Necrotizing pneumonia caused by nanC-carrying serotypes is associated with pneumococcal haemolytic uraemic syndrome in children

Abstract

Streptococcus pneumoniae infection is a leading cause of morbidity and mortality worldwide. One of the most severe complications of invasive pneumococcal disease (IPD) is haemolytic uraemic syndrome (HUS). This study was undertaken to determine the risk factors and role of pneumococcal neuraminidases in HUS in children with IPD. Eighteen cases of HUS and 54 patients with IPD without HUS were identified. The controls were patients with culture-confirmed IPD without HUS. Clinical and laboratory characteristics of the two groups of patients were compared. Bacterial isolates from both groups were serotyped, sequence typed and examined for their carriage of three neuraminidase genes. Necrotizing pneumonia and serotype 3 infection were significantly associated with HUS in children with IPD, suggesting that a severe pulmonary suppurating disease increase the risk of HUS. Serotype 14 was associated with necrotizing pneumonia but not HUS. Children with HUS were more likely to require surgery and had a longer duration of hospitalization. The study identified a significantly higher carriage of a neuraminidase gene, nanC, in the causative pneumococcal isolates from patients with HUS (89% versus 41%, p 0.001). The sensitivity and specificity of nanC to predict HUS were 89% and 59%, respectively. In conclusion, necrotizing pneumonia, serotype 3 infection and neuraminidase gene nanC were associated with HUS in children with IPD. The result suggests that NanC could provide an additive effect to NanA and NanB in the overall activity of pneumococcal neuraminidases to expose Thomsen-Friedenreich antigen on various cells in patients with HUS.

Lung Abscess Due to Streptococcus pneumoniae: A Case Series and Brief Review of the Literature

“…They were admitted to intensive care. Also, the serotypes found in our cases were extremely rare compared to most cases of pneumonia and/or pulmonary abscess [4,24,25]. The same is true in the patient with spinal meningitis [24,25].…”

“…In Taiwan, serotype 14 was another common serotype that caused necrotizing pneumonia. However, there is no monopoly among the serotypes; other serotypes, including 6B, 19F, 23F and 19A, at a lower frequency, may also cause necrotizing pneumonia [4]. In a retrospective review conducted by Yen et al covering twenty years , 23 patients presented with a lung abscess; the most common micro-organism isolated was again Streptococcus pneumoniae [5].…”

Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology

“…Table 3 presents data on serotype epidemiology [7–9, 14, 15, 17, 18, 30–35, 37, 39–41, 43, 44, 46, 47, 49, 51–60, 62, 64, 66–69, 72, 73, 75–84, 86–91, 93, 94, 97, 99, 101, 102]. Globally, serotypes 1 and 19A exhibited strong associations with pneumococcal PE [15, 52, 66, 69], PnEmp [10, 31, 43, 46, 49, 54, 57, 58, 60, 68, 72, 81, 83, 88, 90, 93, 101], or both [32, 39, 44].…”

Treatment and management of children with haemolytic uraemic syndrome

“…This reveals an element of the glycoprotein that is usually hidden, the Thomsen-Friedenreich antigen or T-antigen. It is proposed that this T-antigen reacts with circulating IgM resulting in p-HUS 53. Interestingly, the T-antigen is also found in infants with necrotising enterocolitis (NEC), where it is associated with increased severity of disease, although the clinical role for T-antigen in NEC is unclear 54…”