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Invasive pneumococcal pneumonia is the major cause of paediatric haemolytic‐uraemic syndrome in Taiwan
Author(s) -
LEE CHINGSUNG,
CHEN MEIJU,
CHIOU YEEHSUAN,
SHEN CHINGFEN,
WU CHANYAO,
CHIOU YUANYOW
Publication year - 2012
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2011.01500.x
Subject(s) - medicine , empyema , pneumonia , pleural effusion , incidence (geometry) , gastroenterology , disseminated intravascular coagulation , peritoneal dialysis , complication , dialysis , streptococcus pneumoniae , surgery , antibiotics , physics , microbiology and biotechnology , optics , biology
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.