytic anaemia and organ damage. A secondary complication is infection, which can be bacterial, fungal or viral. Universal newborn screening, routine use of penicillin prophylaxis, availability of conjugated vaccines against S. pneumoniae and comprehensive care programmes instituted during the past few decades in industrialized countries have dramatically reduced childhood mortality and improved life expectancy. Yet patients with SCD remain at increased risk of infection. Unfortunately, the treatment of most bacterial infections that are common in SCD is not based on the results of randomized controlled clinical trials. In their absence, treatment decisions are based on consensus guidelines, clinical experience or adapting treatment applied in other diseases. This leads to wide variation in treatment among institutions and even between treating physicians in a single institution. Prevention of infection, when possible, is most important and we focus on prevention through targeted prophylaxis and vaccination. We will share our management strategies for managing the more common infections in SCD and provide the rationale for our recommendations.
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.|Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Sobota
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.|Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Vishakha
authors.initials: V
authors.lastname: Sabharwal
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.|Department of Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Gwendoline
authors.initials: G
authors.lastname: Fonebi
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.|Department of Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinberg
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D019072:Antibiotic Prophylaxis; D019468:Disease Management; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012306:Risk; D014611:Vaccination
keywords: S. pneumoniae; acute chest syndrome; bacteraemia; vaccination