Streptococcus pneumoniae-Associated Hemolytic Uremic Syndrome: Classification and the Emergence of Serotype 19A

Streptococcus pneumoniae-associated hemolytic uremic syndrome (HUS) is an underrecognized condition that mainly occurs in young children. Early diagnosis is important because of the potential to improve morbidity and mortality rates. The purposes of this report are to review the clinical and laborat...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2010-01, Vol.125 (1), p.e174-e182
Main Authors: Copelovitch, Lawrence, Kaplan, Bernard S
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Biopsy, Needle
Child
Child, Preschool
Childrens health
Cohort Studies
Combined Modality Therapy
Early Diagnosis
Empyema, Pleural - diagnosis
Empyema, Pleural - mortality
Empyema, Pleural - therapy
Female
Hemolytic-Uremic Syndrome - diagnosis
Hemolytic-Uremic Syndrome - mortality
Hemolytic-Uremic Syndrome - therapy
Hospitals, Pediatric
Humans
Immunohistochemistry
Infant
Kidney diseases
Male
Medical diagnosis
Morbidity
Mortality
Pediatrics
Philadelphia
Pneumococcal Infections - diagnosis
Pneumococcal Infections - mortality
Pneumococcal Infections - therapy
Prognosis
Registries
Renal Dialysis - methods
Risk Assessment
Serotyping
Severity of Illness Index
Streptococcus infections
Streptococcus pneumoniae - classification
Survival Rate
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Summary:Streptococcus pneumoniae-associated hemolytic uremic syndrome (HUS) is an underrecognized condition that mainly occurs in young children. Early diagnosis is important because of the potential to improve morbidity and mortality rates. The purposes of this report are to review the clinical and laboratory features of 14 patients with pneumococcal HUS and present a modified classification to capture cases that may not have been documented with a diagnosis of pneumococcal HUS. We thereby provide a rationale for including patients with concurrent disseminated intravascular coagulopathy and/or those whose culture results were negative, and we highlight the emergence of serotype 19A subsequent to the introduction of 7-valent pneumococcal protein conjugate vaccine (Prevnar). This is the largest series of such subjects (to our knowledge) from a single center. Sixty-four percent of the patients recovered without any long-term sequelae. Three patients developed chronic kidney disease, 1 developed end-stage renal failure, and 1 died in the acute phase. The greatest risk factor for the development of chronic kidney disease is the need for acute dialysis for >20 days, and death in the acute phase is rare unless meningitis is the primary infection.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2007-2017