Hemolytic Uremic Syndrome Associated With Streptococcus Pneumoniae in Pediatrics: A Case Series

Abstract

Objective: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. Cases description: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. Comments: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.

Síndrome hemolítico urémico y falla hepática fulminante por <i>Streptococcus pneumoniae</i>

“…1,5 El mecanismo fisiopatológico de esta entidad aún no está bien definido. Se cree que la neuraminidasa producida por el Streptococcus pneumoniae elimina el ácido N-acetilneuramínico de diversas glicoproteínas y glicolípidos de la superficie de membrana de eritrocitos, plaquetas y capilares glomerulares, exponiendo de este modo el antígeno de Thomsen-Friedenreich (antígeno T), 2,3,6 Tabla 1: Comparación de reportes de casos con síndrome hemolítico urémico por Streptococcus pneumoniae.…”

“…el cual reacciona con el anticuerpo anti-T, presente en la mayoría de los individuos, dando lugar a la tríada clásica característica del SHU. 2,6 La neumonía complicada constituye la presentación inicial más frecuente asociada al SHU-SP (hasta en 90% de los casos), 2,4 seguida de meningitis. El SHU-SP en comparación al SHU desencadenado por Escherichia coli tiene peor pronóstico.…”

“…1 Hasta en 90% de los casos se presenta después de un proceso infeccioso causado por cepas de Escherichia coli productoras de la toxina Shiga-like. 1,2 Por su parte, el SHU asociado a Streptococcus pneumoniae (SHU-SP) es más raro y, de acuerdo con Novak y cols., fue descrito por primera vez en 1971. 3 Se esti-…”

“…3,4 El curso clínico es típicamente más grave, por lo que causa mayor morbilidad y mortalidad. 1,2,5 El tratamiento del SHU-SP es principalmente con antibióticos, soporte transfusional y terapia de reemplazo renal, según la necesidad de cada paciente. [1][2][3]5 Reportamos un caso de un lactante que desarrolló SHU-SP, asociado a falla hepática fulminante, que fue atendido en una institución de alta complejidad de la ciudad de Bogotá D.C., Colombia.…”

Thrombotic microangiopathies in Pediatrics: current nomenclature and differential diagnoses with Thrombocytopenia-associated multiple organ failure (TAMOF)

“…In their recent article, Hemolytic-uremic syndrome associated with Streptococcus pneumoniae in pediatrics: a case series, published in Revista Paulista de Pediatria, Guerra et al 1 reported four cases of thrombotic microangiopathy (TMA) related to pneumococcal infection in the unicentric pediatric population of Bogotá, Colombia. One can highlight the excellence in the management of these cases, which is exemplified by the absence of deaths and recovery of renal function in three of the four children.…”