title: The Acute Chest Syndrome in Cameroonian children living with sickle cell disease.
abstract: BACKGROUND
  Although sub-Saharan Africa (SSA) is particularly affected by sickle cell disease (SCD), there is dearth of research on this topic in the region, specifically targeting the magnitude of SCD-related complications. We therefore conducted this study to determine the burden of acute chest syndrome (ACS) and describe its clinical and therapeutic aspects among SCD children in Cameroon, a SSA country.
  
  
  METHODS
  This was a retrospective study carried-out from September 2013 to June 2014 at the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, a pediatric reference centre in Yaoundé, Cameroon. We enrolled all SCD children with confirmed diagnosis of ACS, and recorded their clinical presentation at admission along with their evolution during hospitalization.
  
  
  RESULTS
  Twenty one cases of ACS were identified during the study period, from 338 hospitalizations of children with SCD. Ages ranged from 11 months to 16 years with a mean (standard deviation) of 5.5 (3.4) years, and a male/female sex ratio of 3.2/1. We noticed relatively low levels of HbF, from 6.4 to 21.9% with a mean of 14.6% (6.0%). The three main symptoms at admission were fever (90.5%), cough (81%) and chest pains (28.6%). Two patients (9.5%) developed ACS 2 days after admission. The mean values of leukocytes, neutrophils, serum CRP, serum LDH and hemoglobin were respectively 32479.4 (17862.3)/mm(3), 23476 (11543.7)/mm(3), 228.2 (132.6) mg/l, 3452.3 (2916.3) IU/l and 6.5 (1.2) g/dl. The main localizations of radiological alveolar consolidations were the lower lobes (90.5%). Treatment associated broad-spectrum antibiotics (100%), hydration (100%), analgesics (43.2%), whole blood transfusion (66.7%), and oxygen supplementation (33.3%). Blood transfusion significantly improved hemoglobin level (p = 0.039). The duration of hospitalization, the mean of which was 6.8 (3.1) days, was influenced by none of the tested variables (all p values > 0.05).
  
  
  CONCLUSIONS
  ACS is frequent among SCD children in our milieu. Its etiologies seem to be multifactorial. Patients' parents should be educated to recognize early signs and symptoms of the disease, and consult rapidly. Additionally, clinicians must be trained to diagnose ACS, and manage it promptly and efficiently to avoid its related catastrophic consequences.
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. jobertrichie_nansseu@yahoo.fr.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon. jobertrichie_nansseu@yahoo.fr.
authors.forename: Jobert Richie N
authors.initials: JR
authors.lastname: Nansseu
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. anica_2001@yahoo.fr.
authors.forename: Anastasie Nicole
authors.initials: AN
authors.lastname: Alima Yanda
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. chelodad6@yahoo.fr.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon. chelodad6@yahoo.fr.
authors.forename: David
authors.initials: D
authors.lastname: Chelo
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. tatah_sandra@yahoo.com.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon. tatah_sandra@yahoo.com.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Tatah
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. mbassiahd@yahoo.fr.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon. mbassiahd@yahoo.fr.
authors.forename: Hubert D
authors.initials: HD
authors.lastname: Mbassi Awa
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. jseungue@yahoo.fr.
authors.forename: Judith
authors.initials: J
authors.lastname: Seungue
authors.affiliation: Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon. koki_Paul@hotmail.com.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon. koki_Paul@hotmail.com.
authors.forename: Paul Olivier N
authors.initials: PO
authors.lastname: Koki
mesh_terms: D056586:Acute Chest Syndrome / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors