Lee Lauren Dagyung, Vadlamudi Nirma Khatri, Yu Katherine, Sadarangani Manish, Le Saux Nicole, Embree Joanne, Kellner James D, Morris Shaun K, Halperin Scott A, Bettinger Julie A
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
Paediatr Child Health. 2024 Sep 20;30(2):78-82. doi: 10.1093/pch/pxae055. eCollection 2025 May.
-associated hemolytic uremic syndrome (SP-HUS) is an underreported cause of pediatric atypical HUS. This study describes the epidemiology of the largest Canadian case series of SP-HUS in comparison with non-HUS invasive pneumococcal disease (IPD).
The Canadian Immunization Monitoring Program, ACTive (IMPACT) is a national surveillance network for vaccine-preventable diseases. All confirmed IPD cases from 1991 through 2019 were included in the analysis. IPD cases with new HUS diagnoses were identified as SPHUS cases, and the rest as non-HUS IPD.
There were 30 (0.4%) cases of SP-HUS amongst 6757 IPD cases. The median age of SP-HUS cases was 27.5 months, with no significant differences between SP-HUS and non-HUS cases in age or sex. serotypes 3 (30%) and 19A (26.7%) were more common in SP-HUS compared to non-HUS (P < 0.0001). Pneumonia was more frequently observed in SPHUS than in non-HUS (67% versus 26%; P < 0.0001). All SP-HUS cases were hospitalized, compared with 71% of non-HUS IPD cases (P = 0.0004). SP-HUS cases had a longer median hospital length of stay than non-HUS (23.5 versus 7 days; P < 0.0001) and a higher proportion required an Intensive Care Unit (ICU) admission (70% versus 15.5%; P < 0.0001). Moreover, ICU stays were longer in HUS cases compared with non-HUS cases (9 versus 3 days; P < 0.0001). All 30 SP-HUS patients survived while 3% of non-HUS cases died (P = 0.33).
SP-HUS was usually seen in IPD cases with pneumonia and was most commonly caused by serotypes 3 and 19A. ICU care was lengthy, hospital stay was longer. No deaths occurred among SP-HUS cases.
肺炎链球菌相关溶血尿毒综合征（SP-HUS）是儿童非典型溶血尿毒综合征（aHUS）中报告较少的病因。本研究描述了加拿大最大的SP-HUS病例系列的流行病学情况，并与非HUS侵袭性肺炎球菌疾病（IPD）进行比较。
加拿大主动免疫监测项目（IMPACT）是一个针对疫苗可预防疾病的全国性监测网络。分析了1991年至2019年所有确诊的IPD病例。新诊断为HUS的IPD病例被确定为SP-HUS病例，其余为非HUS IPD病例。
6757例IPD病例中有30例（0.4%）为SP-HUS病例。SP-HUS病例的中位年龄为27.5个月，SP-HUS病例与非HUS病例在年龄或性别上无显著差异。与非HUS病例相比，血清型3（30%）和19A（26.7%）在SP-HUS中更常见（P<0.0001）。SP-HUS中肺炎的发生率高于非HUS（67%对26%；P<0.0001）。所有SP-HUS病例均住院治疗，而非HUS IPD病例的住院率为71%（P=0.0004）。SP-HUS病例的中位住院时间长于非HUS病例（23.5天对7天；P<0.0001），需要入住重症监护病房（ICU）的比例更高（70%对15.5%；P<0.0001）。此外，HUS病例的ICU住院时间长于非HUS病例（9天对3天；P<0.0001）。30例SP-HUS患者全部存活，而非HUS病例的死亡率为3%（P=0.33）。
SP-HUS通常见于伴有肺炎的IPD病例，最常见的病因是血清型3和19A。ICU护理时间长，住院时间也更长。SP-HUS病例无死亡发生。
