Urinary tract infection is defined by the presence of microorganisms in the urinary tract associated with clinical manifestations.
Depending on the symptomatology and the location of the infection we distinguish:
*UTI with undetermined location
*asymptomatic bacteriuria (presence of bacteria in the urine in significant titre without manifestation of urinary infection).
In the infant and small child, the febrile ITU has very high localization, which is why at this age the infection should be considered pyelonephritis.
Depending on the evolution, we distinguish:
- Acute ITU
- Recurrent ITU (negative uroculature between episodes)
- Persistent ITU (positive uroculture persists).
ITU prevalence is age and gender dependent, but regardless of age, ITU is more common in female sex.
The ITU has almost twice the prevalence of girls compared to boys (6.5% vs. 3.3%). Prevalence increases even more in the age group of 1-2 years: 8.1% in girls and 1.9 % of boys. In boys with circumcision, the ITU is 5-10 times as rare as those without circumcision. The infant and the infant with ITU have a higher risk of kidney damage and scarring and vesico-ureteral reflux is more common and more severe.
Clinical manifestations of ITU in infants and young children are nonspecific: fever, agitation, inadequacy, vomiting, weight loss, diarrhea. The infant and the small child with fever without a clinically apparent cause will be suspected of being ITU. The probability is higher if the fever occurs in the baby <8 weeks or if it associates with the toxic condition and dehydration.
Uroculture is the investigation that confirms the ITU suspicion formulated on clinical criteria or in the presence of changes in the urine test. It is the standard gold standard for ITU confirmation.
However, the urine urine test (nitrite, leucocyte esterase, microscopy) is often used by the first intention, being an exploratory diagnostic investigation and having the advantage of a quick result. A negative result does not invalidate the ITU.
The ITU’s suspicion on the basis of the urine test requires confirmation through uroculture. Urine for uroculture can be obtained by 5 procedures: a) from the middle of the jet, b) with sterile collector – plastic bag attached to the perineum, c) urine collecting pads (Euron Uricol), d) bladder catheterization, e) puncture suprapubic bladder. In outpatient medicine, the first three methods can be used, and the last two methods are available in the hospital.
Most commonly, ITU is produced by enteric, aerobic, Gram-negative bacteria, with Escherichia coli first, followed by Enterobacter, Klebsiella, Proteus, Serratia.
Gram-positive bacteria are rarely included: group B streptococci, Enterococcus, Staphylococcus aureus and coguls-negative staphylococci.
Non-bacterial pathogens can produce ITU adenoviruses (often with hemorrhagic cystitis) and Candida. Urinary infection in infants and young children is sometimes a marker of urinary tract abnormalities.
In multiple studies, it was shown that a diagnosis of ITU in the first few months of life is more commonly associated with major obstruction or urinary abnormalities compared to children who have the first ITU episode at a higher age
Imaging evaluation is required for any infant or small child with febrile ITU. The purpose of imaging investigations is to identify some anatomical anomalies that favor ITU relapses and kidney damage. The imaging techniques for urinary tract evaluation are:
Ultrasound of the urinary tract can highlight: hydronephrosis and megaureter secondary to jonctional syndrome or massive vesico-ureteral reflux; bladder wall hypertrophy secondary to a mucosal dysfunction or chronic cystitis; ureterocele. Also, ultrasound can highlight changes in ecogenicity and kidney size produced by acute inflammation of the parenchyma
Mictional urethrocystography reveals vesico-ureteral reflux. More than 50% of infants with ITU are visco-ureteral reflux. In children with high-grade reflux, the risk of renal lesions and scars is 4-6 times higher compared to those with low-grade reflux and 8-10 times higher compared to those without reflux. Urethrocystography is recommended at the first evaluation microwave with contrast substance because it provides more anatomical details. This is done when the child is afebrile and urocultura is negated
Renal scintigraphy with dimercaptosuccinic acid (DMSA) reveals renal parenchymal defects. It is indicated 4-6 months after the acute episode, recurrent ITU regardless of age, and in patients with atypical ITU less than 3 years of age.
Urography i.v. not routinely indicated to a child with ITU. This investigation is only indicated if the ultrasound indicates the dilation of the ureter and / or basinet and the microvascular urethro-histography does not indicate the SVR. Under these conditions, i.v. may reveal megaurether by obstruction of the uretero-bladder junction or dilatation of the pelvis through pleural junction syndrome.
Treatment of Urinary Tract Infection
The objectives of urinary tract therapy are:
a) sterlization of the urine;
b) prevention of dissemination of the infection;
c) reducing the likelihood of kidney damage.
ITU therapy can be done at home with oral antibiotics, or hospitalization is recommended if age <6 months, fever> 38.5 ° C with failing to properly hydrate per os and toxic condition.
