Severe bacterial infection in transfusion-dependent patients with thalassemia major

The incidence and clinical spectrum of severe bacterial infection were studied in 89 patients with thalassemia major that was diagnosed between January 1971 and March 2002. There were 20 patients with 24 episodes of severe bacterial infection, resulting in an incidence of 1.6 infections per 100 patient-years. The clinical spectrum included liver abscess ( 6 cases), septicemia ( 6 cases), soft-tissue infection ( 2 cases), osteomyelitis ( 2 cases), corneal ulcer ( 1 case), enteritis ( 1 case), and abscesses of the lung, kidney, intra-abdominal region, retropharynx, gums, and buttocks ( 1 case each). The leading causal microorganisms were gram-negative bacilli, especially Klebsiella pneumoniae ( 10 of 20 isolates). Other responsible pathogens were Pseudomonas aeruginosa (2/20), Vibrio vulnificus (2/20), Acinetobacter baumanii (1/20), Streptococcus intermidius (1/20), Yersinia enterocolitica (1/ 20), Staphylococcus aureus ( 1/ 20), Escherichia coli ( 1/ 20), and Salmonella species ( 1/ 20). Splenectomy and delays in the start of iron-chelating therapy were 2 independent risk factors.