Romain Guery1,2,3, Anoosha Habibi2,4,5, Jean-Benoît Arlet6,7, François Lionnet8, Victoire de Lastours9, Jean-Winoc Decousser2,10, Jean-Luc Mainardi7,11, Keyvan Razazi12,13, Laurence Baranes2,14, Pablo Bartolucci2,4,5, Bertrand Godeau1,2, Fréderic Galacteros2,4,5, Marc Michel1,2, Matthieu Mahevas1,2. 1. a Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Hôpital Henri-Mondor , Créteil , France. 2. b Université Paris-Est Créteil (Upec) , Créteil , France. 3. c Service de Maladies Infectieuses et Tropicales , Hôpital Necker-Enfants Malades , Paris , France. 4. d Unité des Maladies Génétiques du Globule Rouge (UMGGR), Service de Médecine Interne, Centre de Référence Syndromes Drépanocytaires Majeurs, Thalassémie et autres maladies rares du Globule Rouge et de l'érythropoïèse, Hôpital Henri-Mondor , Créteil , France. 5. e Institut Mondor de Recherche Biomédicale (IMRB-U955 Inserm) , Créteil , France. 6. f Service de Médecine Interne, Centre de référence Syndromes Drépanocytaires Majeurs, Thalassémie et autres maladies rares du Globule Rouge et de l'érythropoïèse, Hôpital Européen Georges-Pompidou , Paris , France. 7. g Faculté de médecine Paris Descartes, Sorbonne Paris-Cité , Paris , France. 8. h Service de Médecine Interne, Centre de Référence Syndromes Drépanocytaires Majeurs, Thalassémie et autres maladies rares du Globule Rouge et de l'érythropoïèse, AP-HP, Hôpital , Paris , France. 9. i Service de Médecine Interne, AP-HP, Hôpital Beaujon , Clichy , France. 10. j Service de Microbiologie, Hôpital Henri-Mondor , Créteil , France. 11. k Unité mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges-Pompidou , Paris , France. 12. l Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri-Mondor , Créteil , France. 13. m Faculté de Médecine de Créteil, IMRB, GRC CARMAS , Université Paris-Est Créteil (Upec) , Créteil , France. 14. n Service d'Imagerie Médicale, Hôpital Henri-Mondor , Créteil , France.
Abstract
BACKGROUND: Non-typhoidal salmonellosis (NTS) often occurs in children with sickle-cell disease (SCD) and remains a significant cause of mortality in developing countries. However, there is lack of reports on the clinical presentation, outcome and complications of NTS in adults with SCD. METHODS: We performed a chart review between 2006 and 2016 of adults SCD diagnosed with NTS in 3 referral centers monitoring approximately 3500 SCD adults. RESULTS: Twenty-three episodes of NTS were diagnosed among 22 SCD adults. Diagnosis was challenging: 65% (n = 15/23) of patients presented with vaso-occlusive crisis (VOC) and 30% had no fever. Isolated serotypes were: ser. Enteritidis (n = 8), ser. Typhimurium (n = 6), others (n = 3). We identified two patterns of infections: (1) bacteremic NTS (n = 15) with (n = 9) or without secondary foci of infections (n = 6); (2) non-bacteremic NTS with extra-intestinal foci of infection (n = 8), including primary bones/joints infections (n = 5). Half of patients with osteo-articular localization (n = 6/13) had a previous history of osteonecrosis (n = 2) or osteomyelitis (n = 4) at the same site. Morbidity was high, 6 patients (26%) were admitted to the intensive care unit, 14 patients (61%) required RBC transfusion for VOC. Half of the episodes (n = 12) required surgery (n = 10) or interventional radiology (n = 2) to control the infection. One patient presented a relapse of NTS bacteraemia one year after the first episode. CONCLUSIONS: Besides bloodstream infections, clinical presentation of NTS in adults with SCD is non-specific at admission. A triad including bacteraemia, secondary focis of infection and bone localizations was observed in 30% of cases.
BACKGROUND:Non-typhoidal salmonellosis (NTS) often occurs in children with sickle-cell disease (SCD) and remains a significant cause of mortality in developing countries. However, there is lack of reports on the clinical presentation, outcome and complications of NTS in adults with SCD. METHODS: We performed a chart review between 2006 and 2016 of adults SCD diagnosed with NTS in 3 referral centers monitoring approximately 3500 SCD adults. RESULTS: Twenty-three episodes of NTS were diagnosed among 22 SCD adults. Diagnosis was challenging: 65% (n = 15/23) of patients presented with vaso-occlusive crisis (VOC) and 30% had no fever. Isolated serotypes were: ser. Enteritidis (n = 8), ser. Typhimurium (n = 6), others (n = 3). We identified two patterns of infections: (1) bacteremic NTS (n = 15) with (n = 9) or without secondary foci of infections (n = 6); (2) non-bacteremic NTS with extra-intestinal foci of infection (n = 8), including primary bones/joints infections (n = 5). Half of patients with osteo-articular localization (n = 6/13) had a previous history of osteonecrosis (n = 2) or osteomyelitis (n = 4) at the same site. Morbidity was high, 6 patients (26%) were admitted to the intensive care unit, 14 patients (61%) required RBC transfusion for VOC. Half of the episodes (n = 12) required surgery (n = 10) or interventional radiology (n = 2) to control the infection. One patient presented a relapse of NTSbacteraemia one year after the first episode. CONCLUSIONS: Besides bloodstream infections, clinical presentation of NTS in adults with SCD is non-specific at admission. A triad including bacteraemia, secondary focis of infection and bone localizations was observed in 30% of cases.