Summary 1. The material consists of 5% consecutive cases of primary (first onset) urinary tract infections appearing from birth up to 16 years of age and which were examined and treated at the Childrens' Hospital in Goteborg. The infections occurred during a seven‐year period within a defined population. The circumstances under which the study was conducted suggest that most symptomatic infections occurring during the study period and for whom the parents sought medical advice, were 2. The total morbidity risk at I 1 years of age of symptomatic UTI was 3.0% for girlsand 1.1 % for boys. These are minimum figures. The morbidity risk is highest during the first month of life and then decreases, more rapidly in boys than in girls. Possible interpretations of the reason for decreasing risk with increasing age of falling ill with a first infection are suggested. The male/female ratio starts at 2.5: 1 during the first month and then successively changes to 1:20.There was no seasonal variation of the time of onset in either sex. 3. Presentation with fever was most common in the first year, after which it slowly decreased. Failure to thrive was a rare symptom. Certain pther age and sex differences in presenting symptoms were recorded. Most infections within the first year of life probablyinvolved the renal parenchyma. 4. The etiology varied with age and sex. If infections reach the urinary tract by theascending route, this could indicate differences in the environmental conditions in the periurethral region and may be a clue to a better understanding of the pathogenesis. 5. Obstructive malformations were found in 10% of boys and 1–2% of girls, and cannotexplain the high frequency of early infantile infections in either sex. 6. Narrowing of the bladder neck was common in males during the first year of life, the frequency declining with age. It disappeared spontaneously during follow‐up of individual cases, and was not regarded as an obstructive malformation. 7. Duplication of the collecting system was seen in 10 % of girls and in 5 % in boys, which is more than expected. The cause and nature of the association between infection and duplication are not known. 8. In 13 % of boys and 4.5 % of girls a reduction of the renal parenchyma was seen either at the first investigation or developed later, probably owing to infection. AlthoughUTI was more frequent in females than in males, the total number of patients with parenchymal damage was equal in both sexes, even during childhood. In boys, the kidneys might bemore vulnerable than in girls. 9. The immediate cure rate after 10 days' therapy was 97%. Recurrences were usually reinfections. 10. Recurrent infections were often difficult to diagnose. Pyuriaand symptoms of UTI were associated with insignificant bacteriuria in 10 % (30 of 300) of suspected recurrences. 11. Susceptibility to recurrence was studied in relation to various parameters. Girlswere at greater risk than boys, and the risk was in both sexes greatest during the first 2–3 months after a previous infection. Boys rare...

Nonobstructive acute pyelonephritis in humans is most often caused by P-fimbriated Escherichia cofl. P-fimbriae are heteropolymeric fibers carrying a Gal(al-4)Gal-specific PapG adhesin at its distal end. The pyelonephritic strain DS17 expresses P-fimbriae from a single gene cluster. A mutant strain, DS17-8, which expresses P-fimbriae lacking the PapG adhesin, was constructed by allelic replacement introducing a 1-bp deletion early in the papG gene. In cynomolgus monkeys, DS17 and DS17-8 were equally able to cause bladder infection, whereas only the wild-type strain DS17 could cause pyelonephritis as monitored by bacteriological, functional, and histopathological criteria. Since DS17, but not DS17-8, adheres to renal tissue, these data underscore the critical role of microbial adherence to host tissues in infectious disease and strongly suggest that the PapG tip adhesin of P-fimbriae is essential in the pathogenesis of human kidney infection.

Escherichia coli FimH adhesin mediates binding to the bladder mucosa. In mice, a FimH vaccine protects against bacterial challenge. In this study, 4 monkeys were inoculated with 100 microgram of FimCH adhesin-chaperone complex mixed with MF59 adjuvant, and 4 monkeys were given adjuvant only intramuscularly. After 2 doses (day 0 and week 4), a booster at 48 weeks elicited a strong IgG antibody response to FimH in the vaccinated monkeys. All 8 monkeys were challenged with 1 mL of 108 E. coli cystitis isolate NU14. Three of the 4 vaccinated monkeys were protected from bacteruria and pyuria; all control monkeys were infected. These findings suggest that a vaccine based on the FimH adhesin of E. coli type 1 pili may have utility in preventing cystitis in humans.

The aim of the present study was to compare temperatures, metabolic adaptation and crying behavior in 50 healthy, full-term, newborn infants who were randomized to be kept either skin-to-skin with the mother or next to the mother in a cot "separated". The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the skin-to-skin group; at 90 min after birth blood glucose was also significantly higher and the return towards zero of the negative base-excess was more rapid as compared to the "separated" group. Babies kept in cots cried significantly more than those kept skin-to-skin with the mother. Keeping the baby skin-to-skin with the mother preserves energy and accelerates metabolic adaptation and may increase the well-being of the newborn.

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