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1.1. CLINICAL PRESENTATION
Unfortunately, the clinical signs and symptoms of urinary tract infection
are often nonspecific and misleading. UTI that diminishes renal function
is often unrecognized and therefore undertreated. The younger the child
is, the signs are more nonspecific. In an outpatient paediatric practice,
almost 20% of clinic visits for fever result from a urinary tract infection.
If both fever and abdominal pain are considered, that number increases
to 31%. Symptoms could include lethargy,irritability, seizure, weight
loss, and failure to thrive. Sepsis may occur in as many as one third
neonates. Toddlers may present with fever, abdominal pain, vomiting,
and diarrhea, as well as feeding problems and failure to thrive. Older
children are more likely to have the classic adult symptoms of frequency,
dysuria, and urgency with lower tract infection. They are also more
likely to experience fever, chills, malaise, and flank pain when pyelonephritis
Urinary tract infection (UTI) is a common problem in the paediatric population. Stork proposed a series of definitions in an effort to standardize the diagnosis of UTI. A simple uncomplicated urinary tract infection is defined as an infection confined to the lower urinary tract (bladder, urethra, and ureters). Upper urinary tract infection (pyelonephritis) is infection of renal parenchyma. Asymptomatic bacteriuria is bacterial growth in urine unassociated with clinical symptoms. Significant bacteriuria depends on the method of collection. For a midstream clean-catch specimen, significant bacteriuria requires more than 100,000 colonies/ml, whereas any growth from a suprapubic aspirate is considered significant. The word asymptomatic, however, may be misleading. When questioned after the positive urine culture was obtained, 66% to 76% admitted urinary symptoms, leading Salvage et al to suggest the term covert bacteriuria rather than asymptomatic bacteriuria. The cumulative risk of symptomatic urinary tract infection from birth to 11 years of age has been estimated at 3.0% for girl.s and 1.1 % for boys.
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