Haemolytic-uraemic syndrome associated with Streptococcus pneumoniae meningitis

Abstract

We report the first case of Haemolytic-uraemic syndrome (HUS) associated with Streptococcus pneumoniae meningitis. This supports a common pathogenic mechanism in HUS following infections by neuraminidase-producing organisms and in pneumococcal meningitis. We recommend that HUS must be considered in cases of renal failure and/or anaemia associated with pneumococcal meningitis, and that bacterial meningitis be considered in all patients with HUS and central nervous system involvement.

Streptococcus pneumoniae-associated hemolytic uremic syndrome

“…Since 1987, 73 children [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] with pneumococcal HUS have been reported in the English language literature. Of these, 12.3% (9/73) died; 10.1% (7/69) progressed to ESRF; and 16% (11/69) survived, with chronic kidney disease or hypertension.…”

“…The improved mortality rate in the past 20 years may have been the result of the advances in critical care medicine as opposed to changes in disease virulence [31]. A careful analysis of the 69 children with comprehensive clinical data [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38] reveals that only 28% of the patients presented with meningitis. However, 88% of the deaths occurred in this subgroup (clinical data available on 8/9 patient deaths).…”

“…However, 88% of the deaths occurred in this subgroup (clinical data available on 8/9 patient deaths). The estimated mortality rate of pneumococcal meningitis in children without HUS is 8-10% [50], while the mortality rate in patients with pneumococcal meningitis complicated by HUS is 37% (7/19) [16,22,23,26,[29][30][31]34]. In marked contrast, pneumococcal HUS not associated with meningitis has a mortality rate of only 2% [14,16,18,19,22,[24][25][26][27][28][29][30][31][32][34][35][36][37][38].…”

“…They also have longer periods of oligo-anuria, more frequent need for acute dialysis (75% vs 59%), longer hospital stays (33 days vs 16 days), more red blood cell and platelet transfusions, and a longer duration of thrombocytopenia [31]. In our review of the 73 patients reported from 1987 to 2007 [14,16,18,19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] 10.1% developed endstage renal failure (ESRF) and 12.3% died in the acute phase. These rates are two-to-three-times higher than those of STEC HUS [43,44,45].…”

Thrombotic Thrombocytopenic Purpura Associated with Pneumococcal Sepsis

“…hemolytic uremic syndrome (4,5). Hemolytic uremic syndrome has been described in association with pneumococcal septicemia (6)(7)(8)(9)(10), including one adult (7); we report the first case of full-blown adult TIP in association with this infection.…”