Mathevan, G (2011) Clinical, Laboratory and Radiological Profile of Urinary Tract Infection in Children. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Urinary tract infection (UTI) is a common problem in children1 .The incidence varies according to age, race and sex of children2,3. UTI occurs in about 1% of boys and 3-5% of girls 4. In girls the first UTI occurs by the age of 5 years with peaks during infancy and toilet training. After the first UTI 60-80% 0f the girls will develop a second UTI within 18 months. In boys most UTIs occur during the first year of life .UTI is much more common in uncircumcised males. The prevalence of UTI varies with age. During the 1st year of life; the male to female ratio is 2.8-5.4:1.Beyond 1-2 years there is a striking female preponderance , with a male to female ratio of 1:10. Three to five percent of febrile children are found to have UTI 6. Symptoms of UTI may be minimal and non-specific in infants and small children 7. In most cases the first episode of UTI occurs in the 1st year of life and it is believed that young growing kidneys are more vulnerable to renal parenchymal damage. UTI may lead to life threatening complications like sepsis and renal scarring. Renal scarring is the most common cause of hypertension in later childhood and renal failure in adulthood.Recognition of UTI in children should be made as early as possible to prevent these complications 7. Therefore, investigations for early diagnosis of UTI are of outmost importance 5. In the pediatric population the recurrence rates for UTI are very high. Within 1 year of a first infection, approximately 30% of boys and 40% of girls will develop a repeat UTI 8. .After the first episode, children can expect a recurrence rate of 30%. This rate will double for each subsequent infection 9.Anatomic obstruction (posterior urethral valves, ureteropelvic junction obstruction, ureterovesical obstruction, and ureterocele) as an etiology for UTI is seen in 2% to 10% 10 and 30% to 50% will have vesicoureteral reflux. AIM OF THE STUDY: To study the clinical presentation, laboratory characteristics and radiological profile of Urinary Tract Infection in hospitalized children between 1 month and 12 years of age. DISCUSSION: This study included 246 children in the age group between 1 month to 12 years. 15 (6.1%) were less than 1 year, 100 (40.7%) were between 1 to 4 years, 75 (30.5%) were between 5 to 8 years and 56 (22.7%) between 9 to 12 years of age. Urinary tract infection was more common in the 1 to 4 years age group in this study and this is supported by other studies by Thaer-Al-Momani et al 12 where 49 % were in the 1 to 4 years age group and Neelam et al 19where 38.7% belonged to the same age group. Of the 246 children 143 (58.1%) were males and 103 (41.9%) were females. The male to female ratio in this study is 1.3:1. This is in contrast to the other studies (15, 16) which show a female preponderance. The study by Malla et al 16also shows a male to female ratio of 1:2, 67.2% being females. N.Choudhuri et al13 study on community acquired UTI ,with a male preponderance (53.6%) when compared to the females(46.4%) supports our study .Another study by G.K.Rai et al 18had 53.3% males and 46.7% females with UTI. Under the less than 1 year age group UTI was more common in the male children (8.5%) as reported in other studies 17. In children more than 5 years UTI was common among the females (34%) and this is supported by other studies. CLINICAL PROFILE: The clinical profile of UTI is varied. Symptoms of UTI may be minimal and non-specific in infants and small children. Febrile children not suspected of having UTI are as likely to have UTI as those who are suspected of having UTI. Many studies have been done to study the clinical characteristics of UTI in children and fever is the most common symptom in younger children while dysuria and fever is more common in older children . In this study dysuria is the commonest symptom found in 89.4% followed by fever accounting for 84.5% diarrhea in 24.8%, vomiting in 22.7%, abdominal pain in 21.5%, febrile seizures in 6%, dehydration in 3.3%, flank pain in 0.4%, recurrences in 6.1% dribbling in 0.8% and poor urinary stream in 6.1%. Azhar Munir Qureshi et al 15study shows dysuria in 98%, fever in 92%, recurrence in 28%, vomiting in 26%,poor stream in 20% and failure to thrive in 31%. CONCLUSIONS: 1. Urinary tract infection was more common in children between 1 to 4 years. 2. In children less than 5 year UTI is common in male children and more common in female children in the 5 to 12 years age group. 3. Dysuria was the most common clinical presentation followed by fever. 4. 54.3% of children fell into the Grade I malnutrition group. 5. Significant pyuria was found in 38%. 6. 59.3% showed significant bacteriuria. 7. Escherichia Coli was the commonest urinary pathogen and showed maximum sensitivity to Amikacin. 8. Radiological abnormalities were found in 43% of the children. 9. Cystitis was the commonest radiological finding. 10. Vesicoureteric reflux was documented in 13.2%. 11. Nephrotic syndrome was the most common comorbidity.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Laboratory ; Radiological Profile ; Urinary Tract Infection ; Children. |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 17 Apr 2018 11:16 |
| Last Modified: | 18 Apr 2018 00:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7054 |
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