Article Text

PNEUMOCOCCUS-INDUCED HEMOLYTIC UREMIC SYNDROME
  1. P Garcia Soler1,
  2. D Moreno Perez2,
  3. F Rodriguez Amuedo1,
  4. S Oliva Rodriguez-Pastor3
  1. 1Cuidados Intensivos Pediatricos, HRU Carlos Haya, Malaga, Spain
  2. 2Infectologia Pediatrica, HRU Carlos Haya, Malaga, Spain
  3. 3Urgencias Pediatricas, HRU Carlos Haya, Malaga, Spain

Abstract

Objetive Hemolytic uremic syndrome (HUS) is a severe complication of invasive pneumoccal infection and is considered to lead to higher mortality and long-term morbidity than the typical form. We report two cases in previously healthy children.

Methods Case series.

Results 1: An eleven-month-old boy with an otitis media was admitted to our hospital because of progressive decay and a left III cranial nerve paresis. Cranial computed tomography was normal. Cerebrospinal fluid showed data consistent with bacterial meningitis and blood culture was positive for S pneumoniae serotype 19F. He developed oliguric acute renal failure, microangiopathic haemolytic anemia (7’2 g/dl) and thrombocytopenia (24000/mm3) and he needed peritoneal dialysis. He underwent acute respiratory distress syndrome and needed mechanical ventilation, with refractory hypoxemia and coma. He finally died. 2: A three-year-old girl with pneumonia and empyema was referred to our hospital for suspected HUS (anemia 6’3 g/dl, schistocytosis, thrombocytopenia 43000/mm3, creatinine 2’21 mg/dl). She had received complete heptavalent pneumococcal conjugate vaccination. She required mechanical ventilation and video-assisted thoracoscopy surgery was performed. S pneumoniae was isolated from pleural fluid; it was resistant to penicillin and macrolides, with intermediate susceptibility to ceftriaxone/cefotaxime and vancomycine, so she was treated with levofloxacin plus ceftriaxone. We started continuous venovenous hemodiafiltration until a permanent peritoneal catheter was placed. She recovered normal renal function after 12 days.

Conclusions HUS is a serious complication associated with S. pneumoniae, which involves establishing an appropriate antibiotic treatment together with supportive measures. In our country, it’s unusual the multiple pneumococcal resistance to antibiotics.

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