Infections and immunizations of children with sickle cell disease.

G D Overturf
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Abstract

Children with SCD are prone to invasive infections caused by S. pneumoniae and H. influenzae. Osteomyelitis is caused most often by Salmonella species and less often by S. aureus. The chest syndrome and its associated microvascular disease carry a risk of prolonged and severe infections for Mycoplasma, Chlamydia, and probably other lower respiratory pathogens, particularly in the group of children with SCD prone to pain or microvascular sequestration, such as those with SC hemoglobinopathy. Despite three decades of investigation, the immunopathologic mechanisms leading to these increased risks is not completely clear. Bone infarction and microvascular disease probably play a part in the predisposition to osteomyelitis. Dysfunctional IgG and IgM antibody response, a lack of splenic clearance, defects in alternative pathway fixation of complement, and opsonophagocytic dysfunction play a role in the predisposition to invasive infection from polysaccharide-encapsulated organisms. Immunization with the conjugate Haemophilus vaccines has largely controlled infections caused by this pathogen. Early recognition of SCD through neonatal screening allows early and vigorous antibiotic management of febrile episodes in children with SCD and has perhaps provided the greatest benefit. Treatment of acute febrile episodes should include antibiotics active against regional strains of S. pneumoniae and H. influenzae, whereas treatment of febrile lower respiratory infections should include macrolide antibiotics that are active against Chlamydia and Mycoplasma, as well as pneumococci and Haemophilus. To date, no convincing evidence exists for the efficacy of pneumococcal polysaccharide vaccines in children with SCD, but preliminary data with the conjugate pneumococcal vaccines in normal children and those with SCD suggest that they may be as successful as Haemophilus vaccines in controlling this infection once they are available. Prophylaxis with daily penicillin administration is recommended and is well founded on clinical trials. However, problems with pneumococcal penicillin resistance and the association of failure with a lack of compliance to antibiotic regimens will dictate continued reexamination of this modality for the prevention of pneumococcal infections.

镰状细胞病儿童的感染和免疫接种。
患有SCD的儿童容易受到肺炎链球菌和流感嗜血杆菌引起的侵袭性感染。骨髓炎最常由沙门氏菌引起,较少由金黄色葡萄球菌引起。胸综合征及其相关的微血管疾病具有支原体、衣原体和其他下呼吸道病原体长期和严重感染的风险,特别是在易于疼痛或微血管隔离的SCD患儿群体中,如SC血红蛋白病患儿。尽管经过三十年的研究,导致这些风险增加的免疫病理机制尚不完全清楚。骨梗塞和微血管疾病可能在骨髓炎的易感性中起作用。IgG和IgM抗体反应功能障碍、脾脏清除不足、补体替代途径固定缺陷和自噬细胞功能障碍在多糖包被生物侵袭性感染的易感中起作用。结合嗜血杆菌疫苗的免疫接种在很大程度上控制了这种病原体引起的感染。通过新生儿筛查早期识别SCD,可以对SCD患儿的发热发作进行早期和有力的抗生素治疗,并可能提供最大的益处。急性发热发作的治疗应包括对肺炎链球菌和流感嗜血杆菌区域菌株有效的抗生素,而对发热下呼吸道感染的治疗应包括对衣原体和支原体以及肺炎球菌和嗜血杆菌有效的大环内酯类抗生素。迄今为止,尚无令人信服的证据证明肺炎球菌多糖疫苗对SCD儿童的有效性,但在正常儿童和SCD儿童中使用的结合肺炎球菌疫苗的初步数据表明,一旦获得,它们在控制这种感染方面可能与嗜血杆菌疫苗一样成功。建议每日给予青霉素预防,这是基于临床试验的。然而,肺炎球菌对青霉素耐药的问题以及治疗失败与不遵守抗生素治疗方案的关系,将要求继续重新检查这种预防肺炎球菌感染的方式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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