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- Title
Invasive pneumococcal pneumonia is the major cause of paediatric haemolytic-uraemic syndrome in Taiwan.
- Authors
LEE, CHING-SUNG; CHEN, MEI-JU; CHIOU, YEE-HSUAN; SHEN, CHING-FEN; WU, CHAN-YAO; CHIOU, YUAN-YOW
- Abstract
ABSTRACT: Aim: Streptococcus pneumoniae-associated haemolytic uraemic syndrome (SP-HUS) is a major concern of paediatric acute renal failure in Taiwan; it leads to significant morbidity and mortality during the acute phase and to long-term morbidity after an acute episode. Methods: Twenty children diagnosed with HUS between 1 May 1995, and 31 December 2008 was enrolled. Clinical variables related to laboratory data, organ involved, and outcomes were examined between patients with and without SP-HUS. Results: Thirteen of the 20 (13/20, 65%) patients required dialysis, nine (9/20, 45.0%) developed hepatic dysfunction, disseminated intravascular coagulation (DIC), gastrointestinal bleeding, and hypertension, respectively. They were the second most common extrarenal complication except empyema (11/20, 55%). Two (10%) died and seven (35%) of the survivors developed long-term renal morbidity. Twelve of the 20 patients (60%) were diagnosed with SP-HUS. Younger age, female children, higher white blood cell count, higher alanine transaminase, higher lactate dehydrogenase and high incidence of DIC were significantly common in SP-HUS cases. All SP-HUS cases were complicated with pleural effusion, empyema, or both. Positive Thomsen-Freidenreich antigen (T-Ag) activation was 83% sensitive and 100% specific for SP-HUS, and a positive direct Coombs' test was 58% sensitive and 100% specific. Conclusion: Invasive pneumococcal infection is the most common cause of HUS in Taiwan. Positive T-Ag activation and a direct Coombs' test are rapid predictors of SP-HUS in children with invasive pneumonia.
- Subjects
TAIWAN; PNEUMOCOCCAL pneumonia; HEMOLYTIC-uremic syndrome; THROMBOTIC thrombocytopenic purpura; ACUTE kidney failure; JUVENILE diseases; ESCHERICHIA coli; EMPYEMA; DISEASE risk factors
- Publication
Nephrology, 2012, Vol 17, Issue 1, p48
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1111/j.1440-1797.2011.01500.x