Urinary tract infection in children: Descriptive, microbiological and ultrasonic study

A descriptive, microbiological and ultrasonic study was done on 100 patients with urinary tract infection under age of 10 years attending pediatric Department of Tikrit Teaching Hospital during the period from 1 st of February to the last of October 2007. The patients were divided into two groups (50 patients for each), the first group were with first attack of urinary tract infection and the second group were with recurrent urinary tract infection. Most of the patients in the first group (60%) were between the ages of 5-10 years, and most of them were males (58%)and they were from the urban areas (64%), while those with recurrent infections were at the ages range between 1-5 years (88%) , most of them were females (86%) and they were also from the urban areas (88%). The commonest presentation of patients with the first attack urinary tract infection was urgency (44%) while those in the second group present with failure to gain weight (98%). E.coli was the most commonly isolated microorganism in both groups with regard to age as well as for sex of patients ( 56% and 66% respectively). Cystitis was the commonest ultrasonic picture in patients with first attack of urinary tract infection (58%)while bladder wall thickening was the commonest picture in the recurrent attack group (66%). Introduction Urinary tract infection (UTI) is defined as the presence of bacteria in urine along with symptoms of infection. UTIs occur in as many as 5 percent of girls and 1 to 2 percent of boys. The kidneys filter and remove waste and water from the blood to produce urine. They get rid of about one and half to two quarts of urine per day an adults and less in children(1). Normal urine contains no bacteria (germs). Urinary tract infection usually occur as a consequence of colonization of the periurethral area by a virulent organism that subsequently gains access to the bladder(2) . Bacteria may, at times, get into the urinary tract and the urine from the skin around the rectum and genitals by traveling up the urethra into the bladder. When this happens, the bacteria can infect and inflame the bladder and cause swelling and pain in the lower abdomen and side. This bladder infection is called cystitis(3). If the bacteria travel up through the ureters to the kidneys, a kidney infection can develop. Kidney infections are much more serious than bladder infections. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females(1). Urinary tract infection (UTI) is common in pediatric practice and an important cause of morbidity and mortality in children. Infected urine stimulates an immunological and inflammatory response leading to renal injury and scarring, ultimately leading to end stage renal failure(4). Prompt diagnosis and management of UTI can reduce the incidence of morbidity and life threatening bacteraemia. Approximately 3-5% of the if undiagnosed leads to permanent renal damage causing hypertension or end stage renal disease. The diagnosis of UTI is difficult in the neonatal period because the signs and symptoms are non-specific in this age group(3). The incidence in the neonates is 0.01-1% and can also be as high as 10% in low birth weight and preterm babies(2). Checking a urine sample is the only way to diagnose a bladder infection, as there is usually no outward sign on the penis or vagina that indicates an infection. E coli usually causes a child's first infection, but other gram-negative bacilli and enterococci may also cause infection. The specimen for urinalysis and culture should be obtained by catheter or suprapubic aspiration in the infant or child unable to void on request . Additional tests may be recommended to check for abnormalities in the urinary tract. Repeated infections in abnormal urinary tracts may cause kidney damage(5). The kinds of tests ordered will depend on the child and the type of urinary infection. Because no single test can tell everything about the urinary tract that might be important, more than one of the following tests may be needed: Kidney and bladder ultrasound, Voiding cystourethrogram, Intravenous pyelogram, Nuclear scans, Computed tomography (CT) scans and magnetic resonance imaging (MRI) (3). Although intravenous urography has been a time-honored examination in the initial radiologic evaluation of UTI in children,ultrasonography has largely replaced intravenous urography as the initial screening examination.Ultrasonography alone is not generally adequate for investigation of UTI in children, as it is unreliable in detecting vesicoureteral reflux, renal scarring or inflammatory changes(6). If reflux or morphologic abnormalities are identified, renal scintigraphy and voiding cystourethrography are recommended to further search for renal scarring or urinary tract abnormalities(7). The way the antibiotic is given and the number of days that it must be taken depend in part on the type of infection and how severe it is(6). Materials and methods A descriptive , microbiological and ultrasonic study was done on children under 10 years with acute and recurrent UTIs attending the Pediatric Department in Tikrit Teaching Hospital during the period from 1 st of February to the last of October 2007. 1. Descriptive study: Each patient with acute or recurrent UTI is assessed by a prepared questionnaire including the name, age , sex, residence, frequency, urgency, painful micturition, fever, vomiting, diarrhea, loss of appetite and failure to gain weight.