1 / 38

Childhood Urinary Tract Infection

Childhood Urinary Tract Infection. Definition and classification. It is an infection of both upper and lower urinary tract. Upper : pyelonephritis, renal abscess. Lower : cystitis , urethritis. Epidemiology .

chassidy
Download Presentation

Childhood Urinary Tract Infection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Childhood Urinary Tract Infection

  2. Definition and classification • It is an infection of both upper and lower urinary tract. • Upper : pyelonephritis, renal abscess. • Lower : cystitis , urethritis

  3. Epidemiology • UTI is one of the most common bacterial infections of childhood. • Affects up to 10% by the teenage years. • Before age of 1 year boys : girls = 3 : 1 • After age of 1 year girls : boys = 10 : 1 40% of children with UTI will have anatomic or functional abnormalities of the urinary tract. e.g. reflux, malpositions, duplications, megaureter and hydronephrosis.

  4. Etiology Source of infection: • Mostly ascending. • The bacteria arise from the fecal flora, colonize the perineum, and enter the bladder via the urethra • In neonates ……………… HEMATOGENEUS. Etiological organisms: • Escherichia coli: (80%), Klebsiella and Proteus. • Staphylococcus saprophyticus in adolesent girls. • Viral infections (adenovirus), can cause cystitis. • Fungal infections

  5. Risk Factors • Type of patient: -Female )short urethra) -Uncircumcised male. -Tight clothing. -Urethral instrumentation Abnormal Urinary tract: -Vesicoureteral reflux. -Obstructive uropathy (major risk factor): Hydronephrosis -Neurogenic bladder

  6. Clinical Manifestations Pyelonephritis Constitutional symptoms: Fever, malaise, chills. Nausea, vomiting ± diarrhea. Localizing symptoms: Abdominal or flank pain.

  7. Clinical Manifestations (cont) Cystitis Usually afebrile • Dysurea • Urgency • Frequency • Incontinence • Hematuria • Malodorous urine. • Suprapubic pain & tenderness.

  8. Clinical Manifestations (cont) Urethritis -Dysurea -Reluctance to void -Perineal discomfort, erythema -Vulval irritation & erythema (girls) -Urethral discharge in older boys

  9. Symptoms of UTI Neonates & infants Change in urine color (or odor) as well as, crying during micturation in an infant may be noted by the mother. BUT Nonspecific symptoms: Jaundice Poor feeding Irritability Weight loss (or poor weight gain)

  10. Asymptomatic bacteriurea • Refers to individuals who have a positive urine culture without any manifestations of infection. • Occurs almost exclusively in girls. • This condition is benign and does not cause renal injury.

  11. Complications • recurrance ( up to 25% to 40% )( follow up) • bacteremia (more in infants) • focal renal abscess ( uncommon )

  12. cont. Acute pyelonephritis may result in renal injury “pyelonephritic scarring” Hypertension If recurrent scarring Chronic renal failure

  13. Diagnosis of UTI

  14. Diagnosis of UTI Suspect: Symptoms Findings on urinalysis, or both. Confirm: Urine culture.

  15. The diagnosis of UTI depends on having the proper sample of urine

  16. Urine analysis

  17. Urine microscopy: Pus cells White cell cast ……… RBCs …….. Gram staining • Urine dipstick: - Leucocyteestrase - Nitrite

  18. Collecting the urine sample

  19. Collecting the urine sample In toilet-trained children midstream urine sample Satisfactory if • The culture shows greater than 100,000 colonies of a single pathogen. • There are 10,000 colonies and the child is symptomatic, it is considered a UTI.

  20. Collecting the urine sample (cont): In infants: (1) Clean catch sample. (2) Urine collection bag. contamination is possible (3) In & out urinary catheterization. (4) Suprapubic urine sample

  21. Notes about urine analysis & culture: • Prompt plating of the urine sample is important - not more than one hour. • A urinalysis should be obtained from the same specimen as that cultured. • Pyuria (leukocytes in the urine) suggests infection, but infection can occur in the absence of pyuria.

  22. Treatment of UTI

  23. Treatment • In acute febrile infections suggestive of pyelonephritis: • Parenteral treatment with ceftriaxone or ampicillin with gentamicin for 10-14 days.

  24. Treatment of UTI (cont): Acute cystitis: • Should be treated promptly to prevent its possible progression to pyelonephritis. • trimethoprim-sulfamethoxazole . • Nitrofurantoin for 3-5 days • Amoxicillin • If the symptoms are mild and the diagnosis is doubtful, treatment can be delayed until the results of culture are known, and the culture can be repeated if the results are uncertain

  25. FOLLOW UP • We usually do urine culture 1 week after stopping of antibiotics ; then periodic reassessment for the next 1-2 years .

  26. Imaging Studies

  27. The goal of imaging studies in children with a UTI • The goal of imaging studies in children with a UTI is to identify anatomic abnormalities that predispose to infection and to If there are any UTI complications

  28. Renal ultrasonogram

  29. Renal ultrasonogram • hydronephrosis • renal or perirenal abscesses • Pyelonephritis • renal scars ( 30%)

  30. VCUG( MCUG)

  31. Voiding cystourethrogram (VCUG) Mituratingcystourethrogram(MCUG) Indications: • All children younger than 5 yr with a UTI, • School-aged girls who have had two or more UTIs • Any male with a UTI The most common finding is vesicoureteric reflux

  32. DMSA scan & DTPA scan

  33. DMSA scan: Technetium-labeled Acute pyelonephritis Structural malformations of the kidney DTPA scan: Dynamic study for: Excretory Function Reflux

  34. DETPA

  35. Prevention of reccurrence of UTI

  36. Prevention of reccurrence of UTI • Aderss and treat underlying cause. • Manage constipation. • Correct bottom wiping. • Encourage drinking adequate fluid. • Advice child not to delay voiding. • Use of prophylactic antibiotics …………..

  37. THANK YOU

More Related