Study on Hemolytic Uremic Syndrome Complicating Invasive Streptococcus pneumoniae Infections: Tunisian Experience

Hemolytic uremic syndrome (HUS) is a common cause of acute renal failure in infants, characterised by the triad of micro-angiopathic hemolytic anaemia, thrombocytopenia, and acute renal insufficiency. Typical HUS occurs after an episode of gastroenteritis caused by enterotoxigenic Escherichia coli. HUS, on the other hand, is a side effect of invasive pneumococcal infection. The lack of a clear laboratory procedure, inconsistent case descriptions, unfamiliarity, a misdiagnosis of disseminated intravascular coagulation (DIC), and cases of micro-angiopathic hemolytic anaemia and only mild renal injury are all reasons for not diagnosing this disorder. The aim of our research is to explain the epidemiology, treatment, and progression of HUS in Tunisia following invasive pneumococcal infections. Between 2008 and 2016, cases were discovered. A culture of cerebrospinal fluid, pleural fluid, or blood was used to validate S. pneumoniae infection. We were able to include eight children in the sample because they met our requirements. Fever, respiratory symptoms, neurological signs, and unusual patterns were the most common patterns. Pneumonia was a presenting feature in 6 of 8 cases (75%) and two patients had pneumococcal meningitis verified. Positive yield for S. pneumoniae by culture in pleural levy or discharge in two cases, cerebrospinal fluid in two cases, and blood in four cases confirmed pneumococcal invasive infection. The average length of stay in the hospital was 23.5 days. Many of the patients were started on antibiotics. Six of the eight patients required dialysis for a total of 27.8 days. Plasma exchange therapy was not used on any of the patients. There were two patients who died. Following a lengthy stay in the intensive care unit, one patient with pneumococcal pneumatocele developed sepsis compounded by a nosocomial infection. One of the patients suffered from bronchiectasis, which resulted in recurrent broncho-pulmonary infections. One patient who was on dialysis at the time of discharge passed away four months later.

Author (s) Details

Hammi Yousra
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia.

Sayari Taha
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia.

Chaffai Haifa
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia.

Borgi Aida
Pediatric intensive care unit of Béchir Hamza Hospital, Tunis, Tunisia.

Jallouli Manel
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia and Laboratory of research immunology of Renal Transplantation and Immunopathology, Charles Nicolle Hospital, LR03SP01, Tunis El Manar University, Tunis, Tunisia.

Abidi Kamel
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia and Laboratory of research immunology of Renal Transplantation and Immunopathology, Charles Nicolle Hospital, LR03SP01, Tunis El Manar University, Tunis, Tunisia.

Bouziri Asma
Pediatric intensive care unit of Béchir Hamza Hospital, Tunis, Tunisia.

Khaldi Ammar
Pediatric intensive care unit of Béchir Hamza Hospital, Tunis, Tunisia.

Gorgi Yousr
Laboratory of research immunology of Renal Transplantation and Immunopathology, Charles Nicolle Hospital, LR03SP01, Tunis El Manar University, Tunis, Tunisia.

Ben Abdallah Taieb
Laboratory of research immunology of Renal Transplantation and Immunopathology, Charles Nicolle Hospital, LR03SP01, Tunis El Manar University, Tunis, Tunisia.

Ben Jaballah Najla
Pediatric intensive care unit of Béchir Hamza Hospital, Tunis, Tunisia.

Gargah Tahar
Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia and Laboratory of research immunology of Renal Transplantation and Immunopathology, Charles Nicolle Hospital, LR03SP01, Tunis El Manar University, Tunis, Tunisia.

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