ro13-9904 and Hemolytic-Uremic-Syndrome

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in children, with the majority of cases caused by an infection with Shiga toxin-producing Escherichia coli (STEC). Whereas O157 is still the predominant STEC serotype, non-O157 serotypes are increasingly associated with STEC-HUS. However, little is known about this emerging and highly diverse group of non-O157 serotypes. With supportive therapy, STEC-HUS is often self-limiting, with occurrence of chronic sequelae in just a small proportion of patients.. In this case report, we describe a 16-month-old boy with a highly severe and atypical presentation of STEC-HUS. Despite the presentation with multi-organ failure and extensive involvement of central nervous system due to extensive thrombotic microangiopathy (suggestive of atypical HUS), fecal diagnostics revealed an infection with the rare serotype: shiga toxin 2d-producing STEC O80:H2.. This report underlines the importance of STEC diagnostic tests in all children with HUS, including those with an atypical presentation, and emphasizes the importance of molecular and serotyping assays to estimate the virulence of an STEC strain.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Biopsy; Blood Culture; Ceftriaxone; Escherichia coli Infections; Hemolytic-Uremic Syndrome; Humans; Infant; Liver; Magnetic Resonance Imaging; Male; Midazolam; Multiple Organ Failure; Real-Time Polymerase Chain Reaction; Resuscitation; Serotyping; Shiga Toxin 2; Shiga-Toxigenic Escherichia coli; Thrombotic Microangiopathies; Virulence

Streptococcus pneumoniae ( S. pneumoniae ) has been associated with hemolytic uremic syndrome (HUS), which is an unusual but serious disease in childhood. We conducted a retrospective review of children aged less than 18 years with S. pneumoniae -associated HUS in northern Taiwan from January 2000 to June 2005. The demographic characters, clinical courses, and outcomes were analyzed. Seven children (three girls, four boys) with S. pneumoniae -associated HUS were studied. The median age at onset of HUS was 40 months (range: 25-60 months). The median duration of hospital stay was 36 days (range: 15-50 days). The interval between the onset of illness attributable to S. pneumoniae and the development of HUS was around 1-2 weeks. The onset of oliguria developed within 2 weeks after illness. Six patients required dialysis with median duration of 16 days. Three patients had leukopenia as the initial presentation. All seven patients had pneumococcal pneumonia complicating with empyema, and two of them received decortication via video-assisted thoracoscopic surgery. Between patients who needed dialysis or not, there was no significant difference in age, sex, duration of thrombocytopenia, incidence of extra-renal complications, such as hepatitis, pancreatitis, and hypertension, and length of hospital stay. The seven patients survived with normal renal function. HUS is a potentially fatal complication of S. pneumoniae infection. Clinicians managing patients with pneumococcal pneumonia with empyema accompanied by leukopenia should beware of the development of HUS. The long-term prognosis for recovery of renal function appears to be good in these patients in northern Taiwan.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Empyema, Pleural; Erythrocyte Transfusion; Female; Hemolytic-Uremic Syndrome; Humans; Length of Stay; Leukopenia; Male; Oliguria; Platelet Transfusion; Pneumonia, Pneumococcal; Renal Dialysis; Respiration, Artificial; Retrospective Studies; Taiwan; Thoracostomy; Thrombocytopenia

A previously healthy eight-month-old infant presented with shortness of breath and pyrexia. He was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by acute renal failure due to haemolytic uraemic syndrome. He received peritoneal dialysis and recovered with normalisation of renal function. This case highlights two important complications of pneumococcal infection in one individual and illustrates the need for rapid diagnosis and treatment of invasive pneumococcal disease. It is anticipated that introduction of the conjugate pneumococcal vaccination to the Australian Standard Vaccination Schedule from 2005 will reduce the incidence of pneumococcal infection and its associated morbidity and mortality.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Ceftriaxone; Follow-Up Studies; Hemolytic-Uremic Syndrome; Humans; Infant; Male; Pericarditis; Peritoneal Dialysis; Pneumococcal Infections; Streptococcus pneumoniae; Suppuration

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Combined Modality Therapy; Drug Therapy, Combination; Erythrocyte Transfusion; Hemolytic-Uremic Syndrome; Humans; Incidence; Male; Pneumococcal Infections; Prognosis; Risk Factors; Severity of Illness Index; Treatment Outcome