VALUE OF THE DETECTION OF FIMBRIAE PROTEI N TYPE ADHESINS ON THE BACTERIA ISOLATED FROM ACUTE PYELONEPHRITIS IN CHILDREN

A prospective bacteriological study in 50 children with acute pyelonep hritis (APN) (32 girls and 18 boys) and 132 children with lower urinar y tract infections (LUTI) (89 girls and 33 boys) was conducted from Ma y to December 1993. Infection was defined by Kass' criteria and APN wa s defined by the clinical findings. C-Reactive Protein (CRP) assay and postcontrast computed tomography in the presence of a doubt concernin g the diagnosis. Escherichia coli (EC) was the bacterial species most frequently isolated (76%). A systematic search for fimbriae protein ad hesins (group PAP : pyelonephritis associated pill) on the EC was perf ormed by haemagglutination (human group A red blood cells). 64% of EC possessed fimbriae protein adhesions in the APN group versus only 20% in the LUTI group. In children in whom an organic abnormality was demo nstrated, the incidence of fimbriae protein-positive EC was 33% while in children with no organic abnormality, particularly without reflux, 89% of EC presented fimbriae protein. A statistically significant diff erence was demonstrated between these two groups (p < 0.01). The resul ts of this study illustrate the important role of these adhesins in th e development of APN. These adhesins facilitate countercurrent ascensi on of bacteria in the ureter towards the upper urinary tract and can m ake the bacteria resistant to certain antibiotics. Testing for fimbria e protein can be useful in clinical practice when investigating the ae tiology of APN in the absence of demonstrated reflux. A latex test sho uld soon be available to facilitate the detection of fimbriae protein.