Predictors of urinary tract infection among children with febrile convulsion in a tertiary hospital in Africa
Main Article Content
Keywords
Febrile convulsion, Urinary tract infection, Pyuria.
Abstract
ABSTRACT
Background: Febrile convulsion (FC) in resource poor setting is usually attributed to malaria. With the decline in malaria prevalence due to interventional programmes, it is pertinent to recognize other causes of FC such as urinary tract infection. Additionally urinary tract infection is associated with deleterious consequences if untreated or poorly treated. This study was therefore conducted to confirm predictors of UTI among children with FC in University of Ilorin Teaching Hospital, Ilorin, North central Nigeria.
Materials and Methods: One hundred and forty five children with FC were recruited over an 18 month period. Demographic and clinical details were obtained using a standardized questionnaire. Samples for urine dipstick, microscopy, culture and sensitivity were obtained. Sensitivity, specificity, positive and negative predictive values for the clinical features and laboratory investigations were calculated.
Results: Fifteen (10.3%) of the children recruited had urinary tract infection. Complex febrile convulsion was a significant finding among children with positive culture results. Complex FC and pyuria had the highest sensitivity while pyuria showed a high positive predictive value.
Conclusion and Recommendation: Predictors of UTI among children with FC were complex febrile convulsion and pyuria. Empirical treatment could be commenced among children with either or a combination of complex febrile convulsion and pyuria in resource poor settings while culture results are been expected.
References
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2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.
1. Ouellete EM. Febrile convulsion In: Dersherwitz RA (ed). Ambulatory paediatric Care 2nd ed. Lippincott-Raven. New York; 1993: 578-580.
2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.
1. Ouellete EM. Febrile convulsion In: Dersherwitz RA (ed). Ambulatory paediatric Care 2nd ed. Lippincott-Raven. New York; 1993: 578-580.
2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.
2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.
1. Ouellete EM. Febrile convulsion In: Dersherwitz RA (ed). Ambulatory paediatric Care 2nd ed. Lippincott-Raven. New York; 1993: 578-580.
2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.
1. Ouellete EM. Febrile convulsion In: Dersherwitz RA (ed). Ambulatory paediatric Care 2nd ed. Lippincott-Raven. New York; 1993: 578-580.
2. White RHR. Vesicoureteric reflux and renal scarring. Arch Dis Child, 1989; 64: 407-412.
3. Hannula A, Perhomma M, Venhola M, Pokka T, Renko M, Uhari M. Long-term follow-up of patients after childhood urinary tract infection. Arch Paediatr Adolesc Med, 2012. 166; 22.
4. Jiya NM, Ibitoye PK, Jiya FB. Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria. International Journal of Medicine and Medical Sciences, 2012. 2(7): 154-157.
5. Eke FU and Eke N. Urinary tract infections. In: Azubuike JC and Nkangineme KEO (eds). Paediatrics and Child-health in a tropical region, 1999. African Educational Services, Owerri, Nigeria.
6. Momen AA, Monajemadah SM, Gbolamian M. The frequency of urinary tract infection among children with febrile convulsion. Iran Journal of Child Neurology, 2011. Vol 3, No 3.
7. Araoye MO. Research methodology with statistics for health and social sciences 1st edn, Netadex (Publ), Ilorin, 2003, 115-121.
1. 8. Oyedeji GA, Socio-economic and cultural background of the hospitalized children in Ilesha. Nig J Paediatr 1985; 12: 111-117.
9. Foxman B. Epidemiology of urinary tract infection: Incidence, morbidity and economic costs, American Journal of Medicine 2002, Vol. 113, no. 1A, pp. 5S-13S.
10. McIntyre PB, Gray SV, Vance JC. Unsuspected bacterial infection in febrile convulsion. Med J Australia. 1990; 152: 183-186.
11.. Lee P, Verrier-Jones K. Urinary tract infection in febrile convulsion. Arch Dis Child. 1991; 66: 1287-1290.
12. Teach SJ, Geil PA. Incidence of bacteraemia, urinary tract infection and uninterrupted bacterial meningitis in children with febrile seizures. Paediatr Emerg Care. 1999; 15: 9-12.
13. Trainer JL, Hampers LC, Krug SE, Listerniate RS. Children with 1st time febrile seizures are at low risk of serious bacterial infection. Acad Emerg Med. 2001; 8: 781-787.
14.. Farivar KH, Tairani BA. The protective effect of breastfeeding in febrile seizures. J Iranian Child 1996; 9: 49-55.
15. Amiri M, Farzin L, Moassasi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Element Res 2010; 35: 38-44.
16. Kaushal RK, Bansal S, Sharma VK, Sood A, Goyal A. UTI among children presenting with fever. India Paediatr 2003; 40: 269-270.
17. Wammanda RD, Ewa BO. Urinary tract pathogen and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002; 22: 197-198.
18. Hebert KL, Herchlire TE. Paediatric urinary tract infection organism-specific therapy, 2015. Available at emedicine.medscape.com/article/197696 (Accessed 1st March 2016).
19. Elder JS. Urinary tract infection In: Kliegman RM, Berhman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Paediatrics 18th Edition, Elsiever and Saunders, Philadelphia, USA 2007. 2223-2228.
20. Richard G. Safety profile of quinolone antibiotics in paediatric population. Paediatr Inf Dis J 2003; 2: 1128-1132.