Expert's Opinion/ How to prevent infections in sickle cell patients? Answers from Dr Hèzouwè Magnang, Haematologist

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Extract from the article: La drépanocytose est caractérisée par une extrême sensibilité aux infections par les bactéries encapsulées, spécifiquement les pneumocoques et aussi le Salmonella typhi en Afrique. Elles peuvent

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Sickle cell disease is characterised by an extreme sensitivity to infections by encapsulated bacteria, specifically pneumococcus and also Salmonella typhi in Africa. These can be respiratory, pulmonary, bone, oral, septicaemia and malaria. Infections are one of the main causes of mortality in sickle cell patients, especially in those under the age of three (3). They are a trigger for vaso-occlusive crises, a complication characterised by a local and temporary obstruction of the blood flow in sickle cell patients.

One of the causes is the poor functioning of the spleen in sickle cell patients from childhood, leading to functional asplenia. In addition, the complement system, which is a cascade of enzymes involved in the body's defence against infection, is impaired. Other causes of infections in sickle cell patients include lack of vaccinations or booster shots, exposure to mosquito bites, poor food, oral and body hygiene and risky sexual behaviour.

Costly management

When it comes to infection, management is expensive and not every patient gets through it. Unfortunately, there are times when we lose patients despite the initiation of treatment. This treatment requires the administration of appropriate medication for several days. This requires quite a lot of financial means, especially in a context where a good part of the patients are not covered by health insurance.

Infections, through the fever they cause, can also be a factor in triggering a vaso-occlusive crisis, which becomes a vicious circle for the sickle cell patient since the vaso-occlusive crisis will itself encourage the occurrence of infections because of the blood stasis it causes.

Preventing infections

As a preventive measure, sickle cell patients should take care of themselves by observing the rules of hygiene to avoid infections that could aggravate their disease. Sleep under a mosquito net impregnated with insecticide, do not forget to take their booster doses, wash their hands regularly, especially after using the toilet and before eating, trim their nails regularly and brush their mouth and teeth in the morning.

Sickle cell disease is a dreadful disease with many complications and is very expensive. I do not want young people who are not yet married to fall into this trap. To avoid this trap, one must know one's haemoglobin status before choosing a spouse. If you have an abnormal haemoglobin, you should choose a partner who carries only haemoglobin A (an AA subject). This is the only way to avoid having children with sickle cell disease.

Sickle cell disease is therefore a preventable disease and everyone can make the choice to avoid it in their children. The frequency of infections in sickle cell patients can also be reduced if the advice given by specialists is followed.

Interview by Jean ELI