Abstract
ACS in sickle cell disease (SCD) includes the often indistinguishable processes of pneumonia and pulmonary infarction. 47 episodes of radiologically positive ACS in 18 months were studied prospectively to determine etiology and clinical consequences. None was associated with a positive blood culture or CIE test. 10 episodes (21%) were associated with positive viral cultures: 3 adenovirus, 2 CMV, and 1 each of RSV, herpes simplex, enterovirus, parainfluenza, and influenza B. 10 (21%) of the patients had ACS due to Mycoplasma pneumoniae (Mp) as documented by 4-fold or greater changes in specific antibody titer. When compared to other cases, ACS due to Mp was more severe with a lower hemoglobin on hospital admission (7.1±1.5 vs 8.0±1.5 g/dl, p=0.05) and a greater fall from the patients' usual level (1.5±1.3 vs 0.8±1.2 g/dl, p=0.05). 2/10 Mp patients and 1/37 other patients required red cell transfusions. Patients infected with Mp had prolonged fever (5.5±4.1 vs 3.2±2.0 days, p=0.009) and longer hospitalizations (8.0±3.7 vs 5.7±2.0 days, p=0.006). Cold agglutinin titers were ≥ 1:16 in 5/6 Mp episodes and in 1/22 other episodes (p=0.0007). In this study Mp caused ACS in many patients and was associated with significant morbidity. Early detection using cold agglutinin titers is usually possible. SCD patients with ACS should be screened with a cold agglutinin titers as a prognostic factor. Those with a high titer may benefit from early treatment with erythromycin.
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Poncz, M., Kane, E. & Gill, F. ACUTE CHEST SYNDROME (ACS) IN SICKLE CELL PATIENTS IS OFTEN DUE TO MYCOPLASMA PNEUMONIAE. Pediatr Res 18 (Suppl 4), 246 (1984). https://doi.org/10.1203/00006450-198404001-00921
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DOI: https://doi.org/10.1203/00006450-198404001-00921