Indian Journal of Applied Microbiology, (2009) 10(1): 73-78 2TGXCNGPEG QH #U[ORVQOCVKE $CEVGTKWTKC KP 5EJQQN %JKNFTGP Thiyagarajan. S*, Shankar. P and M. Rajkumar ABSTRACT The Uninary tract infections may be symptomatic or asymptomatic eventhough they are not associated with significant mortality, they home high morbidity, if complicated. In the present study a total of 305 children studying in Government Primary School at Santhosapuram, a suburban area of Chennai, were studied on the prevalence of asymptomatic bacteriuria. The child volunteers of both sexes of the study were in the age group of 4 to 12. Standard bacteriological methods were followed for the isolation of urinary bacterial pathogens. The present study inferred a relatively low prevalence (15.7%) of bacteriuria. The children in the age group of 4-6 years shown substantial asymptomatic bacteriuria (54.1%). The overall incidence of bacteriuria has been observed to be relatively higher in female (56.2%) than in male children (43.7%). Six bacterial pathogens viz., Escherichia coli, Pseudomonas Sp., Proteus Sp., Klebsiella Sp., Staphylococcus Sp. and Enterococci Sp. were isolated. The E.coli mediated bacteriuria has been observed to be more common (43.7%) followed by that caused by Pseudomonas Sp. and Proteus Sp. (16.6% each). The study also inferred that the bacteria Enterococci Sp. is very uncommon (2.0%) in the asymptomatic bacteriuria of the study population. Possible attributes of predisposing factors such as poor hygienic practices, low socioeconomic status, natural susceptibility and high degree of bacterial virulence were discussed. Introduction but also to enumerate bacteria in the urine and their susceptibility pattern to antimicrobial agents. In man the urinary tract is the second commonest site after the respiratory tract for The different clinical forms of UTIs are Acute invasion of the pathogens. Urinary tract infections pyelonephritis, Renal carbuncle, Pyonephrosis, (UTI) contribute significantly to the cost of providing Bladder dysfunction due to chronic infection, UTI health care in economically developed countries. infection in Diabetes, Bacteriuria of Pregnancy, Urinary tract infections may be symptomatic or Bacterial Prostatitis, Urithtitis, etc. The pathogenesis asymptomatic. The UTIs are not usually associated of a UTI is dependent in great part on factors with mortality, but they lead to high morbidity in associated with both the microorganisms and the complicated cases. However, seemingly innocuous host. A number of intrinsic and extrinsic factors to infections in high rise individuals such as children, the host combine to predispose to UTI such as pregnant women and patients with stones and in obstruction, stasis, reflux, pregnancy, hyperosmolarity dwelling catheters can have an adverse effect on of renal medulla, genetic predisposition, renal function. immunodeficiency, instrumentation (catheters), antimicrobial agents etc. Several facts suggest a As early as in eighteenth century Louis genetic predisposition to UTI, including the Pasteur (1863) recognized urine as good culture association of blood group P antigen with blood medium for bacteria. Bacteriological examination of groups B and AB, i.e., those lacking anti-B the urine is considered to be the major aid to the isohemagglutinin (Tolkoff and Rubin, 1986). diagnosis of infection. Clinical symptoms may sometimes be a good initial guide to the presence and Reflux tends to perpetuate infection by site of infection, but many infections are symptomless maintaining a residual pool of infected urine in the and genital infections may mimic infection of the bladder after voiding. Children with reflux may urinary tract. Urinary cultures may constitute develop upper UTIs and renal scarring. Field et al 25-45% of the work of the average clinical laboratory. (1975) reported that reflux can be detected in 30% to Cultural techniques are employed not only to detect 50% of children with symptomatic or asymptomatic bacteriuria and that the scarred kidney associated *Corresponding Author with reflux is more susceptible to reinfection. Sr. Lecturer & Head, Dept. of Microbiology, In the first month of life the bacteria affects Asan Memorial College of Arts & Science, between 1% and 2% babies (Ruymeadow et al, 1969) Chennai - 600 100. and significantly more common in boys and girls e-mail:[email protected] (Zelikovic et al, 1992). Uncircumcised boys are 10-40 74 Indian Journal of Applied Microbiology Vol. 10 No. 1 times more likely than their circumcised Table 1.1: Sex-wise Distribution of Study counterparts. Prevalence of UTI in adult men is Population commonly low. In males the long urethra and the prostatic antimicrobial activity in prostatic fluid No. of cases (sex-wise) Total No. confer added protection against the development of Age Male Female of cases bacteriuria. 