Etiology of microorganisms causing symptomatic and urinary tract infections among mentally handicapped pupils in Kwale district
Mwavita, Amos Lewa
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Community acquired urinary tract infections in Kwale District are ranked among the top ten morbiditv causing agents. A study was done to establish etiology of microorganisms that may cause symptomatic or asymptomatic urinary tract infections in mentally handicapped pupils of' Kwale District. This study aims at providing awareness that mentally handicapped pupils are at risk of acquiring bacterial urinary tract infections. and that treatment requires selection of empiric antibiotic pattern. entally handicapped pupils aged 5 to 25 years were investigated for community acquired urinary tract infections (UTI) and compared with those of normal pupils. The entire case group was investigated for infections with bacteria, protozoa, fungi and urinary bilharzia. Urine samples were collected aseptically and cultured on cystine lysine electrolyte deficient (CLED) agar and onto Sabourauds dextrose agar. Isolated organisms were identified and analyzed using phenotypic assays including colonial morphology, gram stain, serological assays and biochemical tests including Api 20E. Streptococci species were dominant in the case group (8.1%) while Escherichia coli and Klebsiella (8.8%) dominated the bacteria from control Group. The spectra of bacterial isolates associated with ages of the study groups. Antimicrobial susceptibility tests were performed on drugs commonly used in the management of UTI. Resistance was seen in varying levels from 0% in ciprofloxacin to 83% with septrin. Organisms displaying multiple drug resistance included Klebsiella spp. pseudomonas spp and citrobacter spp: the most inhibited anti microbials included septrin 83%, augmentin 55% and cefotaxime 10.4%. Resistance levels were consistently lower for bacteria from the controls compared to case samples. Yeast infection associated with bacterial infections and with turbiditv. Schistosomiasis was seen in 23 out of I I I and 37 out of I 18 of case pupils and controls respectively. In the case pupils. there was a sign of association between presence of Schistosomiasis eggs and age of child (p<0.01) and no association in the controls (p>0.5). There were concurrent infections of urinary schistosomiasis with bacteria. Consequently pre-puberty to puberty case pupils were more at risk to acquire UTI. This thesis discusses the various associations and differences between ages, UTI and other parameters in "normal" and the mentally handicapped pupils in Kwale district Kenya.