Clinical analysis of Streptococcus pneumoniae associated hemolytic uremic syndrome in children / 中华实用儿科临床杂志

ABSTRACT

Objective:To summarize the clinical characteristics of children with Streptococcus pneumoniae associated hemolytic uremic syndrome(SP-HUS). Methods:Clinical data, laboratory results, treatment and prognosis of patients with SP-HUS in Beijing Children′s Hospital, Capital Medical University from January 2010 to December 2017 were retrospectively analyzed.Results:Seven 7 children (5 boys and 2 girls) aged 18-43 months were enrolled.All of them had toxic symptoms and dyspnea.The clinical symptoms were fever and cough in 5 cases, and abdominal pain and vomiting in 2 cases.Five of them had fever and cough for onset, and two had abdominal pain and vomit for onset, hemolytic anemia, thrombocytopenia and decreasing renal function in 3-9 days.Clinical examination showed cardiac dysfunction in 4 cases, septic shock in 2 cases and neurological damage in 2 cases.Five cases had only Streptococcus pneumoniae infection, 2 cases had both Streptococcus pneumoniae and Acinetobacter infections.Both C-reactive protein and procalcitonin were significantly high(80-200 mg/L and 6.43-100.00 μg/L, respectively) in 7 cases.Peripheral blood smear demonstrated fragmented red blood cells.Marrow smear showed inhibition of erythroid proliferation in 4 cases and toxic granules in the granulocytes.The direct Coombs tests were positive in all but 1 case.Serum complement C 3 decreased in acute phase(0.42-0.66 g/L). In the acute stage chest X-ray showed massive consolidation, followed by liquefaction necrosis, cystic segmented encapsulation and void changes.Ultrasound with Doppler revealed enlarged liver and kidney which normalized in 2-3 months and 6-9 months, respectively.All the patients were treated with antimicrobial therapy for 4-8 weeks and received respiratory support, 5 cases received blood purification treatment, and 4 cases received plasmapheresis.Deteriorating hemolysis was not observed following the infusion of frozen plasma.washed type red blood cells or suspension red blood cells in all 7 cases.Platelet numbers gradually recovered in 2-3 weeks.Kidney function improved and normalized in 2-4 weeks.Radiographic demonstrations of the chest normalized gradually in almost 3-6 months. Conclusions:It is necessary to consider the possibility of SP-HUS in very young children with severe pneumonia who showed microangiopathic hemolytic anemia, thrombocytopenia and decreasing renal function.Clinicians should identify high-risk children.Timely respiratory support and blood purification are important to improve prognosis.