Any paeds on here who can give me some advice?

[MummyBerryJuice]

DS (13months old) was admitted to a private hospital in South Africa on Mondayfollowing febrile convulsions due to a UTI (we have been here on holiday and were due to fly back on Tuesday - which has obvioulsy been delayed).

Nil was found on physical examination but urine was positive for leuocyte esterase and nitrites and urinary leucocyte count was 100u/L. No growth on culture but with evidence of antimicrobial substances.

Bloods (on admission):
Leucocytes 29.48
Neutrophils 13.56
Lymphs 11.79
Monos 4.13
Thombocytosis 507
and hypochromic, microcytic anaemia

U&E normal
CRP 80.8
Procalcitonin ,0.5
Normal Albumin/CMP
Blood culture showed no growth.

Treatment was started emperically with IV ceftriaxone (800mg stat and then repeated daily) (Has eceived 6 doses so far)

He has so far showed a good clinical response although it did take about 3-4 days for fever to fully resolve.

Repeat bloods after 4 days treatment showed and excellent leucocyte response BUT with a sustained thrombocytosis (529), monocytosis (1.81) and only a moderate reduction of the CRP (58.3).

Treatment plan is to complete 7 days IV Rx followed by 3 days oral antibios to complete a full 10days and commencement of FE supplementation. We will be flying home on Monday night and wil be seeing our GP on Wednesday morning.

(Past medical history includes a few URTI with significant febrile response but no chronic illnesses or treatment, he was delivered normally, at term and has been breastfed since birth. Immunisations are up to date except MMR etc and he did receive a BCG at 11 weeks.)

My question is...

What should I be worried about? How worried should I be and what should I push for when we get home?

Bump

Any one?

Please?

I'm sorry i'm not a pead but I think pacificdogwood is a doctor, could you post something on chat for her?

Hope your DS gets better soon

*paed

Not a paed but experienced similar when DS was 6 months. It took 72 hours to see real improvement and within five days he was tired, but fine. I hope your son is similarly lucky :)

Hi am not a paed but am a gp

From hx above would be classed by nice as atypical uti in that has high temp, pyuria ( wcc in urine) but no organism growth and over 48 hours to respond to antibioitcs,

current recommended treatment plans for atypical or a single case of pyelonephritis ( which it could also have been given such high temp and systemic unwell) in a child under 5 are to be referred to paeds routinely for investigation when well, no need usually for routine prophylatic antibiotics unless second uti at home . Paeds will carry out a DMSA which is scan to assess function in kidneys if child is under 5 presents with atypical uti or first case pyelonephritis( kidney infection rather than simple bladder infection) but does not need to be done acutely.

So in short I think a referral to paeds would be in order with prophylatic antibiotics if he has a second uti at home.but obviously your gp will have to check all this is right from history and discharge letter from SA also continue iron ( not uncommon),

is a very comprehensive guideline on uti in children on nice website which you can look at. also your own gp will be more aware of local guidelines as some hospital- our local children hospital has some slightly different guidelines from nice

Thanks everyone.

Hatescolds. I've seen the NICE guidelines and am pretty happy with the treatment we have received for his UTI and am confident that my GP will refer to the Paed when we get home for the DMSA. However, I am concerned about the persistent thrombo- and monocytoses in light of the anaemia and stubborn CRP I am worried about a chronic inflammatory condition/worse*

*disclaimer: seriously paranoid, medically trained parent!

yes see what you mean but would expect raised platelets( thrombocytosis) as part of acute phase response to an acute infection and crp does take a while to reduce to normalremember this from days on icu so would hope that when repeated 3-4 weeks later should return to normal .
obviously if repeated and still abnormla would need further investigation but could all still be part of the acute picture, poor little thing sounds like he was really sick hope he on mend.x

sorry managed to delete large portions of above does not make much sense was supposed to say

sorry misunderstood what you were asking thought you were only asking re uti , can see what you mean re worry re chronic disease and is worth asking your gp to review all the numbers r with paeds but could be a simpler explanation - thrombocytosis along with raised crp / esr and wcc all normal part of acute phase response and 4 days is very soon to see the crp returning to normal in fact all you expect to see is a reduction in crp and sometimes if repeated next day after starting appropriate treatment it rises a bit as crp does show lag behind clinical conditon . so all bloods as described above could be acute phase. anaemia depends on actual nos - if severe wouldn't expect it but a ild anaemia not uncommon but obvioulsy would need to be taken in context wiht your son condition and exam.

you could ask your gp to arrange a repeat of fbc and crp which would help decide on urgency of referral - if still very abnormla perhaps then see paeds asap.

hope all works out for and your gp gives you the answers you need or advice re referral x

Mummyberry, this is very freaky but I am also an anxious medically trained parent and have just left hospital today with dd (3) with EXACTLY the same story!
She had pyrexia for 5 days, msu showed high White cell, red cell and bacteria but negative growth. CRP was 100.
In our case she was not given antibiotics as no evidence of uti on msu. No one can give me an explanation for the urine findings but a microbiologist friend suggested ? Infection higher in urinary tract or shedding of leucocytes and blood secondary to constipAtion.
My daughter also has a microcytic anaemia despite being on iron for the last 6 months

Sorry on my phone need a second post!
We are being followed up in 6 weeks and I am going to request a referral to a paediatric urologist.
I do have a few personal theories though, I am thinking along the lines of an incomplete Kawasaki disease or just some random enterovirus that we will never get to the bottom of. We also had a very similar episode last June that ended with a low grade fever lasting for 3 months along with the same urine findings. Finally after sending many msu's we finally cultured an e coli uti, which was treated and all the symptoms cleared until now.....:
Not sure if I have made things better or worse! Let mr know how you get on .

Mummyberry

If you a doctor you could post in the paeds section of Dnuk would get more informed answers than me x

Me not mr, bloomin I phones!

It's worrying, isn't it? Particulartly when you know just enough to get yourself into a tizz

Hatescolds the logical, reasonable part of me knows that I am probably over reacting somewhat and that I've lost all objectivity when it comes to him but... I'm feeling a little guilty about not picking up how ill he was until he fitted!