The Importance Of Diagnosis Remember the following important facts about urinary infection:
It is not an uncommon disease.
While proper diagnosis and treatment can help, carelessness in its management can lead to malnutrition and kidney damage.
A routine examination of urine may suggest a possibility of infection, but it must be confirmed by urine culture and colony count of bacteria.
The diagnosis is clinched if the count is 1 lakh colonies or more per ml. of a single organism. If the count is of this order, a sensitivity
test must be done to select the right drug for treatment.
The diagnosis is considered in a child with unexplained fever, frequency of micturition (urination), painful urination, unexplained loss of weight,
or failure to gain weight.
Isolated preauricular tags (tags of skin in front of the ear) may be associated with urinary tract abnormalities. A urinary tract ultrasonography
should be conducted in such cases.
The urethral opening (opening of the urinary tract above the vagina) is quite near the anal opening in a female child. Parents should clean the anal
region after the passage of stools, in the backward direction, away from the urethral opening. Children should be trained accordingly.
As long as you change diapers when they need to be changed, the incidence of urinary infection is not affected by whether you use cloth or disposal diapers.
Collection Of Urine Sample
Urine for culture must be collected in a sterile bottle
procured from the hospital. A sample must be taken as per the
direction of the hospital. A morning sample is not essential. The sample
must be taken to the laboratory immediately after
collection. If that is not possible, it should be kept in a
refrigerator.
TREATMENT: Once a diagnosis is confirmed, the child is given the appropriate drug.
A close follow-up is essential. Urine culture is done a
week and 2 weeks after the start of treatment. If the urine
is normal, a culture is done once a month for 3 months,
once in 3 months for 1 year and then twice a year as long as
possible.
In all male children, a sonography for the urinary tract
and a cystoureterogram (an X-ray taken after putting a dye
into the bladder) is undertaken a month after the diagnosis is
made and treatment has started. The same tests are conducted
in female children below the age of 5 years, if they get
another attack of urinary tract infection.
If any abnormality is found in these two tests, an intravenous pyelogram should be done. In
this test, the
dye is given into the vein and its excretion is followed in the kidneys, ureter and
bladder.
Children who get 3 infections in a year are put on a
single small dose of a drug, every night, for 2 years or more.
Less frequently, surgery is indicated in cases of
persistent infection, or where abnormalities of the urinary tract
need to be tackled surgically.
