Invasive pneumococcal disease and hemolytic uremic syndrome

被引:92
作者
Brandt, J
Wong, C
Mihm, S
Roberts, J
Smith, J
Brewer, E
Thiagarajan, R
Warady, B
机构
[1] Univ New Mexico, Sch Med, Dept Pediat, Childrens Hosp New Mexico, Albuquerque, NM 87131 USA
[2] Texas Childrens Hosp, Dept Pediat, Houston, TX 77030 USA
[3] Childrens Hosp & Med Ctr, Dept Pediat, Seattle, WA 98105 USA
[4] Childrens Mercy Hosp, Dept Pediat, Kansas City, MO 64108 USA
关键词
hemolytic uremic syndrome; Streptococcus pneumoniae; empyema; acute renal failure; meningitis; pneumonia; pediatric;
D O I
10.1542/peds.110.2.371
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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.
引用
收藏
页码:371 / 376
页数:6
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