Invasive pneumococcal disease and hemolytic uremic syndrome.
OBJECTIVE
Severe pneumococcal infections have been associated with hemolytic uremic syndrome (HUS), usually with a poor clinical outcome when compared with Escherichia coli O157 gastroenteritis-associated (D+) HUS. We examined our experience with 12 cases of Streptococcus pneumoniae-associated HUS (SP-HUS) and compare it with a cohort of diarrhea-associated HUS (D+ HUS).


METHODS
A retrospective case survey compared 2 unrelated groups of HUS patients. Demographic factors, clinical indices of disease severity, and outcome were used to compare the 2 groups of HUS patients.


RESULTS
Twelve children with SP-HUS were studied. Pneumococcal pneumonia with empyema was the most common precipitating illness (67%), pneumococcal meningitis was present in 17% of children, pneumonia with bacteremia in 8%, and both pneumonia and meningitis in 8%. SP-HUS patients were younger than D+ HUS patients (22.1 vs 49 months) and had more severe renal and hematologic disease than D+ HUS patients. Compared with D+ HUS patients, SP-HUS patients were more likely to require dialysis (75% vs 59%) and had a longer duration of hospitalization (33.2 vs 16.1 days) and duration of thrombocytopenia (11.6 vs 6.8 days). SP-HUS patients were also more likely to require platelet transfusions (83% vs 47%) and needed more platelet (4.7 vs 0.5) and packed red blood cell transfusions (7.8 vs 2.0). The 2 groups did not differ significantly in the incidence of extrarenal HUS complications. There were no deaths in either group. Seven patients have been seen for long-term follow-up; 2 developed end-stage renal disease, and 5 have normal renal function.


CONCLUSIONS
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.
Brandt
John
J
Department of Pediatrics, Children's Hospital of New Mexico, Albuquerque, New Mexico 87131-5311, USA. jbrandt@salud.unm.edu
Wong
Craig
C
Mihm
Susan
S
Roberts
Joan
J
Smith
Jodi
J
Brewer
Eileen
E
Thiagarajan
Ravi
R
Warady
Bradley
B
D002675:Child, Preschool; D004927:Escherichia coli Infections / Q000150:complications; D019453:Escherichia coli O157; D005260:Female; D005759:Gastroenteritis / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae