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 is present.
Although lower urinary tract infection usually resolves without significant sequelae, iincorrectly diagnosed or inappropriately treated upper tract infection can lead to renal scarring. (Renal scarring can result in hypertension and, with repetitive infection and progressive loss of {functioning renal mass, can result in chronic renal failure[2].

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.