Update on Streptococcus pneumoniae associated hemolytic uremic syndrome

Joann M. Spinale, Rebecca L. Ruebner, Bernard S. Kaplan, Lawrence Copelovitch

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE OF REVIEW: Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) is defined by the occurrence of acute hemolytic anemia, thrombocytopenia and acute kidney injury in a patient with a S. pneumoniae infection. We review the pathophysiology, clinical course, treatment and prognosis for SpHUS. We also describe an expanded classification system that uses additional diagnostic criteria to identify more patients with a high likelihood of having SpHUS. RECENT FINDINGS: SpHUS often may be underdiagnosed because of overlapping features with disseminated intravascular coagulation (DIC) and the lack of strict diagnostic criteria. The epidemiology has changed with the emergence of different pneumococcal serotypes as newer pneumococcal vaccines have been introduced. SUMMARY: SpHUS accounts for 5-15% of all HUS cases. The majority of SpHUS patients have pneumonia and a low mortality rate in contrast to those with meningitis, who have a more severe clinical course. Although the pathogenesis of SpHUS remains unknown, the Thomsen-Friedenreich antigen seems to play a central role. S. pneumoniae produces neuraminidase, thereby exposing the Thomsen-Friedenreich antigen on the surface of cell membranes. Thomsen-Friedenreich antigen exposure can result in hemolysis and direct endothelial injury leading to HUS phenotype. Early identification of these patients is critical so that fresh frozen plasma may be avoided.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
JournalCurrent opinion in pediatrics
Volume25
Issue number2
DOIs
StatePublished - Apr 1 2013
Externally publishedYes

Keywords

  • Classification
  • Hemolytic uremic syndrome
  • Pneumonia
  • Streptococcus pneumoniae
  • Vaccination

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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