Invasive Pneumococcal Disease and Hemolytic Uremic Syndrome

Abstract

HUS is a rare but severe complication of invasive pneumococcal infection. Although disseminated intravascular coagulation can also occur in these children, the treatment and follow-up may be different in the 2 conditions. Children with pneumococcal disease and severe hematologic or renal abnormalities should be investigated for evidence of HUS.

Streptococcus pneumoniae-associated hemolytic uremic syndrome

“…Since 1987, 73 children [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] with pneumococcal HUS have been reported in the English language literature. Of these, 12.3% (9/73) died; 10.1% (7/69) progressed to ESRF; and 16% (11/69) survived, with chronic kidney disease or hypertension.…”

“…Detailed clinical [33] and follow-up data [34] were unavailable for four patients. The improved mortality rate in the past 20 years may have been the result of the advances in critical care medicine as opposed to changes in disease virulence [31]. A careful analysis of the 69 children with comprehensive clinical data [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38] reveals that only 28% of the patients presented with meningitis.…”

“…Theoretically, different serotypes may produce varying amounts and activities of neuraminidase, thereby influencing the likelihood of a patient's developing HUS. Some authors have suggested that a heavy bacterial load increases the individual's risk of developing pneumococcal HUS [31]. Evidence for this hypothesis is based on the relatively high frequency of patients with empyema-associated pneumonia and the rarity of patients who present with spontaneous bacteremia or minor pneumococcal infections.…”

“…There is no gender predisposition [19]. Children with pneumococcal HUS are younger at presentation and have more severe initial hospital courses than those with STEC HUS [31]. They also have longer periods of oligo-anuria, more frequent need for acute dialysis (75% vs 59%), longer hospital stays (33 days vs 16 days), more red blood cell and platelet transfusions, and a longer duration of thrombocytopenia [31].…”

“…Children with pneumococcal HUS are younger at presentation and have more severe initial hospital courses than those with STEC HUS [31]. They also have longer periods of oligo-anuria, more frequent need for acute dialysis (75% vs 59%), longer hospital stays (33 days vs 16 days), more red blood cell and platelet transfusions, and a longer duration of thrombocytopenia [31]. In our review of the 73 patients reported from 1987 to 2007 [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] 10.1% developed endstage renal failure (ESRF) and 12.3% died in the acute phase.…”