Hemolytic uremic syndrome associated with invasive pneumococcal disease: the United kingdom experience.
OBJECTIVE
To describe the presentation, management, and outcome of 43 cases of pneumococcal-associated hemolytic uremic syndrome (P-HUS). An increased incidence of P-HUS has been noted in the United Kingdom between January 1998 and May 2005.


METHODS
Cases with microangiopathic hemolytic anemia (Hb <10 g/dL with fragmented RBCs), thrombocytopenia (platelet count < 130 x 10(9)/L), acute renal impairment with oliguria and elevated plasma creatinine for age, confirmed or suspected pneumococcal infection and/or T-activation were included.


RESULTS
The median age at presentation was 13 months (range, 5-39 months). Pneumococcus was identified in 34 of 43 cases; T-activation was identified in 36 of 37 cases. Twelve strains were serotyped: serotypes 3 (n = 2), 6A (n = 2), 12F (n = 1), 14 (n = 1), 19A (n = 6). Empyema was present in 23 of 35 pneumonia cases; 13 cases had confirmed (9) or suspected (4) pneumococcal meningitis; 36 cases required dialysis (median, 10 days; range, 2-240 days). The mortality rate was 11%, comprising 3 cases of meningitis, 1 case of sepsis and 1 case of pulmonary embolism at 8 months follow up while on dialysis. Follow-up data were available for 35 of 38 patients who survived (median follow-up period, 9 months; range, 1-63 months); of these, 10 patients had renal dysfunction, 1 patient was dialysis-dependent, 5 patients had hypertension and 8 patients had at least 1+ proteinuria on urinalysis.


CONCLUSIONS
P-HUS has increased compared with historic surveys (0/288 in 1985-1988; 8/413 in 1997-2001, 43/315 in 1998-May 2005). Early mortality remains high (8-fold that of VTEC-induced HUS). Ten of 12 strains identified would not be covered by the PCV7 vaccine.
Waters
Aoife M
AM
Great Ormond Street Hospital, London, UK.
Kerecuk
Larissa
L
Luk
David
D
Haq
Mushfequr R
MR
Fitzpatrick
Margaret M
MM
Gilbert
Rodney D
RD
Inward
Carol
C
Jones
Caroline
C
Pichon
Bruno
B
Reid
Christopher
C
Slack
Mary P E
MP
Van't Hoff
William
W
Dillon
Michael J
MJ
Taylor
C M
CM
Tullus
Kjell
K
D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology
D000900:Anti-Bacterial Agents