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May 28, 1982

Pneumococcal Infections and Sickle Cell Disease

JAMA. 1982;247(20):2782. doi:10.1001/jama.1982.03320450020023

To the Editor.—  A serious omission occurred in the article by Maurice A. Mufson, MD, entitled, "Pneumococcal Infections" (1981;246:1942).Under the various factors mentioned by the author as those that increase morbidity and mortality from pneumococcal infections, no mention has been made of sickle cell disease. Patients homozygous for sickle cell disease are at an increased risk of severe pneumococcal infection.1 One of every 500 black infants born in the United States suffers from one of the sickle cell diseases (1979;241:1145), and bacterial infection (including pneumococcal infections) is the chief cause of mortality during infancy and early life (1974; 230:1145). Many mechanisms have been proposed to explain both the increased susceptibility to infections and the patient's inability to localize the intruding bacteria.Some of these mechanisms as (functional) asplenia and defects in the immune mechanisms that are responsible for the serious course of (pneumococcal) infections in the patient with