title: Streptococcus pneumoniae-associated hemolytic uremic syndrome among children in North America.
abstract: BACKGROUND
  To better characterize Streptococcus pneumoniae-associated hemolytic-uremic syndrome (SP-HUS), we report the largest series of SP-HUS among children in North America.
  
  
  METHODS
  We surveyed pediatric members of the Emerging Infections Network to identify SP-HUS cases. Respondents contributed clinical and laboratory features of these pediatric cases.
  
  
  RESULTS
  A total of 37 cases occurring between 1997 and 2009 were submitted. Of them, 33 cases (89%) were culture-confirmed and 4 (11%) were diagnosed clinically. The median patient age was 2 years, and 28 (76%) patients had completed their heptavalent pneumococcal conjugate vaccination (PCV7) series. Most patients presented with pneumonia (84%) and bacteremia (78%), whereas other clinical manifestations such as pericardial effusion (14%) and meningitis (11%) were less common. Of 29 patients, with bacteremia 6 (21%) had S. pneumoniae concurrently isolated from cerebrospinal fluid or pleural fluid. Severe illness was common with 35 (95%) patients requiring admission to the intensive care unit, over half requiring mechanical ventilation and chest tube placement or video-assisted thoracoscopic surgery, and 27 (73%) requiring dialysis during hospitalization. Among 30 patients with follow-up of 6 months, 7 (23%) remained dialysis dependent, 3 (10%) had undergone renal transplantation, 4 (13%) had neurologic sequelae, and 1 (3%) died. Among 24 serotyped isolates, 96% were non-PCV7 serotypes, most commonly 19A (50%), 92% are included in PCV13, and 10% were penicillin nonsusceptible (minimal inhibitory concentration >2 μg/mL).
  
  
  CONCLUSIONS
  North American children with SP-HUS had severe clinical manifestations and significant morbidity. In this series, nearly all cases were caused by serotypes that are not in PCV7 but are included in PCV13.
authors.affiliation: Department of Pediatrics, Mayo Clinic, Rochester, MN, USA. ritu@mayo.edu
authors.forename: Ritu
authors.initials: R
authors.lastname: Banerjee
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Jason
authors.initials: J
authors.lastname: Newland
authors.forename: Susan E
authors.initials: SE
authors.lastname: Beekmann
authors.forename: Philip M
authors.initials: PM
authors.lastname: Polgreen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bender
authors.forename: Jana
authors.initials: J
authors.lastname: Shaw
authors.forename: Lawrence
authors.initials: L
authors.lastname: Copelovitch
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Kaplan
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D009656:North America; D011008:Pneumococcal Infections / Q000150:complications* / Q000382:microbiology*; D012189:Retrospective Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents