Introduction

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Sickle Cell Disease (SCD) is a group of inherited blood disorders characterized by the presence of abnormal hemoglobin, which impairs the ability of red blood cells to transport oxygen efficiently throughout the body. The most severe form, sickle cell anemia, is a major global public health concern due to its high morbidity and mortality, particularly in low- and middle-income countries [1].

Africa bears the highest burden of SCD, accounting for nearly 80% of global cases, with carrier prevalence ranging from 2% to 30% depending on the region, with approximately 8 to 10% of Senegalese being carriers [1,2]. The natural history of sickle cell anemia is marked by chronic hemolytic anemia beginning in infancy, often accompanied by vaso-occlusive crises (VOCs), which can lead to acute and chronic complications, including organ damage and disability. One of the most critical challenges in managing SCD is the high susceptibility to infections, particularly among children under five years of age [1]. In sub-Saharan Africa, infections remain a leading cause of early mortality among children with SCD. According to the World Health Organization (WHO), SCD was responsible for over 81,000 deaths in children under five in 2021, making it one of the top causes of mortality in this age group [1].

Despite the availability of preventive measures such as vaccination and antibiotic prophylaxis, infectious diseases continue to pose a serious threat to this vulnerable population [3,4]. A study conducted in Libreville, Gabon, demonstrated that infectious diseases remain common and can be fatal among children with sickle cell disease (SCD) [5]. In Senegal, although data on infection rates in this population are limited, a retrospective study at Albert Royer Children’s Hospital in Dakar reported that 107 out of 327 children with SCD admitted to the emergency department (32.7%) presented with infections [6].

These findings highlight the ongoing vulnerability of children with SCD to infectious complications and underscore the need for further research to better characterize the burden of infections in this high-risk group.

Methodology

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Study Design and Setting

We conducted a retrospective study based on physical medical records collected between January and December 2024 at Diamniadio Children’s Hospital, a leading pediatric referral center in Senegal. The hospital is located approximately 3 kilometers from the town of Diamniadio, along the national highway toward Thiès.

Inclusion and Exclusion Criteria

Inclusion criteria: All children and adolescents diagnosed with sickle cell disease (SCD) who received care at Diamniadio Children’s Hospital during the study period were included.

Exclusion criteria: Patients without a diagnosis of SCD who were treated at the hospital during the same period were excluded from the analysis.

Data Collection

Patient data were extracted from hospital registries and compiled into a Microsoft Excel spreadsheet. The variables collected included:

Results

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• Demographic information (age and sex)
• Hemoglobin electrophoresis profile
• Reason for consultation
• Identified pathogens
• Results of antibiotic susceptibility testing.

Among the 240 patients with sickle cell disease included in this study, 56 (23.3%) presented with infectious complications. Analysis of the socio-demographic characteristics of these 56 patients revealed a slight predominance of females (55.36%) over males (44.64%). The majority of infections occurred in children under 10 years of age, with 53.6% of cases in the 0–5years age group and 35.7% in the 5–10year age group. Only 10.7% of cases were observed in patients older than 10 years (Table 1)

Table 1

Septicemia was the most common infection, representing 37% of cases, followed by osteomyelitis (25%) and bronchopneumonia (20%).

Less frequent infections included urinary tract infections (9%), arthritis (5%), and myositis (4%). This pattern underscores the predominance of invasive bacterial infections particularly bloodstream and bone infections among children with sickle cell disease (figure 1)

Figure 1

The analysis of pathogens isolated from patients with infectious complications revealed that Salmonella spp. was the most prevalent, responsible for 29% of cases. This was followed by Staphylococcus aureus (16%), Escherichia coli and Streptococcus pneumoniae (each 14%). Less frequently identified pathogens included Citrobacter freundii (11%), Proteus mirabilis (9%), and Klebsiella oxytoca (7%) (Figure 2).

Figure 2

Antibiotic susceptibility testing of the isolated Salmonella spp. strains revealed complete sensitivity to all antibiotics evaluated including Amoxicillin, Amoxicillin-Clavulanic Acid, Ertapenem, Cefoxitin, Aztreonam, Colistin, Netilmicin, Norfloxacin, and Cotrimoxazole (figure 3).

Figure 3

Discussion

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Among the 240 patients with sickle cell disease (SCD) included in this study, 56 (23.3%) presented with infectious complications. This prevalence aligns with global data indicating that infection remains a leading cause of morbidity and mortality in children with SCD, particularly in Senegal [7].

The socio-demographic analysis revealed a slight predominance of females (55.36%) over males (44.64%) among infected patients. While gender differences in infection susceptibility are not consistently reported in the literature, some studies suggest that hormonal and immunological factors may influence disease expression [8]. More notably, the age distribution showed that 89.3% of infections occurred in children under 10 years, with the highest burden in the 0–5year age group (53.6%). This is consistent with evidence that functional asplenia develops early in life, often before the age of five, leaving young children particularly vulnerable to encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Salmonella spp. [9]. In this study, septicemia emerged as the most common infectious complication among children with sickle cell disease (SCD), accounting for 37% of cases, followed by osteomyelitis (25%) and bronchopneumonia (20%). These findings reflect the well-documented vulnerability of children with SCD to invasive bacterial infections, particularly those affecting the bloodstream and bones [10, 7]. The high prevalence of septicemia is consistent with the pathophysiology of SCD, where functional asplenia often occurring within the first few years of life compromises the immune system’s ability to clear encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Salmonella spp. [11,9].

In low-resource settings, where access to early diagnosis, vaccination, and antibiotics may be limited, septicemia remains a leading cause of mortality [12]. With a prevalence of 29%, Salmonella emerges as the leading pathogen in pediatric patients with sickle cell disease. This aligns with findings from a large European multicenter study (2014–2019), which showed that Salmonella spp. was the most frequently isolated pathogen in IBIs among children with SCD, particularly in osteomyelitis and primary bacteremia [10]. Salmonella is especially problematic in SCD due to bone infarctions, which create a favorable environment for bacterial colonization and infection [13].

The observation that Salmonella spp. isolates demonstrated complete sensitivity to a broad spectrum of antibiotics is a significant and encouraging finding, particularly in the context of rising global antimicrobial resistance (AMR). Nevertheless, global trends indicate increasing resistance in Salmonella, particularly to fluoroquinolones and third-generation cephalosporins [14].

Conclusion

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These findings underscore the critical need for routine screening of Salmonella infections, particularly in young children living with sickle cell disease. The predominance of invasive infections and the central role of Salmonella call for enhanced infection prevention strategies, including vaccination, prophylactic antibiotic use, and early intervention protocols. The observed antibiotic susceptibility of Salmonella supports the continued use of current treatment regimens, while also highlighting the importance of sustained antimicrobial stewardship to preserve the long-term effectiveness of available therapies.

Acknowledgements

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We thank all of people who have participated in this research.

Funding Information

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There has been no funding for this research.

Ethics Approval and Consent to Participate

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Not relevant.

Conflict of Interest

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There has been no conflict of interest.

References

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