HEMOGLOBINOPATHY AND PATTERN OF MUSCULOSKELETAL INFECTION IN CHILDREN: DISCUSSION

infection children

Bacterial infections of bone and its soft tissue envelope are serious disease conditions especially in communities where abnormal hemoglobin genotype is common. The prevalence of HbSS and HbAS in Nigeria is 1.6-2% and 25-30%, respectively. Morbidity resulting from disabilities from some of these conditions may be life long. Mortality is also not infrequent. A review of death in the accident and emergency dept by Adesunkanmi et al. showed that pyomyositis accounted for 14% of deaths in surgical nontrauma conditions.

Our results indicate that COM is the most common MSS infection for which these patients are hospitalized. This suggests that there exists a large burden of chronic MSS disease of infectious origin in children and may complicate the socioeconomic situation by contributing significantly to the rate of dropout from school with adverse social consequences. Continuous public education is required on the symptomatology of acute osteomyelitis and the need for prompt and adequate treatment to prevent chronicity.

The prevalence of pyogenic arthritis—12% in this report—suggests that it is not uncommon. It may actually predispose to osteoarthritis later in life. Involvement of the knee in 56% of affected patients may result in similar prevalence of knee involvement in adult osteoarthritis. This report also suggest that pyomyositis is not a common complication of SCD. However, this is not true of trait. Clinical experience in Nigeria has shown a worrisome level of generic antibiotic abuse. This may have contributed to the greater number of children with osteomyelitis and septic arthritis, compared with cellulites.

Our results support previous observation that S. aureus is the most common pathogen in osteomyelitis and pyomyositis. Furthermore, S. aureus is the most prevalent individual pathogen in those infections with hemoglobinopathies in this African population. This is also consistent with the report of Nwadiaro et al. on COM in SCD. Reports of Salmonella osteomyelitis are predominantly from outside the African continent. It is possible that Salmonella osteomyelitis is common in environments where Salmonella infections are generally common. Gram-negative bacilli are important causes of MSS infections in children with HbSS, as indicated by the rate of 60% in this report. This supports the observation of a change in the trend of causative organisms.
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This report indicates that hospitalized children with and without hemoglobinopathies have a similar risk of developing MSS infections. It is possible that environmental factors determine to a large extent who actually develops a MSS infection. HbSS, however, is likely to be an independent risk factor for bone and soft tissue infections in these patients.

From the foregoing, it can be concluded that tuberculous arthritis is uncommon in children, unlike osteomyelitis and pyomyositis. S. aureus is the most common bacterial pathogen in MSS infections in hospitalized children—even in those with abnormal genotypes. However, Gram-negative bacilli are important pathogens in patients with HbSS in particular and in those with other hemoglobinopathies in general. Hemoglobin SS is probably an independent risk factor for bone and soft tissue infections. canadian pharmacy viagra

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