The association of infection and clinical severity in sickle cell anaemia patients

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Transactions of the Royal Society of Tropical Medicine and Hygiene

Volume 105, Issue 3, March 2011, Pages 121-126

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doi:10.1016/j.trstmh.2010.11.007 |

Royal Society of Tropical Medicine and Hygiene Published by

Elsevier Ltd.

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The association of infection and clinical severity in sickle cell anaemia

patients

P. Moura Netoa, b, Isa Menezes Lyrac, Mitermayer G. Reisa and Marilda S.

Goncalvesa, b, ,

a Centro de Pesquisas Goncalo Moniz, Fundacao Oswaldo Cruz (FIOCRUZ); Rua

Waldemar Falcao, 121, Candeal, CEP: 40.296-710. Salvador, Bahia, Brasil

b Departamento de Analises Clinicas e Toxicologicas, Faculdade de Farmacia da

Universidade Federal da Bahia (UFBA), Av. Barao de Geremoabo, Campus

Universitario de Ondina, CEP:40.000-000. Salvador, Bahia, Brasil

c Fundacao de Hematologia e Hemoterapia do Estado da Bahia (HEMOBA), Av. Vasco

da Gama, s/n° Rio Vermelho, CEP: 40.240-090. Salvador, Bahia, Brasil

Received 12 April 2010; revised 12 November 2010; accepted 12 November 2010.

Available online 8 January 2011.

Summary

Sickle cell anaemia (SCA) patients have a high risk of infection. We

retrospectively investigated the prevalence of infection among SCA patients from

Bahia, Brazil. A total of 1415 SCA patients were studied between 1995 and 2009:

190 (13.4%) had hepatitis C virus (HCV), 67 (4.7%) had human T-lymphotropic

virus type I (HTLV-I), 44 (3.1%) had hepatitis B virus (HBV), 40 (2.8%) had

Chagas’ disease, 11 (0.8%) had human immunodeficiency virus (HIV), and 5 (0.4%)

had syphilis. Patients with HCV infection had a higher risk of hospitalisation

(OR = 1.52, 95% Cl: 1.07-2.17, P = 0.020), bone disorders (OR = 1.94, 95% Cl:

1.15-3.27, P = 0.011), stroke (OR = 2.17, 95% Cl: 1.12–4.14, P = 0.017), painful

crisis (OR = 1.61, 95% Cl: 1.17-2.22, P = 0.004) and leg ulcers (OR = 1.61, 95%

Cl: 1.04-3.03, P = 0.031). Patients with HBV infection had a higher risk for

bone disorders (OR = 4.90, 95% Cl: 2.08-11.54, P < .010), stroke (OR = 3.01, 95%

Cl: 1.29-6.04, P = 0.007), painful crisis (OR = 3.51, 95% Cl: 1.62-7.63, P <

0.001), acute chest syndrome (ACS) (OR = 2.66, 95% Cl: 1.34-5.28, P = 0.004),

leg ulcers (OR = 6.60, 95% Cl: 3.37-12.91, P < .001) and vaso-occlusive crisis

(OR = 6.34, 95% Cl: 1.96-20.66, P < 0.001). Patients with HTLV-I infection had a

high risk for bone disorders (OR = 2.94, 95% Cl: 1.28-6.74, P = 0.011),

respiratory failure (OR = 2.66, 95% Cl: 1.26-5.51, P = 0.012), leg ulcers (OR =

3.27, 95% Cl: 1.69-6.11, P < .001), painful crisis (OR = 1.82, 95% Cl:

1.07-3.13, P = 0.025) and ACS (OR = 1.85, 95% Cl: 1.10-3.41, P < .047). SCA

patients with HCV infection had increased triglycerides and low-density

lipoprotein cholesterol (P = 0.036; P = 0.027), iron serum (P = 0.016) and

ferritin (P = 0.007). These results reveal important roles for these infections

in SCA patients’ clinical outcomes, and studies are warranted to determine the

mechanisms utilised by these agents and their involvement in disease severity.