Significance of Pyuria in the Diagnosis of Urinary Tract Infection in Children with Sickle Cell Anaemia in Maiduguri, Nigeria

Abstract

Urinary tract infection (UTI) is a significant cause of morbidity and mortality in children, especially in those with sickle cell disease, who are at higher risk of infections. It will be useful to have a simple test which can be used in resource limited health facilities as a means of screening such children for UTI with the view to instituting prompt treatment. This study is carried out to determine the usefulness of significant pyuria in detecting UTI in febrile children with sickle cell anaemia (SCA). Two hundred and fifty febrile children with sickle cell anaemia that attended State Specialist Hospital and University of Maiduguri Teaching Hospital (UMTH) were prospectively studied with their consent. Urine sample was collected using standard procedure, examined for pus cells and was cultured at the Microbiology laboratory of UMTH. The study showed UTI prevalence of 26%. Significant pyuria was found to have sensitivity of 55.4%, specificity of 77.8%, the efficacy of the test was 72.0% and the test has low positive predictive value of 46.8% in detecting bacteriuria in SCA patients. The significant pyuria observed in this study support its usefulness in the diagnosis of UTI among children with SCA especially in communities having limited facilities or personnel for carrying out urine culture.

Significant bacteriuria in children with sickle cell anaemia in a Nigerian tertiary hospital

“…The most frequently isolated organism from the urine specimens was Escherichia coli, followed by Klebsiellaspp, a finding similar to that of other studies 9,14 . The virulent factors associated with E.coli 18 may have contributed to the organisms being the most frequently isolated.…”

“…The differences in the genetic constitutions among the study populations may explain the difference in the prevalence. Regarding those in crisis, significant bacteriuria was also found to be commoner among the age group less than 5 years than in the older children, a finding similar to that of Akuse 7 and Mava et al 9 . Preponderance of significant bacteriuria in this age group could be explained by the fact of incompletely developed immunity 8,9 .…”

“…This study revealed that prevalence of significant bacteriuria did not decreased with increasing age a finding different from that reported by Akuse 8 and Mava et al 9 where their prevalence decreases with increasing age. The differences in the genetic constitutions among the study populations may explain the difference in the prevalence.…”

“…12 in Ibadan. The lower prevalence of significant bacteriuria obtained in our study could be due to the fact that most of our study population were SCA subjects in steady state, while Zaria 8 , Maiduguri 9 and Ibadan 12 studies were febrile children with SCA. Differences in the methodology may have contributed to the lower prevalence observed in our study as compared to studies by Akinbami et al 11 and Cumming et al 10 Whilst our study used clean-catch, mid -stream and supra pubic aspiration urine specimen, Cumming and Akinbami et al 11 used only clean catch, midstream urine sample for their study.…”

“…Our study revealed that significant bacteriuria was not associated with gender even though it had been shown that bactriuria is commoner in females than males in children older than one year 9,12,14 . This could be attributed to the small number of children with confirmed significant bacteriuria in the present study and the varying cultural/ religious practices in these environments.…”