Urinary tract infection in childhood the role of nitrite test

ABSTRACT

Since the symptoms of urinary tract infection may be vague or abscent and the urine abnormalities may be variable. The practitionner must maintain a high degree of suspicion in order not to overlook the diagnosis.The accurate diagnosis of urinary tract infection is the first and the most important state of the child's management. The aim of this study is to evaluate urinary tract infection [UTI] as a community problem and to compare between some diagnostic methods used in diagnosis of UTI. This work was carried out in Pediatric Department, Zaggazig University Hospital in association with clinical Pathology Department .65 subjects 30 were males, 35 were females, the age ranged between 1.5-14 years with a mean of 5.4 years, they were divided into Control group 20 children [10 males- 10 females] Group I 30 cases with symptoms of urinary tract infection, positive urine culture.Group II 15 cases with repeated UTI and detected radiological abnormalities of urinary tract. All children were age and sex matched and they were subjected to full history-taking complete physical examination and laboratory aids [urine examination-urine culture-urine nitrite test-C-Reactive protein-serum creatinine].Radiological examination [plain-x ray- abdominal ultrasonography].Our results were UTI was more prevalent among females [55.5%] than males [44.5%] between age of 1.5-14 years. Lack of circumcision and catheterization represented an important predisposing factors for UTI among our cases. Frequency, dysuria and enuresis were the commonest presenting clinical manifestation of lower UTI while fever and loin pain were the commonest clinical manifestations of upper UTI.E.coli was being the commonest urinary pathogen among our manifested cases [80% group I and 53.3% group Il] coming next, Citobacter and Staphylococcus among group I [10% and 10%] respectively Klebsiella and Pseudmonmonas [33.3%, 13.3%] respectively among group II. Leucocyturia [> 10 WBC/HPF] was of low sensitivity [74.4%] and specificity [50%] but of high positive predicitve value [96.7%] in diagnosis of UTI. Nitrite test showed a low sensitivity [34.9%] high specificity [100%] and high positive predicitive value [100%] in diagnosis of UTI