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Questions and Answers
What is the primary treatment recommended for UTI in early infancy associated with sepsis?
In cases of obstructive UTI, which of the following interventions may be necessary?
Which drug is typically used for long-term prophylaxis in recurrent UTIs?
What condition can develop as a complication of UTI involving the kidney?
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What assessment is crucial for a child with recurrent UTI episodes?
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What initial antibiotics are given for pyelonephritis suspected in older children?
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What is a potential long-term consequence of untreated chronic UTIs?
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Which of the following investigations is NOT typically associated with UTI diagnostics?
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What is the approximate prevalence of urinary tract infections (UTIs) during childhood in girls?
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Which gender is more likely to experience UTIs during the first year of life?
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What organism is responsible for 75-90% of all UTIs?
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Why do females have a higher incidence of UTIs compared to males?
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What is the male to female ratio of UTIs beyond 1-2 years of age?
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What role do bacterial pili or fimbriae play in UTIs?
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In what scenario could Klebsiella be a common aetiology for UTIs?
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What is the mechanism of infection for most urinary tract infections?
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Which of the following is NOT a risk factor for urinary tract infections (UTIs)?
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What symptoms would most likely indicate pyelonephritis in a patient?
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Which of the following laboratory findings indicates a UTI diagnosis?
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What is the primary characteristic of asymptomatic bacteriuria?
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Which of the following is true regarding the clinical features of cystitis?
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In younger children, which of the following symptoms is NOT commonly associated with a UTI?
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What is considered an abnormal finding in urine microscopy for diagnosing UTI?
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Which method is NOT used for obtaining a urine sample for UTI investigation?
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Study Notes
Urinary Tract Infection (UTI)
- UTI is a common bacterial infection in children, affecting approximately 1% of boys and 3% of girls during childhood.
- It is caused by bacteria ascending from the fecal flora into the bladder via the urethra.
- Escherichia coli is the most common causative agent, followed by Klebsiella spp. and Proteus spp.
- UTI can occur at any age, but the incidence is higher in females due to a shorter urethra and greater predisposition to dysfunctional voiding.
Epidemiology
- In neonates, boys are more likely to have UTIs due to a higher incidence of congenital urinary tract abnormalities.
- Prevalence of UTIs varies with age. The male:female ratio is 2.8–5.4:1 in the first year of life. Beyond 1–2 years, females have a striking preponderance, with a male:female ratio of 1:10.
- Females are also more prone to UTI when they become sexually active.
Risk Factors for UTI
- Female gender: The shorter urethra and greater predisposition to dysfunctional voiding makes females more susceptible.
- Obstructive uropathy: Blockage in the urinary tract increases the risk of infection.
- Vesicoureteral reflux: Backflow of urine from the bladder to the kidneys increases the chance of infection.
- Neurogenic bladder: Disruption of bladder control due to neurological conditions increases the risk of UTIs.
- Uncircumcised male: The presence of the prepuce can harbor bacteria that can easily ascend to the bladder.
- Urethra instrumentation: Procedures involving the urethra can introduce bacteria.
- Wiping from back to the front in females after defecation: This can transfer bacteria from the anus to the urethra.
- Constipation: Straining can cause back pressure on the bladder and increase the risk of infection.
- Immunosuppression: A weakened immune system leaves the body vulnerable to infections, including UTIs.
Clinical Features
- Pyelonephritis: Infection of the kidneys, causing abdominal or flank pain, fever, malaise, nausea, vomiting, and diarrhea. Newborns may present with nonspecific symptoms like poor feeding, irritability, and weight loss.
- Cystitis: Infection of the bladder, causing dysuria, urgency, frequency, suprapubic pain, incontinence, and malodorous urine.
- Asymptomatic bacteriuria: Positive urine culture without any symptoms of infection.
Investigations
- Urine sample: Collected via clean catch, suprapubic aspiration, or urethra catheterization.
- Urine microscopy: May show WBC casts.
- Urine culture: Diagnostic if ≥10⁵ bacterial colonies per ml. Any colony growth in suprapubic aspiration is significant.
- Dipstick examination: Detects leucocyte esterase and nitrite.
- Microscopy of an uncentrifuged urine: >10 WBC/cu mm is abnormal.
- Complete blood count (CBC): May show signs of infection, like leukocytosis.
- Blood culture: Helps to identify bacteremia.
- Electrolytes, urea, creatinine (E/U/Cr): Assesses renal function.
- Plain abdominal X-ray: May reveal abnormalities in the urinary tract.
- Abdominopelvic ultrasound (USS): Examines the kidneys and bladder.
- Intravenous urography: Provides detailed images of the urinary tract.
Treatment
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General measures:*
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Liberal fluid intake: Flushes out bacteria.
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Regular bladder emptying: Prevents urinary stasis.
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Specific measures:*
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Early infancy: Combination of parenteral ampicillin with an aminoglycoside for 10-14 days. Alternatively, a third-generation cephalosporin can be used.
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Older children: Treatment depends on severity. Parenteral antibiotics initially for pyelonephritis, followed by oral therapy once toxicity resolves.
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Non-toxic and tolerating orally: Amoxicillin, co-amoxiclav, cephalexin, or cefixime for 10 days.
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Follow-up: Repeat urine culture.
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Surgical intervention: May be required for obstructive uropathy.
Prophylaxis
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Long-term prophylaxis: Considered for children:
- Age 3 years being investigated for the underlying cause of UTI.
- Recurrent UTI of ≥3 episodes in one year being investigated for the underlying cause.
- UTI with vesicoureteral reflux.
- Prophylactic drugs: Cotrimoxazole, nitrofurantoin.
Differential Diagnosis
- Malaria: Fever and abdominal pain.
- Respiratory tract infection: Fever and malaise.
- Gastroenteritis: Nausea, vomiting, and diarrhea.
Complications of UTI
- Renal injury and scar formation: Can lead to parenchymal damage and distortion of renal vessels.
- Hypertension: Renal scars can contribute to hyperreninemic hypertension.
- Chronic kidney disease (CKD): Rarely, chronic UTIs can cause progressive renal injury leading to CKD and end-stage renal disease.
Problem-Based Learning Session
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Case Scenario: A 6-year-old boy presents with a 3-day history of fever, vomiting, and loin pain.
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Relevant questions:
- Frequency and urgency of urination.
- Dysuria (painful urination).
- Abdominal or flank pain location and intensity.
- Nausea and vomiting severity.
- History of previous UTIs.
- Family history of UTIs.
- Recent fever or illness.
- Recent travel or exposure to any illness.
- Diaper changes (for infants).
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Investigations:
- Urine culture.
- CBC.
- Electrolytes, urea, creatinine (E/U/Cr).
- Abdominal ultrasound.
- Renal scintigraphy.
- Voiding cystourethrogram.
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Diagnosis: Likely pyelonephritis based on fever, vomiting, loin pain.
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Complications: Potential for renal scarring, hypertension, and CKD.
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Description
This quiz provides an in-depth look at Urinary Tract Infections (UTIs), focusing on their prevalence, causes, and the differences in risk factors between genders, particularly in childhood and during adolescence. By understanding the epidemiology and causative agents, learners can better recognize patterns and risks associated with UTIs during early life and beyond.
