Complications Ostéoarticulaires de la Drépanocytose au Département de Pédiatrie du CHU Gabriel Touré

RESUME Objectif. Decrire les complications osteoarticulaires de la drepanocytose chez l’enfant au departement de pediatrie du CHU Gabriel Toure. Materiel et methodes. Il s’agit d’une etude transversale retrospective s’etendant d’avril 2015 a mars 2017 portant sur les complications osteoarticulaires des enfants drepanocytaires de 0-15 ans. Les donnees ont ete recueillies sur une fiche d’enquete individuelle a partir des dossiers medicaux. Les parametres d’interet etaient les donnees sociodemographiques, la presentation clinique, les principaux sites, le diagnostic clinique, le germe etiologique, les modalites et le resultat du traitement. Resultats. Trente-sept drepanocytaires ont presente des complications osteoarticulaires sur un total de 90 soit 41,1%. Les enfants de 5 a 15 ans ont ete les plus touches (73%) et le sex-ratio etait de 0,85. La forme SS a ete observee dans 67,6% des cas (25/37) suivie de la forme SC (10/37). Vingt-six enfants etaient suivis regulierement. La consanguinite du 1er degre a ete retrouvee chez 77,8%. La douleur osteoarticulaire etait le motif de consultation le plus frequent (83,8%) et les membres inferieurs etaient les plus atteints (32 cas/37). L’atteinte articulaire etait predominante au genou gauche (16,2%) et les hanches (10,8%). Les germes retrouves suite a des prelevements sur site etaient des salmonelles dans 24,3% des cas suivis des staphylocoques (13,5%). L’osteomyelite aigue a ete le diagnostic le plus retrouve (40,5%). L’antibiotherapie probabiliste etait dominee par l’association ceftriaxone + gentamycine (67,6%). Le paracetamol injectable a ete l’antalgique utilise chez la totalite des patients, suivi du tramadol injectable (26 cas/37). Les traitements medical et chirurgical ont ete associes dans 91,9% des cas. La duree moyenne d’hospitalisation etait de 29 jours. La letalite etait de 5,4% (2 patients/37). Conclusion. L’osteomyelite aigue etait la complication osteoarticulaire la plus redoutable. Les salmonelles et les staphylocoques etaient les germes frequemment retrouves. ABSTRACT Objective. To describe bone and joint complications of sickle cell disease in children in the pediatric department of CHU Gabriel Toure. Material and methods. This was a retrospective study from April 2015 to March 2017 on the osteoarticular complications of sickle cell children aged 0-15 years. The data was collected on an individual survey sheet from medical records. Our data of interest were: sociodemographic data, clinical presentation, bone and joints affected, clinical diagnosis, causative germ, management and outcome of the disease. Results. Thirty-seven sickle-cell patients had osteo-articular complications out of a total of 90 (41.1%). Children aged 5 to 15 years were the most affected with 73% and a sex ratio of 0.85. The SS form was observed in 67.6% of cases (25/37) followed by SC (10/37). Twenty-six children were followed regularly. First degree consanguinity was found in 77.8%. Osteoarticular pain was the most frequent reason for consultation (83.8%) and lower limbs were more affected (32 cases / 37). Joint involvement was predominant in the left knee with 16.2% and hips (10.8%). The germs found following on-site sampling were salmonella in 24.3% followed by staphylococci (13.5%). Acute osteomyelitis was the most recovered diagnosis with 40.5%. Probabilistic antibiotic therapy was dominated by the combination ceftriaxone + gentamycin (67.6%). Paracetamol injection was the analgesic used in all patients, followed by injectable tramadol (26 cases / 37). Medical and surgical treatments were associated in 91.9% of cases. The average duration of hospitalization was 29 days. The lethality was 5.4% (2 patients / 37). Conclusion. Acute osteomyelitis was the most formidable osteoarticular complication. Salmonella and staphylococci were the common germs found.