title: Invasive pneumococcal pneumonia is the major cause of paediatric haemolytic-uraemic syndrome in Taiwan.
abstract: OBJECTIVE
  Streptococcus pneumoniae-associated haemolytic uraemic syndrome (SP-HUS) is a major concern of paediatric acute renal failure in Taiwan; it leads to significant morbidity and mortality during the acute phase and to long-term morbidity after an acute episode.
  
  
  METHODS
  Twenty children diagnosed with HUS between 1 May 1995, and 31 December 2008 was enrolled. Clinical variables related to laboratory data, organ involved, and outcomes were examined between patients with and without SP-HUS.
  
  
  RESULTS
  Thirteen of the 20 (13/20, 65%) patients required dialysis, nine (9/20, 45.0%) developed hepatic dysfunction, disseminated intravascular coagulation (DIC), gastrointestinal bleeding, and hypertension, respectively. They were the second most common extrarenal complication except empyema (11/20, 55%). Two (10%) died and seven (35%) of the survivors developed long-term renal morbidity. Twelve of the 20 patients (60%) were diagnosed with SP-HUS. Younger age, female children, higher white blood cell count, higher alanine transaminase, higher lactate dehydrogenase and high incidence of DIC were significantly common in SP-HUS cases. All SP-HUS cases were complicated with pleural effusion, empyema, or both. Positive Thomsen-Freidenreich antigen (T-Ag) activation was 83% sensitive and 100% specific for SP-HUS, and a positive direct Coombs' test was 58% sensitive and 100% specific.
  
  
  CONCLUSIONS
  Invasive pneumococcal infection is the most common cause of HUS in Taiwan. Positive T-Ag activation and a direct Coombs' test are rapid predictors of SP-HUS in children with invasive pneumonia.
authors.affiliation: Department of Pediatrics, Kuo General Hospital, and Department of Nursing, Chung Hwa University of Medical Technology, Rende Shiang, Tainan, Taiwan.
authors.forename: Ching-Sung
authors.initials: CS
authors.lastname: Lee
authors.forename: Mei-Ju
authors.initials: MJ
authors.lastname: Chen
authors.forename: Yee-Hsuan
authors.initials: YH
authors.lastname: Chiou
authors.forename: Ching-Fen
authors.initials: CF
authors.lastname: Shen
authors.forename: Chan-Yao
authors.initials: CY
authors.lastname: Wu
authors.forename: Yuan-Yow
authors.initials: YY
authors.lastname: Chiou
mesh_terms: D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003298:Coombs Test / Q000379:methods*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015994:Incidence; D007223:Infant; D017093:Liver Failure / Q000209:etiology; D008297:Male; D010996:Pleural Effusion / Q000209:etiology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D013624:Taiwan / Q000453:epidemiology; D013995:Time
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; C016467:Thomsen-Friedenreich antigen