Streptococcus pneumoniae-associated Hemolytic Uremic Syndrome Among Children in North America

Abstract

North American children with SP-HUS had severe clinical manifestations and significant morbidity. In this series, nearly all cases were caused by serotypes that are not in PCV7 but are included in PCV13.

Postdiarrheal Hemolytic Uremic Syndrome in United States Children: Clinical Spectrum and Predictors of In-Hospital Death

“…Pneumococcus-associated HUS can be preceded by a bloody or nonbloody diarrheal illness, and the HUS typically is more severe than STEC-associated HUS. 5,24 The fact that a smaller percentage of children with recent RTI had laboratory evidence of STEC infection than did children without recent RTI suggests that pneumococcus or another etiology other than STEC infection may have caused some D + HUS. Thus, although not directly supported by our findings, suspicion of and testing for S pneumoniae infection among children presenting with D + HUS, especially those with recent RTI (even those with bloody stools) may help identify patients at risk for poor outcomes including death.…”

Thrombotic Microangiopathy and the Kidney

“…In a recently published North American cohort, pneumococcal HUS was most commonly observed in children aged ,2 years with pneumonia and empyema who were extremely unwell and frequently required prolonged hospitalization and intensive care unit admission; the mortality rate was 3%, and 33% developed ESRD (72). The hypothesized mechanism is that pneumococci produce neuraminidase, which cleaves sialic residues from glycoproteins on erythrocyte, platelet, and endothelial cell membranes, exposing the cryptic Thomsen-Friedenreich antigen (T antigen), to which IgM in the plasma can then bind, resulting in cell damage and TMA (73).…”

The Infectious Diseases Society of America Emerging Infections Network: Bridging the Gap Between Clinical Infectious Diseases and Public Health

“…Two case series examples in our pediatric infectious disease community include the largest case series of pediatric S. pneumoniae –associated hemolytic uremic syndrome (37 cases) [24] and the largest case series of colistin use among pediatric patients (92 cases) [25]. In the future, these case-based activities could be greatly expanded.…”