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Pneumococcal Infections
PEDIATRICS Vol. 110 No. 2 August 2002, pp. 371-376

Invasive Pneumococcal Disease and Hemolytic Uremic Syndrome

John Brandt, MD, MPH*, Craig Wong, MD, MPH*, Susan Mihm, MD{ddagger}, Joan Roberts, MD§, Jodi Smith§, Eileen Brewer, MD{ddagger}, Ravi Thiagarajan, MD§ and Bradley Warady, MD||

* Department of Pediatrics, Children’s Hospital of New Mexico, Albuquerque, New Mexico
{ddagger} Department of Pediatrics, Texas Children’s Hospital, Houston, Texas
§ Department of Pediatrics, Children’s Hospital and Medical Center, Seattle, Washington
|| Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri

Objective. Severe pneumococcal infections have been associated with hemolytic uremic syndrome (HUS), usually with a poor clinical outcome when compared with Escherichia coli O157 gastroenteritis-associated (D+) HUS. We examined our experience with 12 cases of Streptococcus pneumoniae-associated HUS (SP-HUS) and compare it with a cohort of diarrhea-associated HUS (D+ HUS).

Methods. A retrospective case survey compared 2 unrelated groups of HUS patients. Demographic factors, clinical indices of disease severity, and outcome were used to compare the 2 groups of HUS patients.

Results. Twelve children with SP-HUS were studied. Pneumococcal pneumonia with empyema was the most common precipitating illness (67%), pneumococcal meningitis was present in 17% of children, pneumonia with bacteremia in 8%, and both pneumonia and meningitis in 8%. SP-HUS patients were younger than D+ HUS patients (22.1 vs 49 months) and had more severe renal and hematologic disease than D+ HUS patients. Compared with D+ HUS patients, SP-HUS patients were more likely to require dialysis (75% vs 59%) and had a longer duration of hospitalization (33.2 vs 16.1 days) and duration of thrombocytopenia (11.6 vs 6.8 days). SP-HUS patients were also more likely to require platelet transfusions (83% vs 47%) and needed more platelet (4.7 vs 0.5) and packed red blood cell transfusions (7.8 vs 2.0). The 2 groups did not differ significantly in the incidence of extrarenal HUS complications. There were no deaths in either group. Seven patients have been seen for long-term follow-up; 2 developed end-stage renal disease, and 5 have normal renal function.

Conclusions. HUS is a rare but severe complication of invasive pneumococcal infection. Although disseminated intravascular coagulation can also occur in these children, the treatment and follow-up may be different in the 2 conditions. Children with pneumococcal disease and severe hematologic or renal abnormalities should be investigated for evidence of HUS.

Key Words: hemolytic uremic syndrome • Streptococcus pneu-moniae • empyema • acute renal failure • meningitis • pneu-monia • pediatric

Abbreviations: HUS, hemolytic uremic syndrome • D+ HUS, diarrhea-associated hemolytic uremic syndrome • DIC, disseminated intravascular coagulation • SP-HUS Streptococcus pneumoniae-associated hemolytic uremic syndrome • T-antigen, Thomsen-Freidenreich antigen • FFP, fresh-frozen plasma • ESRD, end-stage renal disease • IgM, immunoglobulin M

Received for publication Jun 4, 2001; Accepted Feb 19, 2002.




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