Streptococcus pneumoniae-associated hemolytic uremic syndrome among children in North America

Ritu Banerjee, Adam L. Hersh, Jason Newland, Susan E. Beekmann, Philip M. Polgreen, Jeffrey Bender, Jana Shaw, Lawrence Copelovitch, Bernard S. Kaplan, Samir S. Shah

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: To better characterize Streptococcus pneumoniae-associated hemolytic-uremic syndrome (SP-HUS), we report the largest series of SP-HUS among children in North America. Methods: We surveyed pediatric members of the Emerging Infections Network to identify SP-HUS cases. Respondents contributed clinical and laboratory features of these pediatric cases. Results: A total of 37 cases occurring between 1997 and 2009 were submitted. Of them, 33 cases (89%) were culture-confirmed and 4 (11%) were diagnosed clinically. The median patient age was 2 years, and 28 (76%) patients had completed their heptavalent pneumococcal conjugate vaccination (PCV7) series. Most patients presented with pneumonia (84%) and bacteremia (78%), whereas other clinical manifestations such as pericardial effusion (14%) and meningitis (11%) were less common. Of 29 patients, with bacteremia 6 (21%) had S. pneumoniae concurrently isolated from cerebrospinal fluid or pleural fluid. Severe illness was common with 35 (95%) patients requiring admission to the intensive care unit, over half requiring mechanical ventilation and chest tube placement or video-assisted thoracoscopic surgery, and 27 (73%) requiring dialysis during hospitalization. Among 30 patients with follow-up of 6 months, 7 (23%) remained dialysis dependent, 3 (10%) had undergone renal transplantation, 4 (13%) had neurologic sequelae, and 1 (3%) died. Among 24 serotyped isolates, 96% were non-PCV7 serotypes, most commonly 19A (50%), 92% are included in PCV13, and 10% were penicillin nonsusceptible (minimal inhibitory concentration >2 μg/mL). Conclusions: North American children with SP-HUS had severe clinical manifestations and significant morbidity. In this series, nearly all cases were caused by serotypes that are not in PCV7 but are included in PCV13.

Original languageEnglish
Pages (from-to)736-739
Number of pages4
JournalPediatric Infectious Disease Journal
Issue number9
StatePublished - Sep 2011


  • Hemolytic uremic syndrome
  • Streptococcus pneumoniae
  • pneumococcal serotypes
  • pneumococcus


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