Dilemmas in Diagnosis of Urinary Tract Infection (UTI) in Fever without Focus and other conditions

Abstract

Aim: To show that pyuria and significant growth in urine culture (UCx) in fever without focus done early and with only urinary symptoms in girls don't always indicate a urine infection and need antibiotic treatment. Materials and methods: Three children had fevers without focus for about 2 days, and one girl with urinary symptoms but no fever had urine tests done. These included urine microscopies and a UCx by collecting a midstream urine/clean catch urine sample. As they looked well, despite significant pyuria in all of them, antibiotic therapy was withheld till the UCx results were available 48 hours later. Results: The three children having fever without focus became afebrile before the UCx report was available. The girl was treated with moisturizing and emollient creams for local application, and her symptoms disappeared. Hence, despite the significant growth of bacteria in the UCx, none of the children received antibiotics, and they remained well. Conclusion: Despite significant pyuria and positive UCx in the three children who had a fever without focus, the fever settled without antibiotics. In case 4, vulval redness was present, and despite significant pyuria and positive UCx, symptoms settled with the local application of moisturizing creams. Clinical significance: UTI guidelines suggest urine tests in children having fever without focus or only urinary symptoms. The time to send the urine samples is not clear in fever without focus. In a well child, where urine tests are done after at least 2 days of fever, if the fever or symptoms settle without antibiotics before the urine culture is available, these children should not be labeled as having UTIs even if the urine Cx is positive. An algorithm suggests the way out in such cases.

Keywords

• asymptomatic bacteriuria
• fever without focus
• significant pyuria
• urine infection