Pyuria as a diagnostic test for urinary tract infection in children with sickle cell anaemia in Zaria, Nigeria

Abstract

Objective: This study aimed at determining the significance of pyuria as a screening test for UTI in children with sickle cell anaemia (SCA).
Methods: Two hundred and seventy-two children with SCA, aged 6 months to 15 years, were studied out of which 185 (68.0%) were in stable state and 87 (32.0%) were in crises. Their urine was assessed for microscopy culture and sensitivity. Significant pyuria and bacteriuria was determined using standard methods. 
Results: Significant bacteriuria was detected in 22 (8.1%) of the 272 subjects with SCA. The prevalence of significant bacteriuria was higher among those in crisis (18/87; 20.7%) than in those in steady state (4/185; 2.2%) and the difference was statistically significant (χ² = 27.323, p = 0.001). Of the 22 SCA subjects with confirmed UTI, 19 (86.4%) had significant pyuria with a sensitivity of 86.4%, specificity of 68.8%, and positive predictive value of 19.6%. The most common bacterial isolates were Escherichia coli 11 (50.0%) while the least isolated were Salmonella typhi 1 (4.6%).
Conclusion: This study indicates that pyuria as a screening test for UTI is not very specific but very sensitive necessitating a more test to be done for diagnosis of UTI.

Keywords: Sickle cell anaemia, bacteriuria, pyuria, children