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...
Bergstrom, T. (1972). Archives of Disease in Childhood, 47, 227. Sex differences in childhood urinary tract infection. Comparison of the clinical picture of nonobstructed urinary tract infection in boys and in girls over the age of 1 year revealed marked differences. The male infections were characterized by a high rate of 'atypical' bacterial aetiology, macroscopical haematuria, and normal temperature, as compared to the female ones. The proportion of patients getting recurrent infections during long-term follow-up was the same in the two sexes. The number of recurrences was, however, higher in the girls than in the boys. Radiological changes similar to postinfectious scar formation were found in 20% of the boys at their apparent first infection.Male and female urinary tract infections (UTI) in childhood show some clinical differences. A greater proportion of male than of female infections appears during the first month of life (Smellie et al., 1964;Stansfeld, 1966;Smallpeice, 1968). Males show a higher ratio of obstructive malformations (DeLuca, Fisher, and Swenson, 1963;Stansfeld, 1966), which, however, does not explain the early onset (Laplane and Etienne, 1968; Bergstrom et al., 1971). Smallpeice (1966) noticed a sex difference in the frequency of haematuria in UTI and made a plea for the inclusion of sex incidence in reports both on clinical and experimental work. However, mixed materials are still used for conclusions regarding aetiology, radiology, and natural history of UTI as if the disease were identical in males and females. The aim of the present investigation is to examine the clinical features of urinary infections with onset between the ages of 1 and 16 years in males and to compare these data with those of a matched female material. Material and MethodsDuring the period [1960][1961][1962][1963][1964][1965][1966] 49 boys aged 1 to 16 years and living in the town of Goteborg appeared in the Children's Hospital with their apparent first UTI. Since the town has only one paediatric department and few private practitioners, the material can be considered as unselected.
It is possible to determine the thickness of the low echogenic layer of the bladder wall with a systematic and anatomically defined method of acceptably reliable measurements. The ventral and dorsal walls should continue to be measured until more is known about their pathological appearance.
Vomiting, lethargy and metabolic acidosis were the main initial symptoms of metabolic disease in a 1 month old girl. Her older sister had died from a similar disease, considered to be Reye's syndrome, at an age of 15 months. The urine of the present case contained 2-methylcitric acid, 3-hydroxypropionic acid, N-propionylglycine, 2-hydroxy-3-methylbutyric acid, N-tiglylglycine, 3-hydroxyvaleric acid and glutaric acid. These metabolites are all known to be associated with propionyl-CoA accumulation. Free propionic acid was not detected in the urine. In addition, the urine contained 3-oxo-2-methylvaleric acid and 3-hydroxy-2-methylvaleric acid, probably formed by condensation of two molecules of propionyl-CoA. The identity of these metabolites was confirmed by synthesis. An elevated urinary concentration of maleic acid and fumaric acid was another constant abnormality. The activity of propionyl-CoA carboxylase in leucocytes was about 20% of the normal activity. The girl was teated with a low-protein diet since the diagnosis was made at an age of 1 month, and her psychomotor development was satisfactory at an age of 2 1/2 years. She had a few episodes of acidosis during infections.
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