cefotaxime and Hemolytic-Uremic-Syndrome

We report the case of a 4-week-old infant with severe Bordetella pertussis infection resulting in hemolytic anemia, thrombocytopenia, and acute renal failure leading to a diagnosis of hemolytic uremic syndrome (HUS) associated with pertussis. In addition to antibiotic and supportive therapy, he was treated with plasma transfusions based on the possibility of underlying complement defect, and he improved. The association of B. pertussis infection and HUS has previously been described in a patient with a mutation in the gene encoding complement factor H (CFH). However, whereas a genetic workup for complement regulator mutations was performed, no mutation was found in our patient. This case demonstrates the possible association between pertussis infection and HUS and highlights the need for increased vigilance for renal complications in this diagnosis. Despite negative results in this case, in-depth workup of the complement system may be important to guide treatment efforts and strategies.

Topics: Acute Kidney Injury; Ampicillin; Anti-Bacterial Agents; Bordetella pertussis; Cefotaxime; Clarithromycin; Combined Modality Therapy; Hemolytic-Uremic Syndrome; Humans; Infant, Newborn; Male; Oxygen Inhalation Therapy; Treatment Outcome; Whooping Cough

Topics: Anti-Bacterial Agents; Blood Transfusion; Cefotaxime; Cerebrospinal Fluid; Drug Therapy, Combination; Hemolytic-Uremic Syndrome; Humans; Infant; Magnetic Resonance Imaging; Male; Pneumococcal Infections; Streptococcus pneumoniae; Treatment Outcome; Vancomycin

Among the most severe complications of invasive pneumococcal infection are hemolytic uremic syndrome (P-HUS) and hemolytic anemia (P-HA), which occur when the Thomsen-Freidenreich antigen (TA) is exposed on erythrocytes, platelets and glomeruli.. To determine the positive predictive value, sensitivity, and specificity of early TA activation testing for P-HUS or P-HA and to compare the microbiologic features of pneumococcus isolates associated or not associated with TA activation. The case records for 36 patients with invasive pneumococcal infection who had been tested for TA activation were retrospectively reviewed. Clinical and laboratory data were compared between patients with and without TA activation.. Positive TA activation was 86% sensitive and 57% specific for P-HUS or P-HA. The positive predictive value was 76%. There were no between-group differences in antibiotic susceptibility of the pneumococcal isolates. Pneumococcal serotype 14 was the most frequent (5/10 isolates tested) serotype causing P-HUS. Of the 36 patients, 13 required packed red blood cell transfusion, 3 died, and 2 required extracorporeal membrane oxygenation. No patient had long-term renal sequelae.. TA activation is a reasonable predictor of P-HUS or P-HA and could be useful if tested soon after invasive pneumococcal disease is first diagnosed.

Topics: Anemia, Hemolytic; Antigens, Tumor-Associated, Carbohydrate; Cefotaxime; Child; Child, Preschool; Female; Hemolytic-Uremic Syndrome; Humans; Infant; Male; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Retrospective Studies; Sensitivity and Specificity; Streptococcus pneumoniae; Taiwan