Urinary tract infection in infants and young children presenting with fever without a focus in Port Moresby.

ABSTRACT

A prospective study was undertaken to document the importance of urinary tract infection (UTI) as a cause of fever without a focus (FWF) in children less than 3 years of age presenting to the Children's Outpatients Department (COPD) of Port Moresby General Hospital (PMGH). 98 children, 55 males and 43 females, with a median age of 17 months and an interquartile range of 5-31.25 months, were recruited. In addition to a history and physical examination each child had a full blood count, a malaria parasite smear, and a urine sample (obtained by clean catch or midstream methods) for dipstick testing, microscopy and culture. Blood culture was performed where practicable. Lumbar puncture and cerebrospinal fluid (CSF) examination were done only if clinically indicated. UTI was diagnosed on urine culture in 9 of the 98 children. Both urinary nitrite and leukocyte esterase tests were sensitive (89%) and specific (96%). Other causes of FWF were classified as non-specific viral infection (31 children), lower respiratory tract infection (11), malaria (7), meningitis (4), bacteraemia (1 neonate) and other or unknown causes. The finding of UTI in 9% of the children is consistent with data from other tropical countries. Checking for urinary tract infection, which can be done using noninvasive methods of urine collection, is an important part of the investigation of infants and children with FWF.