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Archives de pédiatrie
Volume 8, n° S4
pages 732-741 (septembre 2001)
Doi : S0929-693X(01)80189-5
Infections graves chez l'enfant drépanocytaire : aspects cliniques et prévention
Severe infections in sickle cell disease : clinical features and prevention in children
 

P. Bégué , B. Castello-Herbreteau
Service de pédiatrie générale, pathologie infectieuse et drépanocytose, hôpital Armand-Trousseau, 24, avenue du Dr Arnold-Netter, 75012 Paris, France 

Correspondance.
Résumé

La gravité des infections chez les malades drépanocytaires est liée à leur risque vital et à la possibilité de déclenchement de crises de falciformation et de complications. Cette sensibilité à l'infection est d'origine multifactorielle : asplénie, anomalies du complément, anomalie de la réponse du polynucléaire neutrophile aux cytokines. Les bases génétiques de cette sensibilité sont en cours d'étude. Les infections les plus graves sont les bactériémies, les méningites, les ostéomyélites, les pneumopathies. Le pneumocoque et les salmonelles sont les bactéries les plus fréquentes, mais la prévention et l'hygiène ont modifié leur épidémiologie. M. pneumoniae et C. pneumoniae sont souvent la cause de pneumopathies graves favorisant le syndrome thoracique aigu (STA). Le pneumocoque est plus rare et la mortalité a spectaculairement régressé grâce à la prévention. Les infections à salmonelles deviennent rares dès que les conditions d'hygiène s'améliorent. Les ostéomyélites à salmonelles sont donc très rares dans les pays industrialisés alors que les infarctus osseux sont fréquents : la scintigraphie osseuse précoce apporte une grande aide pour ce diagnostic. Parmi les infections virales, le parvovirus B19 donne une érythroblastopénie aiguë en règle bien tolérée. La grippe peut provoquer des crises et des complications respiratoires justifiant la prévention vaccinale. Au cours du paludisme à P. falciparum , le neuropaludisme est très rare, mais l'accès simple est fréquent et cause d'anémie grave chez les drépanocytaires. La prévention est donc importante. Le traitement des infections bactériennes doit tenir compte de l'épidémiologie et du risque, ce qui justifie l'association fréquente d'antibiotiques couvrant pneumocoque et M. pneumoniae .

The full text of this article is available in PDF format.
Abstract

Sickle-cell disease (SCD) is associated with frequent and often severe Infections as a result of immune function impairment and functional asplenia. Also, infection can trigger a vasoocclusive crisis. Pneumonococcal bacteremia and meningitis due to S. pneumoniae are often lethal and justify the penicillin prophylaxis, which has provided a dramatic decrease in early mortality bacterial pneumonia is common in patients younger than four years, with most cases being due to S. pneumoniae , H. influenzae , Mycoplasma pneumoniae , Chlamydia pneumoniae . Acute chest syndrome is both a difficult differential diagnosis and a common concomitant of bacterial pneumonia, because they are often intricated. Osteomyelitis is generally due to Salmonella , most often S. enteritidis . Multiple foci are common and treatment is difficult, with some patients developing chronic osteomyelitis with sequestration.Osteomyelitis is less frequent in developed countries and must been differentiated with bone infarction by use of bone scintigraphy. Parvovirus B19 infection causes acute erythroblastopenias. Malaria does not result in cerebral malaria, but can lead to severe anaemia or vasoocclusive crisis, and should therefore be effectively prevented. Antimicrobials are generally selected for efficacy against pneumococci (septicemia, meningitis), Salmonella (osteomyelitis, meningitis), and M. pneumoniae (pneumonia). Prophylactic therapy is of paramount importance and relies on long-term or lifelong penicillin therapy started at three months of age and on closely-spaced immunizations, most notably against peumococci, hepatitis B virus, S. typhi and H. influenzae . Resistant pneumococcal strains have not been reported to cause prophylactic treatment failures., New conjugated pneumococcal vaccines are effective in protecting very young infants and should therefore be used in sickle cell patients.

The full text of this article is available in PDF format.

Mots-clé : drépanocytose / infection

Keywords : anemia / sickle cell / child / infection




© 2001  Published by Elsevier Masson SAS.
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