Bacterial osteomyelitis in major sickling haemoglobinopathies: geographic difference in pathogen prevalence

Controversy exists about the bacterial pathogen that is most often associated with osteomyelitis in major sickling haemoglobinopathies, that is, HbSS, HbSC, and HbSthalassemia. To determine the existence of regional or continental differences in the prevalence of bacterial pathogens associated with osteomyelitis in sickling haemoglobinopathies. A meta-analysis is done of 11 year hospital data set and published studies in African Journals Online (Ajol) and Pubmed electronic databases on the subject. Fifteen studies including two hundred and eighty one bacterial pathogens from SubSaharan Africa, United States, Europe and the Middle East were analysed. There were 129 (45.9%) salmonellae, 82 (29.2%) Staphylococcus aureus, 55 (19.6%) other Gram negative bacilli (GNB) and 15 (5.3%) other Gram positive cocci (GPC). There were 117 isolates in the studies from Africa out of which salmonellae accounted for 21.4%, S. aureus 38.5%, other GNB 34.2% and other GPC 6%. In contrast, out of 110 isolates in the studies from the USA, salmonellae were 70%, S. aureus 16.4%, other GNB 9.1% and other GPC 4.5%. Salmonellae and S. aureus accounted for 37.9% and 62.1%; 64% and 4.9% in isolates from the Middle East and Europe respectively. Salmonellae are the most common bacterial pathogens of osteomyelitis in major sickling haemoglobinopathies in the USA and Europe whereas Staphylococcus aureus is the most common pathogen in SubSaharan Africa and the Middle East. The worldwide prevalence of salmonella may be reducing while that of S. aureus may be increasing. Possible reasons for this observation are suggested.