Insights on osteoarticular Infections in Children with Sickle Cell Disease: A Four-Year Study

Background: Osteoarticular infections like osteomyelitis and septic arthritis are a well-known complication in children with sickle cell disease (SCD). They often require prolonged hospital admissions with high morbidity. Their presentation, differential diagnosis and management can still present a challenge.

Objective: Characterise osteoarticular infections in a cohort of children with sickle cell disease.

Methods: Retrospective study of emergency room visits from 1st January 2015 to 31st December 2019, in SCD patients between 0 and 18 years-old. Episodes that included bone and joint pain, not caused by trauma, were analysed, with selection and characterization of osteoarticular infections. When faced with diagnostic uncertainty, image studies were accounted for inclusion criteria.

Results: Of the 131 emergency room visits selected we identified 11 cases of presumptive osteoarticular infection, of which 3 were excluded due to absence of radiological confirmation. Concerning the remaining 8 cases, confirmed by image studies, the average age was 11,67 years, with a balanced gender distribution (4 females and 4 males). Upon admission only one had fever (10,1%), the average C-Reactive Protein value was 6,02 mg/dL. Culture of the periosteal exudate was positive in 2 patients (25% culture rentability) and haemoculture was positive in one (12,5%). All the patients with osteoarticular infections had hospital admission, with an average hospital stay of 23 days. During the hospital stay all had magnetic resonance studies performed. Surgical procedures were performed in the 8 patients. Antibiotic treatment duration was on average 39,3 days.

Conclusion: The diagnosis of an osteoarticular infection in children with SCD requires a high index of suspicion. In this study we aimed to characterize the epidemiology, clinical and imagiological features regarding these important complications.