Particularities of Tuberculosis in Children and Adolescents with Sickle Cell Disease in Senegal

Introduction: Tuberculosis and sickle cell disease are one of the main global health priorities particularly in Africa. We aimed to determine the epidemiological, diagnostic and therapeutic aspects of tuberculosis in children and adolescents with sickle cell disease. Patients and methods: Patients aged 0 - 20 years with sickle cell anemia presented with tuberculosis at the Centre Hospitalier National d’Enfants Albert Royer (CHNEAR), Dakar, Senegal were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was analyzed using the SPSS software, version 16. Results: A total of 25 cases of tuberculosis were documented from January 1st, 1991 to December 31st, 2019 (hospital prevalence: 0.97%). Mean age was 12.5 years. The sex ratio was 1.5 (15 girls and 10 boys). Pulmonary tuberculosis in 14 cases was the most frequent followed by lymph nodes in 7 cases involvement and Pott’s disease in 4 cases. In 5 patients Tb was multifocal. Mean duration of treatment was 8.27 months (6 to 12 months). Outcome was good on antituberculosis treatment. None patient died. Conclusion: Children and adolescents with sickle cell disease can be infected with Mycobacterium tuberculosis. Pulmonary tuberculosis, lymph nodes and bone involvement are the most frequent localizations. Outcome is good on antituberculosis treatment.

Malaria Characteristics in Children with Sickle Cell Disease

Background: The relationship between sickle cell disease and malaria is the subject of much controversy. However, there is a lack of data in our services. Our objective was to study the epidemiological, diagnostic and evolutionary characteristics of malaria in children with sickle cell disease followed in a specialized setting. Patients and Methods: We conducted a retrospective, descriptive, and analytical study of children with sickle cell disease (SCD) who presented with malaria and were followed at the Ambulatory Care Unit for Sickle Cell Children and Adolescents (USAD) at the Albert Royer National Children’s Hospital in Dakar, from January 1st, 2017, to December 31th, 2019. We included all the followed pediatric patients, less than 16 years, with sickle cell disease who presented at least one episode of malaria, confirmed by a positive thick drop, during this 3 years. We did not include patients with incomplete records or those older than 16 years. The clinical and biological signs, the follow up was collected and analyzed with Excel package 2019. Results: Of 3773 patients followed for sickle cell disease, 21 had presented malaria. The frequency was 0.5% or 7 cases/year. However, we exploited the data of 14 of them. The sex ratio was 6 boys for a girl and the mean age at admission was 7.3 years. The highest number of malaria cases was observed in 2018 and the peak frequency was observed in November with 8 cases (57.1%). Fever was the most frequent symptom, observed in 10 patients (71.4%). All patients were SS homozygous, with a mean baseline hemoglobin level of 7.5g/dl. All patients had a positive thick blood smear and Plasmodium falciparum was the only species found in the blood smear, with a mean parasite density of 1693 parasites/ml of blood. All patients had anemia, with a mean hemoglobin level of 7.74 g/dl. Twelve patients (85.7%) were hospitalized and had all received injectable artesunate followed by oral Artemisinin Combination Therapy (ACT). Long-lasting insecticidal nets were used in 9 patients (69.2%). The evolution was favorable in all patients, any death was reported. NO REPRESENTATION OF YOUR DATA IN TABLES OR FIGURES: it was a little serial. Conclusion: The patients who presented the association of malaria and sickle cell disease were all SS homozygotes. However, malaria must be considered as serious in this chronic anemic setting. That’s why it is important to improve prophylaxis.

Primary Immune Deficiencies (PID): Diagnosis Challenges

Background: Primary Immune Deficiencies (PID) are rare, under-determined diseases particularly in sub-Saharan Africa. The diagnosis is often suspected with uncommon clinical signs. Infections are the main diagnostic circumstances in infants. Confirmation is often difficult because some additional examinations are unavailable in many of our countries. Aim: Our aim was to share the challenge of diagnosis and treatment in PID. Case Presentation: It is about two infants, a boy and a girl, with early several infections. Both of them presented a hypo-gammaglobulinemia and to the boy, the immuno-phenotyping lymphocyte showed a decreased level of lymphocytes CD19. We are looking for genetic confirmation but it is not easy. The treatment of these infants requires a substitution for life of immunoglobulin which is unavailable in our countries. Conclusion: PID are suspected with atypical clinical signs. Confirmation genetic diagnosis is difficult in low income countries. To improve the follow up, we need to strengthen clinical-biological collaboration.