Carrier state of streptococcus pneumoniae in the nasopharnyx of Sickle Cell Children in Mulago Hospital - Kampala, Uganda.

Abstract

Introduction: Invasive pneumococcal disease has been recognised as a serious complication of homozygous sickle cell (SS) disease since the first description of this association (Wollstein & Kriedel, 1928). In Uganda there was also a dearth of Streptococcus pneumoniae as a cause of septicemia (Monica Etima, 2002, personal communication, Nantanda, 2006, Katureebe, unpublished data 2007). No studies in sickle cell children have been done before in Uganda. Objectives: The objective of this present study was to address the rate of nasopharyngeal carriage of Streptococcus pneumoniae inn SS children attending the Sickle Cell Clinic in Kampala, Uganda and the antibiotic sensitivity of the isolated organisms. Design: A descriptive cross-sectional study. Setting: The study site was the Sickle Cell Clinic of Mulago Hospital and Complex. Methods: The patients attended the Sickle Cell Clinic of Mulago University Teaching Hospital and the study was restricted to clinically well subjects with SS aged less than 6 years. Nasopharyngeal samples were taken for culture in all and the parents /guardians were questioned on the use of antibiotics over the 4 proceeding weeks and for the history of pneumococcal immunization. Results: S. pneumoniae was found in 27 (33%) of the study group (Table 1), occurring in 2/23 (9%) of those with recent hospitalization and in 25/58 (43%) of those without (2 = 8.8, p=0.003) where the p-value was obtained with Fisher's Exact test. Two subjects had received pneumococcal immunization and neither carried the organism. Antibiotic usage, usually for persistent coughs, was reported in 64/81 (79%) subjects (Table 2). Antibiotic sensitivity of isolated organism showed all to be penicillin resistant but sensitive to other commonly used antibiotics. Conclusion: The nasopharyngeal carrier rate of S. pneumoniae in SS children aged below 6 years is high in Uganda and penicillin resistance is high among the isolated organisms. Further to that study on the prevalence or incidence of SCD in children in Uganda is recommended as this information is missing.