Pyelonephritis in Adult Women with Homozygous Sickle Cell Disease: about 42 Cases

Sickle cell disease is a condition with 3 parts of speech including infectious complications. They are essentially encapsulated bacterial organisms. There is a significant incidence of urinary infections to adults with sickle cell disease most particularly among women. The frequency and characteristics of pyelonephritis in women with sickle cell disease is poorly understood to this day, it seemed interesting to analyze over a period of one year, the profile of sickle cell patients followed in the genetic disease unit of red blood cell Hospital Henri Mondor, Creteil, and who took at least one episode of pyelonephritis. Patients and Methods: This study was conducted in the genetic disease unit of red blood cell (UMGGR) Hospital Henri Mondor in Creteil (France). This is a retrospective descriptive and analytical study on patients with homozygous sickle cell disease, females, aged 18 years or more. The selection was conducted over a period of one year from February 2007 to February 2008. Data were collected from medical records and from reports of record of each patient. We considered the clinical, paraclinical and therapeutic latest episode of pyelonephritis. Data processing was done using the software Statview. Results: The prevalence of pyelonephritis in women with sickle cell disease aged over 15 years was 6.12% annually. The median age at first episode of pyelonephritis was 23.5 years. The majority (71.42%) was the first episode after 20 years. Among the factors predisposing to pyelonephritis, pregnancy has been implicated in 16.7% of cases. The symptoms of cystitis, with 52.4%, were the fact favoring predominant. The average number episodes of pyelonephritis to our patients were 2. The risk of recurrent pyelonephritis was significantly correlated statistically with the presence of cholelithiasis (p = 0.04). Fever was the clinical symptoms that prompted the consultation in 95.24% cases. The consequences of sickle cell disease were important. We identified 16.7% cases of sepsis and 16.7% of worsening anemia requiring transfusion. The causative agent was E. coli in 85.7% of patients. 61.9% of patients received combination therapy. The intravenous therapy as first-line was found in 81%. Fluoroquinolones were the molecules widely used in 71.4% of cases. The rate of clinical failure at 3 days of antibiotics was 4.76%. The average time for obtaining apyrexia was 3 days. The average duration of treatment was 15 days. We observed no cases of death secondary to the episode of pyelonephritis. Conclusion: This preliminary work has highlighted the incidence of pyelonephritis in women adult with sickle cell and the the potential impact on sickle cell disease. Despite being underestimated because of the retrospective nature and short duration (1 year) of study, this frequency must motivate strategy to encourage more active educational preventive towards patients and early diagnosis of urinary tract infections to women with sickle cell disease.