Hemolytic Uremic Syndrome Associated With InvasiveStreptococcus pneumoniaeInfection

Abstract

* Abbreviations: HUS = : hemolytic uremic syndrome • ECH = : Egleston Children's Hospital • HSCH = : Hughes Spalding Children's Hospital • SRCH = : Scottish Rite Children's Hospital • CDC = : Centers for Disease Control and Prevention • CT = : computed tomography • BUN = : blood urea nitrogen • PT = : prothrombin time • PTT = : partial thromboplastin time • CSF = : cerebrospinal fluid • DIC = : disseminated intravascular coagulopathy Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, is characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. The majority of HUS cases occur after infectious diarrhea, and most of these cases are associated with Escherichia coli O157:H7 infection.1 2 However, atypical cases of HUS also occur in the absence of infectious diarrhea, although less commonly.3 Among 117 children <18 years of age identified with HUS in the state of Minnesota from 1979 through 1988, 16 patients had no preceding diarrheal illness, and 6 had a respiratory illness prodrome.4 Invasive infection with Streptococcus pneumoniae has rarely been associated with atypical HUS cases.5-14 However, there are no published data on the prevalence of invasive pneumococcal infections among patients with HUS or on the prevalence of HUS cases associated with invasive S pneumoniae infection. We report 7 cases of S pneumoniae -associated HUS managed at three Atlanta children's hospitals over a period of 3 years. Recognition of these cases encouraged us to review our recent experience and determine the frequency of S pneumoniae as a cause of HUS at our institutions. An ongoing pneumococcal disease surveillance project in the metropolitan Atlanta area enabled us to determine the incidence of HUS associated with systemic pneumococcal infection. Medical records from the three children's hospitals in the metropolitan Atlanta area (Egleston Children's Hospital [ECH], Hughes Spalding Children's Hospital [HSCH], and Scottish Rite Children's Hospital [SRCH]) were searched for all patients with HUS from January 1994 to December 1996 using International Classification of Diseases, Ninth Revision coding for nonimmune hemolytic anemia (283.1) and HUS (283.11). Case databases of pediatric nephrologists serving these three hospitals were also reviewed to determine the existence of HUS cases not captured by this chart search. Medical records of all patients …