Haemato-urological profile and asymptomatic urinary tract infection in Ghanaian steady-state sickle cell disease patients.

Background: 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 asymptomatic urinary tract infection and compared urine and haematology parameters among SCD patients in Ghana to their healthy counterparts. Methods: In this study, 104 SCD participants and 80 non-SCD subjects were recruited. Participants' information was thoroughly documented using a well-structured questionnaire and patient case records. To evaluate the prevalence of asymptomatic urinary tract infection, a clean catch early morning urine was collected from each participant and cultured on Cystine-Lactose-Electrolyte Deficient (CLED). Also, venous blood was collected for the haematological profile of the study participants. Findings: Prevalence of ASM-UTI among SCD participants and non-SCD individuals were 22(21.2%) and 18(22.5%) respectively. S. aureus 15 (8.2%) accounted for the majority of the organisms isolated with the larger proportion 9(60.0%) being isolated from the SCD patients. This study found a statistical difference between SCD with ASM-UTI, without ASM-UTI, and non-SCD with respect to urine appearance (p=0.047) , proteinuria (p=0.024) , leucocyte (p<0.0001) . Significantly high total WBC ( p <0.0001), low platelets ( p <0.0001), and low haemoglobin ( p <0.0001) in SCD with ASM-UTI compared to non-SCD with ASM-UTI were also observed. Major risk factors associated with ASM-UTI includes a cloudy urine appearance (8.11, p<0.042 ), a positive (+1) and positive (+2) urine leucocytes and positive (+1) urine bilirubin with a significantly increased odd (7.65, p=0.001 ), (9.50, p=0.001 ) and (3.39, p=0.019 ) respectively of having ASM-UTI in SCD compared to having a clear urine appearance, a negative urine leucocyte, and a negative urine bilirubin. Conclusion: This study has shown ASM-UTI to be common in adult SCD participants with higher rate in females. This study also showed that ASM-UTI can exist alongside other clinical states such as anaemia, microalbuminuria, haematuria and proteinuria which are characteristics of kidney disease which can trigger crises in SCD participants.