Antibiotic prophylaxis of the ITU is indicated in the following situations: all children up to imaging, recurrent ITU after an acute pyelonephritis, RVU, urinary tract obstruction (partial), and immunodeficiency. Prophylactic measures are also recommended: perineal region hygiene, regular 3-hour micturition and constipation therapy. Also, circumcision is a prophylactic, statistically proven fact that the incidence of ITU in boys under 6 months, uncircumcised, is 1-4%, whereas in circumcision it is only 0.1-0.2 %.
Antibiotic prophylaxis is not recommended in those with asymptomatic bacteriuria!
I would conclude, stressing that urinary tract infection must not be tolerated, it can and should be treated, and it is necessary to confirm urinary sterilization; also, parents whose children develop an ITU episode in their first year of life or repeated episodes in a relatively short period of time must present themselves to both the pediatrician and a urologist surgeon for the screening of possible congenital malformations of the urinary system!
Home remedies for UTI
#1. Cranberry juice – it has been used for over a century to prevent and treat urinary tract infections. Although in the past it was thought that the positive effect of cranberries is justified by the production of acid in urine, recent evidence suggests that proanthocyanins in the bovine composition have the role of preventing bacteria from adhering to the walls of the urinary tract.
Thus, bacteria can be easily removed by urine.
Cantaris, Apis mellifica, Staphysagria, Sarsasparilla are four of the most commonly used homeopathic remedies for treating various symptoms of urinary tract infections.
#2. Uva Ursi – is a plant used as a popular remedy for certain types of urinary tract infections. The active substance is arbutin, which will be decomposed and excreted in the kidney, where it appears to have antiseptic properties.
Uva bears also contains significant amounts of tannins that may affect the liver following prolonged use of this plant. Therefore, people who suffer from kidney or liver disease, pregnant women, nursing mothers and children will not use Uva bears.
Other home remedies
Prepare a tea of 25 grams of birch per liter of water, let it stand for 10 minutes, squeeze it and drink up to three cups a day.
Mix a hand from each of the following plants: broad-leaved root, banana, lancet, nettle. Mix all the plants with a spoon and pour over them a mug of boiling water. Cover the mixture, let it sit for 15 minutes, squeeze it and drink two cups a day.
Boil 20 grams of barley in one liter of water. When water starts to boil, add 20 grams of juniper. Put the small fire and let the mixture boil for a few minutes. Cover it with a lid and let it stand for 20 minutes, then squeeze it and drink up to three cups a day.
In one liter of water, mix four tablespoons of each of the following ingredients: marigold, linseed, horsetail, and thyme. Boil the mixture for 10 minutes, then cover it with a lid and let it stand for 15 minutes. Stretch him and sit twice a day.
Add a spoonful of celery seed in a cup of boiling water, then cover the mixture and leave it for 10 minutes to cool. Drink it before you cool completely.
Dissolve one quarter teaspoon of sodium bicarbonate in a glass of water and drink once a day. Before drinking this drink, drink two glasses of plain water.
Clean and remove the core of an apple, then slicing it. Clean a banana and cut it on this slices. Mix the two ingredients in a blender and drink this smoothie on the empty stomach.
Prepare a smoothie from two cups of fresh blueberries, a slice of red melon and half a cup of cherry. Drink immediately after preparation.
Heat half a cup of cherry with water in the water. Remove the kernels after the cherries have softened and pass the rest into the blender. Add a spoonful of honey and put the mixture in a jar with a well screwed lid. Consume two tablespoons of it every day.
Clean and crush two cloves of garlic. Add a cup of hot water and let the mix stand for five minutes. Drink three times a day.
In one liter of water dissolve two tablespoons of apple vinegar. Drink throughout the day.
Clean an onion and cut it in four pieces. Put them in half a liter of water and let them boil for 20 minutes. Take the mixture on the stove and let it stand for 8 hours. Then squeeze the liquid and drink it. It will help you urinate more and eliminate bacteria.
Add two tablespoons of basil to a mug of boiling water. Let the mix stand for 10 minutes and drink it twice a day for 48 hours.
Prepare a smoothie of two cups of cranberry juice, a cup of pomegranate juice, a cup of chopped papaya, 1/4 cup lemon juice and a spoonful of ginger juice or a slice of grater. You can also add some ice cubes. Drink five cups a day.
Prepare a tea from a cup of boiling water and a spoonful of chopped parsley. Allow the mixture to stand for 15 minutes, then sweeten it with honey. Drink three cups a day.
Due to its rich antioxidant content, pomegranate juice helps kill bacteria that adhere to the walls of the bladder. It contains a considerable amount of vitamin C, strengthens the immune system and combats urinary tract infections.
To treat the infection, drink two to three glasses of pomegranate juice every day.
Garlic is a food with antibiotic and antibacterial properties, helping to prevent and stop the development of bacteria responsible for urinary tract infections.
Crush two cloves of garlic and add them to a cup of hot water, let the mix stand for 5 minutes, squeeze it and drink at least three cups a day.
Another option would be to eat raw garlic daily.