Streptococcal infection is common trigger for HSP

Henoch-Schönlein purpura (HSP) is highly associated with streptococcal infection. However, this infection does not aggravate renal pathologic damage, and its elimination appears to protect against relapse or recurrence of HSP. Those were the major findings of a retrospective study conducted in China in 2074 children with HSP based on patients’ histories associated with HSP onset; laboratory data, including urine tests, blood samples, and infectious agents; and renal biopsy. Patients, all of whom were aged younger than 17 years and had purpura, had a median age of 8 years. HSP onset was most common in spring and winter, with the lowest rates in July, August, and September.

Investigators divided patients into 3 groups: those with streptococcal infection (the most common infectious trigger), identified in about 19% of patients with HSP; those with other infections, such as Helicobacter pylori; and those with noninfectious triggers, such as allergy. Investigators found no significant differences among the 3 groups with regard to renal pathologic damage. More than a quarter (26.1%) of total patients relapsed or had a recurrence of HSP more than once within a 5-year period. The relapse/recurrence rate was significantly lower in the streptococcal infectious group than in the other infectious group or the noninfectious group.

Thoughts from Dr. Farber

My work-up for HSP is minimal, usually only a urinalysis. This is just 1 study, retrospective and not conclusive—in a homogenous population, at that—but enough is here that I will probably be adding a strep test when I see these patients.

Reference

1. Fan GZ, Li RX, Jiang Q, et al. Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015-2019. Pediatr Rheumatol Online J. 2021;19(1):79. doi:10.1186/s12969-021-00569-3