Hemolytic uremic syndrome (HUS) is a disease characterized by thrombotic microangiopathy with a triad of non-immune hemolytic anemia, thrombocytopenia, and renal impairment. Approximately 10% of cases of HUS are classified as atypical (aHUS). While today many genetically forms of aHUS pathology are known, only about 50% of carriers precipitate the disease. The reason remains unclear, and triggering events like intercurrent infections have been postulated. In rare cases, influenza A is the known trigger of aHUS; however, no cases of influenza B have been reported.
Conclusion: We describe for the first time that influenza B strain as a trigger for aHUS in children with primary hereditary forms. We also showed in our three cases that immunization appears to be safe; however, this needs to be confirmed in a larger cohort.
|What is Known:|
|• Known triggers of aHUS are infectious specimen.|
|• Influenza A-associated aHUS cases are rarely published.|
|What is New:|
|• aHUS can be triggered by influenza B virus infection.|
|• Influenza vaccination of patients with aHUS appears safe.|
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Atypical hemolytic uremic syndrome
Complement factor H
Estimated glomerular filtration rate
Enterohemorragische Escherichia coli
Hemolytic uremic syndrome
Membrane cofactor protein
Thrombotic thrombocytopenic purpura
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Karen van Hoeve: Dr. van Hoeve is the first author and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted.
Corine Vandermeulen: Prof Vandermeulen was the advisor regarding the flu vaccination of subjects and therefore acquisition of data. She provided input and feedback on the manuscript and approved the final manuscript as submitted.
Marc Van Ranst: Prof Van Ranst supervised virology data collection and approved the final manuscript as submitted.
Elena Levtchenko: Dr. Levchenko reviewed and revised the manuscript, and approved the final manuscript as submitted.
Lambert van den Heuvel: Mr. van den Heuvel analyzed and interpreted the genetic data and approved the final manuscript as submitted.
Djalila Mekahli: Dr. Mekahli conceptualized the study and approved the final manuscript as submitted.
The manuscript has not been submitted to more than one journal for simultaneous consideration. The article has not been published previously. All authors have materially participated in the research and/or article preparation. All authors have approved the final article.
All authors acknowledge receiving no funding for this work from any organization, nor any sources of support, including pharmaceutical and industry support.
Conflict of interest
The authors declare that they have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Communicated by Mario Bianchetti
Electronic supplementary material
Evolution of the hematological testing during hospitalization. - X-axis: time of hospitalization (day). Day 0: time of hospitalization. - Y-axis: Blood results of hemoglubin, platelet count, creatinine level, haptoglobin, LDH and total bilirubine. - Curve: full line (▬) Patient 1, dashed line (- -) Patient 2 and dotted line (…) Patient 3. - Cut off reference value (blue line) (PDF 226 kb)
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van Hoeve, K., Vandermeulen, C., Van Ranst, M. et al. Occurrence of atypical HUS associated with influenza B. Eur J Pediatr 176, 449–454 (2017). https://doi.org/10.1007/s00431-017-2856-5
- Atypical hemolytic uremic syndrome
- Hemolytic uremic syndrome
- Influenza B