Chlamydial infection of the urinary tract in children and adolescents with hematuria

Abstract

Urogenital infection with Chlamydia trachomatis in adults and adolescents is a common sexually transmitted disease. The purpose of this study was to investigate whether isolated microhematuria in children and adolescents is associated with Chlamydia trachomatis infection of the urinary tract. The study group included 37 children and adolescents with isolated nonglomerular microhematuria. Urethral smears for the isolation of Chlamydia trachomatis in cell culture were taken at the time of cystourethroscopy from all patients. Polymerase chain reaction (PCR) for the detection of chlamydial DNA in urine was carried out in 25 of 37 (68%) patients and direct immunofluorescence (DIF) of urine in 16 of 37 (43%) patients. The control group included 33 children and adolescents without hematuria; PCR and DIF of urine were carried out in all controls. Chlamydia trachomatis infection of the urinary tract was confirmed in 8 of 37 (22%) patients in the study group, and in none in the control group (0 of 33, P<0.001). Further studies of larger groups of patients should be conducted, before recommending testing for Chlamydia trachomatis infection of the urinary tract in children and adolescents with unexplained microhematuria.

Plasma Cell–Free DNA Next-Generation Sequencing to Diagnose and Monitor Infections in Allogeneic Hematopoietic Stem Cell Transplant Patients

“…In Case 1, given the patient’s atypical presentation, directed chlamydia testing was not sent until the end of his second admission. Although urethritis with dysuria and leukocyturia is the most common presentation of chlamydia infection in men, hematuria and proteinuria have been described in pediatric and adolescent males with chlamydia urethritis [7, 8]. Plasma NGS testing was positive 19 and 30 days before standard microbiology and could have potentially prevented a 10-day hospitalization with invasive ureteroscopy with stent placement.…”

Management of Hematuria in Children

“…Though the approach is currently the topic of much debate, clinicians should evaluate children where a concern for vesicoureteral reflux (VUR) confers an increased risk of UTI [12]. In adolescents, a history of sexual activity is important to identify sexually transmitted pathogens when concurrent UTI symptoms are present [58]. Interestingly, among children in whom UTI is clinically suspected, parental report of foul-smelling urine increases the probability of diagnosing UTI, though it cannot on its own be used to rule in or out a UTI diagnosis [59].…”

Pediatric Hematuria Remains a Clinical Dilemma

“…41 Hematuria in the sexually active adolescent, with or without other symptoms, necessitates testing for sexually transmitted infection, because this is a common presentation of chlamydia and gonorhhea. 41,42…”