Various medical and anatomical co-morbidities commonly associate with DS increase the

susceptibilty of infections and might also affect the immune reponses. The abnormalities of the
immune system associated with DS include: mild to moderate T and B cell lymphopenia, with
marked decrease of naive lymphocytes, impaired mitogen-induced T cell proliferation, reduced
specific antibody responses to immunizations and defects of neutrophil chemotaxis. 1

Urinary tract infections (UTI) are the most common bacterial infections in childhood,
accounting for 5%-14% of pediatric emergency department visits. Roughly 7% of infants and toddlers
under 24 months of age who present with fever have a UTI. The diagnosis of UTI in children is based
on the results of urinalysis and urine culture. Leucocyte esterase has sensitivity 83%, specificity 78%,
nitrite has sensitivity 53%, specificity 98%, and both of them have higher sensitivity and specificity
(93% and 72%). Culture results typically take 12-24 hours before bacterial growth is detected, 1-2
days before the specific bacterium is identified, and 2-3 days before susceptibilities are available,
however, IV antibiotics should be administered when a child is clinically toxic appearing and may
also have bacteremia and/or sepsis or when the child cannot tolerate oral antibiotics. Renal and
bladder ultrasonography is recommended for infants and toddlers less than 24 months of age after a
febrile UTI to detect anatomic abnormalities, such as obstructive process. 2

Congenital anomaly of kidney and urinary tract (CAKUT) as the predisposing factor of UTI
have an estimated prevalence of 2.3%-3.2%, which is about five times highet than the one known in
children without the chromosomopathy. Even more, in the long term, the commitment of the
urinary tract can rise up to 27%, including congenital and acquired diseases. In DS , the CAKUT group
covers glomerulonephritis, renal agenesis, microcysts, ectopic kidneys, abnormalities of the urinary
tract with hydronephrosis, and hydroureter, posterior urethral valves and abstruction of the anterior
urethra, as well as hypospadias. 3

1. Ram G, Chinen J. Infections and immunodeficiency in Down syndrome. Clin Exp Immunol.
2011;164:9–16.
2. Prajapati H. Urinary tract infections in children. Paediatr Child Heal (United Kingdom).
2018;28:318–23.
3. Winnicki E, Copp H. Congenital Anomalies of the Kidney and Urinary Tract in Adolescents.
Adolesc with Chronic Kidney Dis. 2019;5:81–92.