Saturday, April 13, 2013

Urinary tract infections in children


The term urinary tract infection means the invasion of microorganisms in the tissues of the urinary system. 
Urinary infections are the primary causes of intestinal bacteria. Escherichia coli causes 60-90% of uncomplicated urinary tract infections. The sources of one's own gut flora. Urinary tract infections are usually caused by so-called. "Uropathogen" serogroup Escherichia coli (UPEC), certain virulence properties. 


The term urinary tract infection means the invasion of microorganisms in the tissues of the urinary system. The vast majority of these are bacterial infections to urinary tract infections, the term refers to the practice of all the states in which a significant number of bacteria found in the urine. Urinary tract infections occur in both sexes in all age groups. The children's ages are most common immediately after the inflammation of the airways. The frequency depends on the age and sex of the child. In the neonatal age are often associated with an abnormality of the urinary system. The incidence of infections in the first three months is more common in boys, and then it became more frequent in girls. Short urethra female urinary system provides three times more often than men.Conducive to infection and anatomical malformations (eg, double ureter), the presence of obstructions (stones), vesicourethral reflux (return of urine from the bladder into the upper parts of the urinary system), diabetes and so on. When urinary tract infections occur in the normal urinary system, called primary (uncomplicated), while those in the urinary system anatomical abnormalities secondary means (complicated). Clinically, urinary tract infections can flow either symptomatic or asymptomatic. 
Asymptomatic UTI indicating the presence of significant bacteriuria without symptoms of urinary system. Symptomatic urinary tract infections can affect any part of the urinary system. When kidney surgery and its channel system speaks of pyelonephritis. Infections of the urinary bladder and the urethra is called urethritis and cystitis (cistouretritis). In children, especially young people, is prone to infection quickly spread to the entire urinary system, regardless of which part is started. Children with risk factors for Urinary infections, and those with completely normal urinary system, Urinary infections can be repeated. Such repeated urinary tract infections can be a relapse or reinfection. 
Relapse is the inflammation caused by the same microorganism that is detected before treatment sore back, and in the two weeks after the treatment was not detected by urine culture bacterial growth.When a small group of patients relapse due to the silent (subclinical) infection kidney (pyelonephritis).It is believed that relapse may be due to duplication of the same bacteria in the vagina or the area around the urethra and anus. These recurrent infections occur due to "climb" and again multiplied microorganisms in the urinary system. This mechanism inflammation occurs again two weeks after cessation of antibiotic therapy prior to infection. "Silent" inflammation of the kidneys in the beginning can cause symptoms of inflammation of the lower part of the urinary system, and look like an inflammation of the urethra or bladder. Since the initial dose of antibiotics do not cure kidney infection, symptomatic relapse occurs shortly after the termination of their intake. Proper and sufficiently long treatment with antibiotics can cure the infection. 
Reinfection is a new episode of propagation of microorganisms and the development of inflammation caused by bacterial infection other than the former (ie the inflammation caused by Klebsiella spec. Following the inflammation caused by the Escherichia coli). Infection can be caused by the same organism as the inflammation passed, in which case a relapse and reinfection distinguished by the fact that reinfection is separated from the previous period of asymptomatic infection of at least one month after discontinuation of antibiotics and regular urine. The difference between relapse and reinfection is important because it is used differently in each treatment. Relapsing infections associated with a more comprehensive diagnostic, treatment, and longer in some cases surgical intervention. It is believed that most of inflammation due to repeated reinfection. 
Cause - "uropathogen" Escherichia coli 
Urinary infections are the primary causes of intestinal bacteria. Escherichia coli causes 60-90% of uncomplicated urinary tract infections. The sources of one's own gut flora. Urinary tract infections are usually caused by so-called. "Uropathogen" serogroup Escherichia coli (UPEC), certain virulence properties. Uropathogen Escherichia coli differs from the others by the presence of specific growth on the surface (saw), which specifically bind to the epithelial cells of the urinary tract. This has prevented their mechanical removal of the urine stream. This explains why some children, even when they have no more prone to urinary tract anomaly, urinary tract infections, particularly pyelonephritis.Infections caused by Escherichia coli Uropathogen is usually more severe, longer lasting, more repeats and takes longer antimicrobial treatment. So, out of a total of 150 serotypes of E. coli Uropathogen only some (01, 02, 04, 06, 07, 025, 075, 0150), of which again only one cause infection of renal parenchyma. 
The clinical picture 
Clinical symptoms of urinary tract infections depend on the site of the infection, the cause of the infection, a person's age, the presence anomlija urinary system and the number of previous infections.When the site of infection lower urinary tract, the typical symptom is dysuria. Body temperature is usually elevated. In contrast, inflammation of the upper urinary tract and kidney parenchyma is manifested by a sharp increase in body temperature with Treskavica and a feeling of general illness.Often there is pain in the lumbar area. The symptoms are especially pronounced for E. coli infection, while other bacterial infections give significantly fewer symptoms. The rule is that the symptoms of urinary tract infections that are less typical younger child. 
Diagnostic 
When a suspected urinary infection is necessary to prove the direct causes of the causes of urine. In adults and older children, that control urination, it is best to use the first morning urine. To avoid contamination of urine in natural discharge, it is a mild soap and water to wash the external genitalia.The first stream of urine should be left to her otplavili microorganisms that live in front of the urethra and then into a sterile sample container. For the collection of urine in young children using the pediatric bags which are placed immediately after washing genitals and removed immediately after the urine. If the urine does not show up within 45 minutes of putting a new bag after repeated washing genitals. Urine for culture should be sent to the microbiology laboratory immediately after taking it, but if this is not possible, the sample can be kept at a temperature of 4 º C up to 24 hours after ingestion. To determine the presence of pathogens, urine biochemical and microbiological examination. Microscopic examination required signs of inflammation, including: leukocytes, erythrocytes and bacteria. For the purpose of isolation of bacteria, urine is sown on nutrient media, ie.It is a urine culture. Normal urine contains no bacteria (it is sterile). If the underlying growth of bacteria, urine culture is positive. Positive urine determines the number of bacteria per ml of urine, type isolates, and to determine the sensitivity tj.resistance to certain groups of antibiotics. 

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