One hundred and thirty one children upto five years of age presenting with fever of >38ºC for at least 48 hours duration were evaluated prospectively from November 1997 to October 1998 in the Department of Pediatrics, IGMC, Shimla. Children who had received antibiotics in the preceding 48 hours were excluded. Midstream urine collection was done after cleaning the genitalia with soap and water in all boys and girls over 4 years. Suprapubic aspiration (SPA) was done in all girls and boys less than 4 years old who showed bacteriuria on midstream sample. The samples were processed for culture in the laboratory within 2 hours of collection or stored at 4-8ºC for a maximum of 24 hours before transporting to the laboratory. Colony count of at least 105/ml in midstream specimen and any growth on SPA was considered significant. Single culture on SPA and two consecutive positive urine cultures with the same organism on midstream specimen were considered diagnostic of UTI. Statistical significance was determined by chi-square test.

There were 82 (62.6%) boys and 57 (43.5%) infants. Urinary symptoms including dysuria, burning micturition, increased frequency, malodorous and turbid urine were seen in 15 (11.5%). Symptoms unrelated to the urinary tract included those of acute respiratory infection (ARI) in 94 (75%), diarrhea in 20 (16.1%), suspected meningitis in 10 (8.1%) and septicemia in 7 (5.6%). Twenty four children had associated diseases like nephrotic syndrome, febrile convulsions, pyoderma, otitis media and acute leukemia. Some patients had more than one symptom. Eight children had both urinary and non-urinary symptoms. The incidence of UTI was 8.4% (11/131). The incidence was 6.1% (5/82) in boys, 12.2% (6/49) in girls, 12.3% (7/57) in infants and 5.4% (4/74) in 13-60 months age group respectively.

The incidence of UTI was 33.3% (5/15) among children presenting with urinary symptoms and 4.3% (4/94) in those with ARI. Of the non-urinary symptoms, diarrhea was significantly associated with UTI (4/20) as compared to ARI (4/94) (P <0.05). All four children, (2 boys and 2 girls) with diarrhea and UTI were below 24 months.

Incidence of UTI in febrile children has been reported to be between 1.7 and 10% (2,3). A higher incidence of 8.4% in the present study could be due to exclusion of febrile children with urinary symptoms in previous studies. Higher incidence of UTI in girls, infants and those with urinary symptoms as compared to boys, older children and those lacking urinary symptoms respectively is similar to as reported by other workers(1-4). Significant association of diarrhea with UTI in children below 24 months of age has also been reported earlier(2,4). This probably represents spread of infection from gastrointestinal tract to urinary tract. While children with UTI may occasionally present with diarrhea, the definite cause for this association remains unexplained.

The present study suggests that all acutely febrile children below 5 years with urinary symptoms and those below 24 months with diarrhea should be investigated for UTI.

R.K. Kaushal,
Sumeet Bansal,
V.K. Sharma,
Ashwini Sood,
Asha Goyal*
Departments of Pediatrics and Microbiology*,
I.G. Medical College,
Shimla 171 001,
India.

1. Hogg RJ. A search for the "elusive" urinary tract infection in febrile infants. Pediatr Infect Dis J 1987; 6: 233-234.

2. Dharnidharka VR, Kandoth PW. Prevalence of bacteriuria in febrile infants. Indian Pediatr 1993; 30: 987-990.

3. Bauchner H, Philipp B, Dashefsky B, Klein OJ, Prevalence of bacteriuria in febrile children. Pediatr Infect Dis J 1987; 6: 239-242.

4. Srivats PR, Rath B, Prakash SK, Talukdar B. Usefulness of screening febrile infants for urinary tract infection. Indian Pediatr 1996; 66: 159-165.