Differential Diagnosis for UTI in a 12-year-old Male

Single Most Likely Diagnosis

• Bacterial Urinary Tract Infection: This is the most common cause of UTI in children, including males. The typical pathogens include Escherichia coli, Klebsiella, and Proteus. A 12-year-old male presenting with symptoms such as dysuria, frequency, and urgency is likely to have a bacterial UTI.

Other Likely Diagnoses

• Viral Urinary Tract Infection: Though less common than bacterial infections, viral UTIs can occur, especially in children. Symptoms may be similar to those of bacterial UTIs but can also include systemic symptoms like fever and malaise.
• Urethritis: In males, urethritis, often caused by sexually transmitted infections (STIs) like Chlamydia or Gonorrhea, can present with dysuria and discharge. Given the age, it's essential to consider sexual activity, if any, and the risk of STIs.
• Fungal Urinary Tract Infection: More common in immunocompromised patients or those with underlying conditions like diabetes, fungal UTIs can occur, especially with the use of catheters or prolonged antibiotic use.

Do Not Miss Diagnoses

• Kidney Stones: While less common in children, kidney stones can cause severe pain, nausea, and vomiting, along with urinary symptoms. Missing this diagnosis could lead to severe complications, including obstruction and infection.
• Testicular Torsion: Though not directly related to UTI symptoms, testicular torsion is a medical emergency that can present with acute scrotal pain and might be initially mistaken for a urinary issue. It requires immediate attention to preserve the testicle.
• Posterior Urethral Valves: A congenital condition more common in males, posterior urethral valves can cause obstructive uropathy, leading to UTIs, and if not addressed, can result in renal failure.

Rare Diagnoses

• Tuberculosis of the Urinary Tract: A rare cause of UTI in children, especially in areas with low TB prevalence. It can present with chronic symptoms, including frequency, nocturia, and hematuria.
• Schistosomiasis: In endemic areas, Schistosoma haematobium infection can cause urinary symptoms, including hematuria and dysuria, due to the parasite's eggs in the bladder wall.
• Urinary Tract Anomalies: Various congenital anomalies, such as duplex kidneys or ureteroceles, can predispose to UTIs. While not a direct cause, their presence can complicate the diagnosis and treatment of UTIs.