RESUMO
Hemolytic uremic syndrome (HUS) is the primary cause of acute renal failure in children younger than 3 years of age. It usually occurs after a diarrheal illness due to Shiga-toxin-producing Escherichia coli. Streptococcus pneumoniae (SP)-induced HUS remains rare, involving 5% of all cases of HUS in children, but its frequency has increased over the last decade. The incidence of HUS following invasive pneumococcal infections is estimated at 0.4 to 0.6%. We report here the case of a 3.5-year-old child who presented SP serotype-3-associated HUS. The diagnosis was suspected by the patient's multiple organ failure. The pathogenesis involves the activation of the Thomsen-Friedenreich antigen. To prevent transfusion-associated hemolysis, it is recommended that fresh-frozen plasma or unwashed blood products should be avoided when possible. Our patient was transfused with 4 units of unwashed red blood cell and 2 units of fresh-frozen plasma. No special complication was noted. The risk of immediate complications requires close clinical and biological monitoring, and the possibility of starting dialysis immediately. Twenty-five to 35% of SP-HUS patients exhibit long-term renal aftereffects. The acute mortality rate depends on the site of infection. The increased frequency of SP-HUS may be related to the new ecology of serotypes created by widespread Prevenar7(®) vaccination.
Assuntos
Síndrome Hemolítico-Urêmica/microbiologia , Infecções Pneumocócicas/complicações , Streptococcus pneumoniae/classificação , Pré-Escolar , Feminino , Humanos , SorotipagemRESUMO
OBJECTIVE: Knowing about the clinical aspects of dengue in endemic zones is essential to implementation of appropriate case management protocols and public health interventions. PATIENTS AND METHODS: The authors made a 4-year prospective, observational study of dengue-infected patients admitted to the emergency department of the Fort-de-France University Hospital. RESULTS: Two hundred and sixty-three male and 297 female patients were included. The median age was 37 years (range: 14-91). The diagnosis was based on a positive RT-PCR (463 patients) or on the presence of specific IgM (97 patients). Two hundred and seventy-seven patients (49.5%) presented with dengue fever without complications. According to WHO criteria, 95 patients (17%) developed plasma leakage, including 39 patients (7%) diagnosed with DHF, and 10 (1.8%) diagnosed with DSS. Among the other patients without plasma leakage, 84 (15%) had isolated thrombocytopenia, 14 (2.5%) had internal bleeding, and 90 (16%) had unusual manifestations. Seven patients died (1.3%): fulminant hepatitis (two), myocarditis (one), encephalitis (one), acute respiratory failure (one), gangrenous cholecystitis (one), and post-traumatic intracranial hemorrhage (one). The other patients recovered. Seven patients were pregnant (1.3%) from 6 to 27 weeks of amenorrhea and carried their pregnancy to term without complications. CONCLUSION: With this experience, we were able to develop appropriate case management protocols for patients during dengue epidemics.