Diagnosis of Streptococcus pneumoniae-associated hemolytic uremic syndrome.
BACKGROUND
Hemolytic uremic syndrome related to pneumococcal infection (P+HUS) can be difficult to diagnose due to the lack of a specific test and the absence of a consensus for definite diagnostic criteria.


METHODS
A retrospective study was conducted on the cases that have been considered as P+HUS in the participating centers during the past 10 years. Diagnostic strategy and criteria used for the diagnosis of P+HUS were evaluated and compared with a review of literature data.


RESULTS
A total of 17 children were studied. Tests ruling out other causes of HUS were performed in 94% of cases. Direct confirmatory tests for P+HUS were done in a minority of cases as Thomsen-Friedenreich antigen testing using lectin assay were done in only 2 patients (11%). Retrospectively, the diagnosis of P+HUS was confirmed in 28% to 89% of cases depending on the already published criteria used. A literature review focused on the last 15 years confirmed these diagnostic difficulties due to variable definition criteria and bring a new light on the potential usefulness of tests used to reveal T activation in this setting.


CONCLUSIONS
To date, in a context of suspicion of P+HUS, no precise, practical and consensual strategy exists for T-antigen exposure diagnosis. The T-antigen activation test using peanut lectin might be the most appropriate test for a direct diagnosis of P+HUS. A large prospective study is required to confirm this hypothesis. However, before such data are available, its use could be of help when a suspicion of P+HUS is present given the therapeutic impact of such a diagnosis.
From the *Department of Pediatrics, Limoges University Hospital and CHREC, Limoges; †Pediatric Nephrology Unit, Marseille University Hospital, Marseille; ‡Pediatric Nephrology Unit, Montpellier University Hospital, Montpellier; §Pediatric Nephrology Unit, Toulouse University Hospital, Toulouse; ¶Pediatric Nephrology Unit, Nice University Hospital, Nice; ‖Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux; and **UMR CNRS 7276, Limoges University, Limoges, France.
Alexandra
A
Loupiac
Abeer
A
Elayan
Mathilde
M
Cailliez
Anne-Laure
AL
Adra
Stéphane
S
Decramer
Marie-Christine
MC
Thouret
Jérôme
J
Harambat
Vincent
V
Guigonis
D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000382:microbiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
D015295:Antigens, Tumor-Associated, Carbohydrate; C016467:Thomsen-Friedenreich antigen