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Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of

America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell

trait. While SCD is known to primarily affect individuals of African American descent, individuals from South

America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the

SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are

estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By

increasing awareness about SCD and promoting patient education, health care professionals can help patients

and their families cope with SCD and better manage the associated pain. Recurring episodes of acute and/or

severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to

patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point,

most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the

duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others

may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted

to manage the pain. An acute pain event is the most common type of pain, and the onset is typically abrupt. It is

often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled

erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme

temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold

climates, menstruation, and fatigue. Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain

often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of

chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and

chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of

potential addiction and adverse effects. Many studies report that some health care professionals are also

concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may

involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.

Out of this group, which of the following demographic is the LEAST likely to have SCD?

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace.

Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms – fever,

congestion, and fatigue – resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its

victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of

lingering cough: atypical pneumonia caused by mycoplasma. Mycoplasma – pleomorphic bacteria that lack a

cell wall – are the smallest and simplest self-replicating organisms known to humans. They probably evolved

from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer

organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes

asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more

than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora.

Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans. Mycoplasma

pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory

epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes

initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have

determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5,

approximately 65% of children have been infected. Nearly all adults have been infected at least once, often

repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest

incidence is found in the 5- to 9-year age group. The risk of contracting mycoplasma pneumonia is greatest for

people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term

care units, and military and prison environments. However, many people who develop mycoplasma infections

have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the

infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed

based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus

infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When

mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.

Which of the following is NOT true about mycoplasma infection?

It has an incubation period of over three weeks.

It can be diagnosed without laboratory testing.

It can cause nausea, vomiting, or diarrhea in children.

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