title: Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan.
abstract: Streptococcus pneumoniae ( S. pneumoniae ) has been associated with hemolytic uremic syndrome (HUS), which is an unusual but serious disease in childhood. We conducted a retrospective review of children aged less than 18 years with S. pneumoniae -associated HUS in northern Taiwan from January 2000 to June 2005. The demographic characters, clinical courses, and outcomes were analyzed. Seven children (three girls, four boys) with S. pneumoniae -associated HUS were studied. The median age at onset of HUS was 40 months (range: 25-60 months). The median duration of hospital stay was 36 days (range: 15-50 days). The interval between the onset of illness attributable to S. pneumoniae and the development of HUS was around 1-2 weeks. The onset of oliguria developed within 2 weeks after illness. Six patients required dialysis with median duration of 16 days. Three patients had leukopenia as the initial presentation. All seven patients had pneumococcal pneumonia complicating with empyema, and two of them received decortication via video-assisted thoracoscopic surgery. Between patients who needed dialysis or not, there was no significant difference in age, sex, duration of thrombocytopenia, incidence of extra-renal complications, such as hepatitis, pancreatitis, and hypertension, and length of hospital stay. The seven patients survived with normal renal function. HUS is a potentially fatal complication of S. pneumoniae infection. Clinicians managing patients with pneumococcal pneumonia with empyema accompanied by leukopenia should beware of the development of HUS. The long-term prognosis for recovery of renal function appears to be good in these patients in northern Taiwan.
authors.affiliation: Division of Pediatric Pulmonology, Department of Pediatrics , Chang Gung Children's Hospital, Chang Gung University, College of Medicine, 5, Fu Hsin Street, Taoyuan, Taiwan.
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Huang
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Shen-Hao
authors.initials: SH
authors.lastname: Lai
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000382:microbiology / Q000601:surgery; D017707:Erythrocyte Transfusion; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D007970:Leukopenia / Q000209:etiology; D008297:Male; D009846:Oliguria / Q000209:etiology / Q000628:therapy; D017713:Platelet Transfusion; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013624:Taiwan; D013907:Thoracostomy; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone