Pneumococcal hemolytic uremic syndrome:: About 2 cases

Haemolytic and uremic syndrome (HUS) is the most frequent cause of pediatric acute renal failure. It occurs classically after a diarrhea due to Escherichia coli, seldom in the context of pneumococcus infection. HUS due to pneumococcus has epidemiologic, therapeutic and prognostic characteristics. Observations. We report on the cases of 2 young girls who contracted pneumococcal HUS, one with meningitis and the other with pneumonia. Both were less than 2-year-old. Transfusions of washed blood cells were performed, and dialysis therapy was necessary for 6 days in one and 35 days in the other case. The 1st patient was hospitalised for 15 days and recovered completely in 8 months, the 2nd was hospitalised for 39 days and after 3 months still had renal insufficiency. Discussion. Pneumococcal HUS usually affects healthy children of under 24 months, and often requires dialysis therapy. All usually described serotypes of pneumococci are not included in Prevenar (R) vaccine. The serotypes found in the 2 vaccinated young patients reported here were included in Pneumo23 (R) but not in Prevenar (R) vaccine. The use of washed blood products is preferable in case of blood transfusion, as the presence of plasma may prolong hemolysis through the action of a neuraminidase. The evolution of pneumococcal HUS, usually considered worse than that of the typical HUS, is similar if the last 30 cases described are considered. Conclusion. Pneumococcal HUS is a disease that should be better known, whose incidence may be increasing. Prognosis improves if dialysis and antibiotics are started early. Antipneumococcal vaccination reduces the incidence of this disease. (C) 2008 Elsevier Masson SAS. All rights reserved.