Journal of Pediatric Growth & Health Perspectives

Abstract

Introduction: Acute chest syndrome (ACS) is an acute and serious pulmonary complication of sickle cell disease. ACS is the second leading cause of hospitalization and the leading cause of death in sickle cell patients. In our country, there is little data on this condition, which prompted this study focusing on the epidemiological, diagnostic and therapeutic aspects of acute chest syndrome in sickle cell patients at the Peace Hospital in Ziguinchor.

Materials and Methods: We conducted a retrospective descriptive study from 1 January 2018 to 31 March 2025 in the pediatric department of the Peace Hospital in Ziguinchor. The study included all homozygous SS sickle cell patients and composite SC heterozygotes who were regularly monitored in the department and hospitalized during the study period for ATS. AST was defined in our patients by the combination of a recent chest X-ray with at least one of the following respiratory symptoms: cough, dyspnea, chest pain, hypoxia, fever. The data were entered and analyzed using Sphinx software, Microsoft Excel 2020 and Google Forms.

Results: During the study period, 44 patients were hospitalized in the department for STA, representing a hospitalization rate of 0.68%. The average age was 7.3 years [1–19 years]. Patients were 100% homozygous SS, with a mean baseline hemoglobin level of 7.79 g/dl [6.3–9 g/dl], previous hospitalization in 54.4% of cases, previous transfusion in 29.5% of cases, and comorbidity such as asthma in 11.4% of cases. The main reasons for hospitalization were cough (75%), chest pain (61.4%) and dyspnea (59.1%). The signs observed during examination were predominantly pallor (88.6%), pulmonary condensation syndrome (68.2%), fever (65.9%), altered general condition (47.7%) and hypoxia (45.5%). AST was mainly associated with pneumonia (72.7%), CVO (43.2%) and acute anemia (34%). The mean hemoglobin level on admission was 6.9 g/dl. Chest X-rays showed bilateral parenchymal involvement in 31.8% of cases; on the right in 29.5% of cases and on the left in 20.5% of cases. One patient underwent a chest CT scan, which showed pneumonia with a ground-glass appearance. Patients received hydration (88.6%), oxygenation (56.8%) and transfusions (77.3%).

Paracetamol was the most commonly used analgesic (97.8%). It was used alone in 43.2% of cases or in combination with non-steroidal anti-inflammatory drugs in 27.3% of cases, with tramadol in 15.9% of cases and with morphine in 9.1% of cases. The combination of C3G-based antibiotics + aminoglycosides + macrolides was the most commonly used (28.6%).

Conclusion: Acute chest syndrome is a serious acute complication of sickle cell disease. Treatment must be early and appropriate to prevent the condition from worsening.