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Diagnosis of Streptococcus pneumoniae–associated Hemolytic Uremic Syndrome

Loupiac, Alexandra MD*; Elayan, Abeer MD*; Cailliez, Mathilde MD; Adra, Anne-Laure MD; Decramer, Stéphane MD, PhD§; Thouret, Marie-Christine MD; Harambat, Jérôme MD; Guigonis, Vincent MD* **

The Pediatric Infectious Disease Journal: October 2013 - Volume 32 - Issue 10 - p 1045–1049
doi: 10.1097/INF.0b013e31829ee872
Original Studies

Background: Hemolytic uremic syndrome related to pneumococcal infection (P+HUS) can be difficult to diagnose due to the lack of a specific test and the absence of a consensus for definite diagnostic criteria.

Methods: A retrospective study was conducted on the cases that have been considered as P+HUS in the participating centers during the past 10 years. Diagnostic strategy and criteria used for the diagnosis of P+HUS were evaluated and compared with a review of literature data.

Results: A total of 17 children were studied. Tests ruling out other causes of HUS were performed in 94% of cases. Direct confirmatory tests for P+HUS were done in a minority of cases as Thomsen–Friedenreich antigen testing using lectin assay were done in only 2 patients (11%). Retrospectively, the diagnosis of P+HUS was confirmed in 28% to 89% of cases depending on the already published criteria used. A literature review focused on the last 15 years confirmed these diagnostic difficulties due to variable definition criteria and bring a new light on the potential usefulness of tests used to reveal T activation in this setting.

Conclusion: To date, in a context of suspicion of P+HUS, no precise, practical and consensual strategy exists for T-antigen exposure diagnosis. The T-antigen activation test using peanut lectin might be the most appropriate test for a direct diagnosis of P+HUS. A large prospective study is required to confirm this hypothesis. However, before such data are available, its use could be of help when a suspicion of P+HUS is present given the therapeutic impact of such a diagnosis.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics, Limoges University Hospital and CHREC, Limoges; Pediatric Nephrology Unit, Marseille University Hospital, Marseille; Pediatric Nephrology Unit, Montpellier University Hospital, Montpellier; §Pediatric Nephrology Unit, Toulouse University Hospital, Toulouse; Pediatric Nephrology Unit, Nice University Hospital, Nice; Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux; and **UMR CNRS 7276, Limoges University, Limoges, France.

Accepted for publication May 2, 2013.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Vincent Guigonis, MD, Department of Pediatrics, Hopital de la Mère et de l’Enfant, 8 Ave D Larrey, 87000 Limoges, France. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.