Asymptomatic bacteriuria in Nigerian children with sickle cell anemia

Abstract

Urinary tract infections (UTI) in children with sickle cell anemia (SCA) may result in long term renal dysfunction. The prevalence, potential risk factors, and clinical significance of asymptomatic bacteriuria (ASB) were investigated in 196 Nigerian children with SCA in stable state. These children had clinical evaluation and assessment of their mid-stream urine (MSU) for pyuria, culture, and sensitivity tests; urinalysis for proteinuria, and estimated glomerular filtration rate (eGFR), hematocrit, serum creatinine and uric acid estimation. Children with confirmed ASB were compared with those without ASB. Those with confirmed ASB were monitored for 6 months for persistence of significant growth, development of symptomatic UTI, and evaluation of renal functions. The prevalence of probable and confirmed ASB in this cohort of SCA children were 12.2% and 6.6%, respectively. Confirmed ASB was more prevalent among older (P = 0.046) and female (P = 0.003) SCA children, particularly those with pyuria (odd Ratio, OR = 5.4, 95% confidence interval, CI = 2.7-11.0, P < 0.001) and proteinuria (OR = 1.4, 95% CI = 3.9-8.7, P = 0.006). Previous symptomatic UTI was not associated with ASB. Also, the mean eGFR, serum creatinine, and uric acid were not different in the group with ASB and those without ASB (P > 0.05). At the end of 6 month follow-up, two (15.4%) of the 13 children with ASB had persistence of significant growth, but none develop symptomatic UTI. Also, none of the two with persistent ASB had hypertension or deranged renal function. ASB is a significant problem in older age female SCA children, although renal functions were not different among those with and without ASB. A large scale randomized placebo-controlled trial of conventional treatment for ASB in SCA is advocated to define its long-term clinical significance.

Radiological Abnormalities and Asymptomatic Bacteriuria in Patients with Sickle Cell Disease

“…Asymptomatic bacteriuria did not appear to be persistent in the 11 cases who were initially diagnosed in 2004, with only two (18%) patients having documented ASB in 2010. This was similar to the report of Adegoke where only 2 of 13 patients had persistent ASB after six months of follow-up (14). The lack of persistence of ASB perhaps suggests the transitory nature of the diagnosis and further underscores the lack of guidelines supporting screening or implementation of antibiotic therapy in patients with SCD and ASB.…”

“…The prevalence of ASB in SCD is reported to range from 4% to 6.6% (3,10,13,14). This rate does not appear to differ significantly from the reported prevalence rate of 5% in healthy premenopausal women without SCD (15).…”

“…In fact, UTIs documented in cases did not fulfil the classification of recurrent UTIs, where more than three infections were documented in 12 months (21). Adegoke also failed to show new symptomatic UTIs in 13 patients with ASB and SCD after six months of follow-up (14).…”

“…The prevalence of ASB increases with age and sexual activity and is rare in young men (16)(17)(18). Studies reporting on the prevalence of ASB in SCD were varied with several including only children (3,14), whereas others had a mixed sample of both young males and females (10,13).…”

The Differential Diagnosis of Sterile Pyuria in Pediatric Patients: A Review

“…Sterile pyuria has also been noted in other polyarthritis syndromes in children including: reactive arthritis, juvenile idiopathic arthritis, polyarteritis nodosa and Henoch Schonlein purpura. 39 Adegoke and Adegun 40 in a study of asymptomatic bacteriuria in children with sickle cell anemia found a prevalence of 18.2% of sterile pyuria. This was thought to be due to repeated infarction and papillary necrosis.…”