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.
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.
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.
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.
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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.
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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: email@example.com.