ABSTRACT
Background: Sickle cell disease (SCD) is associated with chronic haemolysis, immuno-suppression and susceptibility to infections, which may trigger infection-associated haemolysis (IAH). SCD patients are vulnerable to anaemic effect of IAH due to vicious interaction between pre-existing 'inherited' chronic haemolysis and 'acquired' IAH. IAH in SCD manifests as febrile haemolytic crisis with clinical and laboratory features of severe anaemia or pancytopenia. Clinico-pathological perspectives of IAH in SCD are fragmented. This review presents a comprehensive but concise overview of pathogenesis, management and prevention of IAH in SCD. Methodology and results: Online literature search using search terms such as 'sickle cell disease, viral, bacterial, parasitic, fungal, infections, hyperhaemolytic crisis, haemophagocytic syndrome, severe anaemia, pancytopenia' in various combinations was done on PubMed/Medline, Google, Google-Scholar and Bing. Overall, 112 relevant publications were retrieved, which included 109 peer reviewed journal articles, 2 World Health Organization (WHO) technical reports, and 1 edited text book. A range of bacterial (Bartonella spp, Mycoplasma spp., Mycobacterium avium complex), viral (Dengue, SARS-CoV-2, Parvovirus-B19, Cytomegalovirus, Epstein-Barr virus), parasitic (Plasmodium spp., Babesia spp.), and fungal (Histoplasma spp.) infections were associated with IAH in SCD. There are two broad types of IAH in patients with SCD;infection associated extra-medullary haemolysis (IAEMH) and infection associated intra-medullary haemolysis (IAIMH). While IAEMH is associated with severe anaemia due to intravascular haemolysis caused by red cell invasion, oxidative injury, auto-antibodies, and/or pathogen-haem interaction, IAIMH is associated with haemophagocytic tri-lineage destruction of haematopoietic precursors in the bone marrow. Conclusion(s): Various microbial pathogens have been associated with IAH in SCD. SCD patients with fever, severe anaemia or pancytopenia should be investigated for early diagnosis and prompt treatment of IAH, which is a life-threatening haematological emergency for which transfusion therapy alone may not suffice. Prompt and sustainable termination of IAH may require therapeutic combination of transfusion, anti-microbial chemotherapy, and immune modulation therapy. SCD patients should also receive counselling on hygiene, barrier protection against vectors, routine chemoprophylaxis for locally endemic diseases, and immunization for vaccine-preventable infections as a long-term preventive strategy against IAH. Copyright AJCEM 2022.
ABSTRACT
The unusual situation that arose due to the COVID-19 pandemic and the 65-day fishing ban (national policy to boost depleted fish stocks) affected the lower-income fishing communities in coastal Bangladesh. Shocks and stresses were posed, and community people adopted strategies to adapt to the changes. In the process of adaptation, social-ecological systems resilience at different levels plays a crucial role. Though resilience is acknowledged as multilevel feature, studies on the interaction between the levels while understanding communities’ responses to shock and stress are limited. Thus, in this study, we explored the shocks and stresses the fishing community faced and their views on the resilience feature at different levels (i.e., individual, household, and community level) in coastal Bangladesh during the COVID-19 pandemic and 65-day fishing ban period. The study found that the most resilience promoting features (e.g., diversified livelihood, friendship, and network of supports) were adopted at the individual and household levels. However, positive and negative interactions were explored between resilience features at all levels. Low community-level resilience was not translated into a lack of household-level resilience, and strong individual-level resilience did not mean high household-level resilience. It was noted that the increased resilience of a particular individual or household could negatively affect community resilience. Resilience features showed inconsistent interactions within or among the three levels’ resilience features. The study also revealed that multilevel resilience features stressed the importance of combining persistence (i.e., keeping fishing as the main livelihood) and adaptation process (e.g., livelihood diversification). The study showcases the importance of considering multilevel resilience that offers insight into crucial resilience factors which would not be evident if only one level were studied. The overall finding of this study will contribute to framing governance strategies to ensure sustainable coastal management even in the time of any abrupt or expected changes, such as the COVID-19 pandemic and the fishing ban policy. © Copyright © 2021 Sultana, Irfanullah, Selim, Raihan, Bhowmik and Ahmed.