Mycoplasma pneumonia and acute chest syndrome in sickle cell disease

Acute chest syndrome [ACS] is the leading cause of hospitalization, morbidity, and mortality in patients with sickle cell disease. Radiographic and clinical findings in ACS resemble pneumonia, however etiologies other than infectious pathogens have been implicated, including pulmonary fat embolism [PFE] and infarction of segments of the pulmonary vasculatures. Data were analyzed from the prospective study of 70 patients with ACS with sickle cell disease, ACS was defined as a new pulmonary infiltrate involving at least complete segment of the lung, excluding atelectasis. In addition, the patients had to have chest pain, fever >38.5C, tachypnea, wheezing or cough. Samples of blood and deep sputum were analyzed for evidence of bacteria. Mycoplasma pneumonia infection was determined by analysis of paired serologies. Detailed information on patient characteristics, presenting signs and symptoms, treatment and clinical outcome were collected. 12.5% of 70 patients with ACS had serological and PCR evidence of mycoplasma pneumonia, infection was higher in patients ages 5 to 9.9 years reaching 50%, all infection occurred in hemoglobin type SS. M. pneumonia is commonly associated with sickle cell disease and occurs in very young children. Aggressive treatment with broad spectrum antibiotics, including Ig from the macrolide class, is recommended for all patients as well as bronchodilator therapy, early transfusion, and respiratory support when clinically indicated