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Archives de pédiatrie
Volume 19, n° 8
pages 842-846 (août 2012)
Doi : 10.1016/j.arcped.2012.05.016
Received : 9 February 2012 ;  accepted : 30 May 2012
Infection urinaire à Haemophilus influenzae chez 3 enfants ayant une malformation de l’arbre urinaire
Urinary tract infection caused by Haemophilus influenzae in 3 children with uropathies

L. Allard a, , M.-L. Joly-Guillou b, G. Champion a
a Service de pédiatrie générale, pôle femme-mère-enfant, CHU d’Angers, 4, rue Larrey, 49933 Angers cedex 9, France 
b Laboratoire de bactériologie, CHU d’Angers, institut de biologie en santé (IBS), plateau de biologie hospitalier (PBH), 49933 Angers cedex 9, France 

Auteur correspondant.

La pyélonéphrite aigue (PNA) est une des infections les plus fréquentes de l’enfant, dans laquelle le genre Haemophilus est très rarement impliqué. De janvier 2010 à octobre 2011, seulement 3enfants âgés de moins de 15ans ont été hospitalisés dans notre établissement pour une infection urinaire à Haemophilus influenzae. Les 3enfants présentaient des tableaux typiques de PNA : fièvre, signes fonctionnels urinaires ou douleurs abdominales. L’examen cytobactériologique des urines (ECBU) montrait à l’examen direct une leucocyturie significative et de nombreux bacilles Gram négatifs. La culture bactériologique standard des urines des 3 patients était négative. H.  influenzae a été mis en évidence secondairement après réensemencement des urines sur milieu enrichi. Les 3 enfants présentaient une uropathie : 2 syndromes de la jonction pyélo-urétérale droit et une duplicité urétérale bilatérale avec reflux de haut grade. Pendant la période étudiée, la prévalence des PNA à Haemophilus dans notre établissement a été de 0,02 % dans les infections urinaires de l’enfant. Dans la littérature, les PNA à Haemophilus sont rares (moins de 1 % chez l’enfant), fréquemment associées à une malformation de l’arbre urinaire et difficiles à mettre en évidence. Lorsque l’ECBU montre des bacilles Gram négatifs à l’examen direct non retrouvés à la culture, il faut réensemencer les urines sur gélose au sang cuit, notamment si le patient est porteur d’une uropathie.

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Urinary tract infection (UTI) is one of the most common infections in children but Haemophilus is rarely involved. In our institution, only 3 children below the age of 15years presented with UTI due to Haemophilus influenzae between January 2010 and October 2011. These children had typical symptoms of UTI: fever, abdominal pain and dysuria. In all 3 patients, standard urinalysis remained negative, but H.  influenzae was found after bacterial growth in special media, i.e., blood agar (or chocolate agar). These patients had abnormalities of the urinary tract. The first patient, a 5-year-old girl, had a right ureteropelvic junction syndrome found after her UTI. The second, a 4-year-old girl, had a bilateral ureteral duplication found after many UTIs. The third, a 2-month-old boy, had a right ureteropelvic junction syndrome that had been diagnosed by prenatal ultrasound. In our hospital, during the study period, the prevalence of UTI caused by Haemophilus was 0.02% of all pediatric UTIs. There are few reports in the literature on UTI caused by Haemophilus in children (<1%): they are frequently associated with urinary tract abnormalities. The bacterium is not able to grow in usual media, so that when there is a clinical UTI with Gram negative bacilli on the direct exam but not found in the culture, an infection with Haemophilus should be discussed, and blood agar used, which is all the more important when there are underlying abnormalities of the urinary tract.

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