Haemato-Urological Profile and Asymptomatic Urinary Tract Infection in Ghanaian Steady-State Sickle Cell Disease Patients: A Case-Control Study.

BACKGROUND AND AIMS: Due to the reduction in immunity caused by auto-splenectomy and the consequent opsonic antibody shortage, patients with SCD are more susceptible to encapsulated organism infections, especially asymptomatic urinary tract infection (ASM-UTI). This study investigated the prevalence of ASM-UTI and compared urine and hematology parameters among SCD patients in Ghana to their healthy counterparts.

METHODS

In this study, 104 SCD participants (cases) and 80 non-SCD (HbAA) controls were recruited. Participants' information was thoroughly documented using a well-structured questionnaire and patient case records. To achieve the study's aims, a mid-stream urine in a cleaned dry aseptic urine capped container and venous blood were collected for laboratory analysis.

RESULTS

The prevalence of ASM-UTI among SCD participants and non-SCD (HbAA) individuals were 22 (21.2%) and 18 (22.5%) respectively. Among the 22 (21.2%) SCD individuals with ASM-UTI, 64% were HbSS and 36% were HbSC. S. aureus 15 (8.2%) accounted for the majority of the organisms isolated with the larger proportion 9(60.0%) isolated from the SCD patients. There was a statistical difference between SCD with ASM-UTI, without ASM-UTI, and non-SCD (HbAA) with respect to urine appearance (p = 0.047), proteinuria (p = 0.024), leukocyte (p < 0.0001). Significantly high total WBC (p < 0.0001), low platelets (p < 0.0001), and low hemoglobin (p < 0.0001) in SCD with ASM-UTI compared to non-SCD (HbAA) with ASM-UTI were also observed. Major risk factors associated with ASM-UTI includes a cloudy urine appearance, a positive (+1 and +2) urine leukocytes and positive (+1) urine bilirubin compared to having a clear urine appearance, negative leukocyte, and a negative bilirubin.

CONCLUSION

This study has shown ASM-UTI to be common in adult SCD participants with higher rate in females. It has also showed that ASM-UTI can exist alongside other clinical states such as anemia, microalbuminuria, hematuria and proteinuria which are characteristics of kidney disease which can trigger crises in SCD participants.