4 111425 The first infections are usually sensitive to antimicrobial agents and are easily treated with most 5 162844 antimicrobial agents. Individuals who have first 6 213354 infections may have recurrences based upon their 7 122537 predisposition. Although first infections in adult 8 142135 women are usually “simple infections”, first UTIs in infants and children and young males should be 9 152641 considered as complicated infection because UTIs in 10 18 24 42 infants often serve as a marker for urinary tracts 11 07 09 16 anomalies (Mathew Konen, 1972; Boucher et al., 12 05 06 11 1987). Many workers have studied the characteristics Specimen: 5 to 10 mL of midstream urine was of symptomless bacteriuria, and the initial reports collected in sterile container from every child, who suggested that it was linked to significant long-term were reported to be healthy. The sample collection morbidity, but it is now accepted that spontaneous was accompanied with a proforma for data collection remission or cure is the commonest outcome and such as Name, Age, Sex, Place or residence, Date and complications occur only under certain conditions. time of specimen collection, colour and turbidity of Schalger (2001) cultured the organisms from the the specimen. bladder and the ureters of women who had aymptomatic bacteriuria, they failed, however, to Method: The collected specimens were transported mention whether they considered the organism to be to the Laboratory of Department of Microbiology of pathogenic when recovered as pure cultures in Asan Memorial College of Arts & Science, Jaladampet, Pallikarani, Chennai, where the whole amounts greater that 105 col./mL. Kunin et al (1962) processing of the specimens were done. The observed the incidence of bacteriuria in school boys specimens were further inoculated on to MacConkey and it therefore appears that screening boys for urinary tract infection is comparatively unrewarding, Agar and Blood Agar and incubated at 37°C for 24 regardless of the method used. Kunin (1966) found hours for the determination of significant bacteriuria 1.2% prevalence of asymptomatic bacteriuria in North and isolation of pathogens (Mackey & Mackartney, American school girls. 1994). The isolated colonies were then subjected for standard bacteriological techniques for the The aim of this study was to observe the identification of the bacteria. The methods employed prevalence of significant asymptomatic bacteriuria in include Gram’s staining, Oxidase test, Catalase test, school children and to study the significant factors Triple sugar iron test, IMViC test, Sugar associated with the same. fermentation test, Urease test, Coagulase test, etc. Materials and Methods Results Study population: A total of 305 urine specimens Out of the 305 urine samples studied no were collected from children studying at a growth were obtained in 228 samples. Moderate Government Primary School at Santhosapuram, a growth was observed in 19 samples and significant suburban area of Chennai, India. The study subjects growth was noted with 48 samples. The number of consisted of 119 male and 186 female children who cases with significant bacteriuria among male and were aged between 4 and 12. The distribution of age female children were 21 and 17, thus accounting to among the study subjects is detailed in the Table 39.1% and 60.9% respectively. The rate of incidence 1.1. The study was conducted for a period of three of bacteriuria in different age groups were 54.1% in months from January to March 2007. Proper consent the age group 4-6 yrs, 27.0% in the age group 7-9 was obtained from the parents of the children and and 18.7% in the age group of 10-12 (Table 2.1). the authorities of the school for the specimen While looking upon the incidence sex wise, a high collection. rate of bacteriuria were observed in female children July 2009 Prevalence of Asymptomatic Bacteriuria in School Children 75 Fig 2.1 Incidence of Different Bacterial Pathogens in Study Population Fig 2.2 Incidence of Bacteriuria in Male and Female cases (56.2%) compared to that in their counterpart (43.7%) Table 2.2: Sex-wise incidence of Significant (Table 2.2). The overall analysis inferred that the bacteriuria asymptomatic bacteriuria is common in the age group 4-6 yrs with a substantial incidence in female sex. Age No. of cases and % Total No. Group (in of Incidence Table 2.1: Incidence of Significant bacteriuria of cases in Different Age Groups years) Male Female 4-6 26 11 (42.30%) 15 (57.69%) Age Group Overall % of No. of Cases (in Years) Incidence 7-9 13 07 (53.8%) 06 (46.15%) 4-6 26 54.16 10-12 09 03 (33.33%) 06 (66.66%) 7-9 13 27.08 The bacteria associated with the significant 10-12 09 18.75 growth observed were Escherichia coli, 76 Indian Journal of Applied Microbiology Vol. 10 No. 1 Pseudomonas Sp., Proteus Sp., Klebsiella Sp., The insight on the incidence of different Staphylococcus Sp. and Enterococci Sp. The bacterial pathogens inferred that Escherichia coli numbers of cases of bacteriuria associated with each seem to be the most prevalent pathogen both in male of these bacteria were 21, 08, 08, 05, 05 and 01 and female cases at a rate of 66.6% and 25.9% respectively.