The Possibility of Urinary Tract Infection in Primary School Students with A Diagnosis of Febrile Pharyngotonsillitis
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 1
Abstract
Background: Urinary tract infection (UTI) is one of the commonest bacterial infection seen in children, ranking second only to those of the respiratory tract. Material & Methods: One hundred and five 6-12 years old school children with pharyngotonsillitis visit our outpatient clinic were recruited in this study. Urinalysis and mid-stream urine collection culture after disinfection of the private area were performed in all children. Serum procalcitonin, CRP and DMSA were performed in student with significant positive urine culture. Results: The urine culture results showed positive rate in 48.6%, negative rate in 39% and contamination urine culture was 12.4%. Urinalysis did not indicate the possibility of positive urine culture. Also, the procalcitonin and CRP could not indicate upper UTI when compared with the results of DMSA. Conclusion: This study indicates that urine tract evaluation is important and should be performed in children who are suspected with pharyngotonsillitis.Urinary tract infections are common in children. They may present with a range of severity form cystitis to febrile UTI or pyelonephritis. The presentation may be vague and have nonspecific symptoms. The younger the child is the more symptoms are atypical. Therefore, a UTI should be considered in all children with a fever and it is even possible associated with febrile pharyngotonsillitis [1,2]. In Scholer SJ study (1996) stated that an acute complaint of abdominal pain in children occurs in 5.1% nonscheduled visits. Close follow-up will identify the 1% to 2% who proceeds to have a more serious disease process including UTI [3]. The clinical prediction rules for UTI was developed. Its sensitivity and specificity were 0.95 and 0.31 respectively if patient confirm to have 2 or more of the following 5 variables: less than 12 months old, white race, temperature of 39 °C or higher, fever for 2 days or more, and absence of another source of fever on examination [4]. The gold standard for UTI diagnosis is significant colony counts of a single organism in urine obtained in a sterile manner. Positive urine culture was defined as 50,000 or more colony-forming units per milliliter of a urinary tract pathogen [5]. The most common uropathogens were E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Proteus mirabilis [6].However, children with Enterococcus species, Klebsiella species, and Pseudomonas aeruginosa were significantly less likely to exhibit pyuria, positive leukocyte esterase on dipstick urinalysis than children with [7]. Moreover, high prevalence of Staphylococcus saprophyticus is in patients > 10 years and Proteus mirabilis is predominant in males [8]. Acute UTIs are relatively common in children, with 8% of girl and 2% of boys having at least one episode by seven years of age. Renal parenchymal defect are present in 3% to 15% of children within one to two years of their first diagnosed UTI. Evaluation of older children may depend on the clinical presentation and symptoms that toward a urinary source (leukocyte esterase or nitrite present on dipstick testing; pyuria of at least 10 WBC/HPF and bacteriuria on microscopy) [9]. Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.
Authors and Affiliations
Che Sheng Huang, Chyi Sen Wu, Ng Man Tsang, Yu Cheng Liu, Wan Kong Sang
Keywords
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- EP ID EP592339
- DOI 10.26717/BJSTR.2018.11.002037
- Views 221
- Downloads 0
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