Ten years of pneumococcal-associated haemolytic uraemic syndrome in New Zealand children

Aim: To describe the epidemiology, clinical features, management and outcome of pneumococcal-associated haemolytic-uraemic syndrome (P-HUS) in New Zealand over the past decade. Methods: A retrospective chart review of children with P-HUS from 1998 to 2007 that were prospectively reported to the New Zealand Paediatric Surveillance Unit. P-HUS was defined as microangiopathic haemolytic anaemia (Hb < 100 g/L with fragmented red blood cells), thrombocytopaenia (platelet count < 130 x 109/L), acute renal impairment with oliguria and elevated plasma creatinine, and confirmed or suspected pneumococcal infection. Results: Eleven children (nine male, two female), predominately Maori and Polynesian (10 children) were studied. The median age was 8.5 months. The median duration of hospitalisation was 25 days. Of the infections, 10 were confirmed pneumococcal (six pneumonia, four meningitis) and one pneumonia was suspected pneumococcal (culture negative, however T activation positive). Nine patients required dialysis for a median duration of 13 days. One child with meningitis died after therapy was withdrawn because of severe neurological injury. One patient developed end stage kidney disease and two further children had evidence of persisting renal sequelae at follow-up. Conclusions: Pneumococcal disease remains an important public health problem in New Zealand children, particularly those of Maori and Pacific Island ethnicity. P-HUS should be considered in pneumococcal disease associated with severe haematological and renal abnormalities. These children should be monitored long-term, as they are at risk of permanent renal injury.