Современные аспекты диагностики инфекции мочевыводящих путей у детей первых двух лет жизни: ретроспективный анализ серии случаев

Abstract

Study Objective: To present the modern pattern of urinary tract infections (UTIs) in infants and toddlers and to systematise diagnostic criteria. Study Design: retrospective case study. Materials and Methods. We conducted a continuous retrospective analysis of 45 medical records (for 2018–2020) of children aged from one month to 2 years old with confirmed UTIs. Authors used a set of complaints, past history, clinical symptoms dynamics, and laboratory and instrumental test results. Study Results. 91.1% (n = 41) of infants and toddlers hospitalised to Nephrology Unit at Children’s City Clinical Hospital No.9 of Ekaterinburg with UTIs had structural anomalies in their urinary system, and 35.5% (n = 16) of cases were associated with a family history. Most common symptoms of UTIs were fever and pale skin in 55.5% of patients, sub-orbital cyanosis in 48.8% of patients, and unrest during urination in 37.8% of patients. One quarter of cases were asymptomatic; the condition manifested itself through leukocyturia and bacteriuria. Laboratory test results were used to diagnose leucocytosis with neutrophilia in 26.6% of patients; and the increase in erythrocyte sedimentation rate correlated with C-reactive protein levels (r = 0.57; p < 0.05). We managed to identify opportunistic pathogens only in 33.4% of cases. One third of children had manifestations that are characteristic of cytomegalovirus infection (CMVI): prolonged subfebrile condition, hepatomegaly, normochromic anemia, monocytosis up to 13% (10.9–14.02). Conclusion. In infants and toddlers, UTIs are caused by structural abnormalities of the urinary system, a family history and are characterised by a certain set of clinical and laboratory signs. In order to expand diagnostic capabilities, we recommend including PCR tests for identifying cytomegalovirus DNA from body fluids of a child (blood, saliva, urine) and ELISA testing of serological markers of the virus. If markers of CMVI replication are found, the treatment protocol should be personalised to achieve stable clinical and laboratory remission. Keywords: urinary tract infection, pyelonephritis, cystitis, children, cytomegalovirus infection, monocytosis.