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Low grade fever, taken antibiotics, urine culture normal, will undergo prostate surgery, diabetic. Could it be a typhoid relapse?

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Practicing since : 1995
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Greetings !

My father-in-law has had typhoid and then immediately had to undergo prostate surgery. He's diabetic, and take oral meds for it. (NO insulin). The surgery went fine and an biopsy was normal as well. About 10 days after surgery one of his testicles had swollen.
But he's been having light grade fever. 99-100. And the Doctor suspected UTI and so they gave him a cocktail of 3 anti-biotics, that also didn't help. Next came antibiotic injections, he's had 2 of 5 injections so far. But the fever remains and he's weak. His TLC/DLC is high and a urine culture came normal.

Could it be a typhoid relapse or something more serious.
What directions should we pursue. what should we also check. what test should we ask for, to rule out or find the underline problem.

Sincere Thank you in advance.
Posted Wed, 6 Jun 2012 in Men's Health
Answered by Dr. V. Sasanka 4 hours later
Hi,From your account, it appears as if your father-in-law has had an attack of acute epididymo-orchitis which basically means an inflammation of the testes post prostate surgery. Though this is not very common, it is seen relatively more frequently among diabetic patients who have bladder infection, and might need long term antibiotics, sometimes at a stretch for 8-10weeks. urine culture usually comes negative if a urine sample has been despatched after antibiotics have been started, but a continued elevation of TLC, DLC means there is active infection inside, and thus those injectable antibiotics should definitely be used. I hope his diabetes is well controlled.
It is unlikely to be due to Typhoid relapse when we know that a cause and effect have been clearly established.
What I can add is make sure the testes are always well supported, and do not hang loose - this lessens the pain. Some analgesics and anti-inflammatory drugs might already have been administered to help him be more comfortable. An USG scan of scrotum may be needed to identify if a pus pocket has formed in which isolated antibiotics alone may not help, and might need drainage.
Hope I have been able to help you. let me know the progress.
Above answer was peer-reviewed by
Follow-up: Low grade fever, taken antibiotics, urine culture normal, will undergo prostate surgery, diabetic. Could it be a typhoid relapse? 3 days later
Dr Sasanka,

Thanks for the response, this indeed helped us lead in the right direction.
Now he's been given the following meds.

1. Piperacillin/Tazobactam 4.5 mg, injection 3 times a day
2. netilmicin sulfate-injection 300mg injection, once a day.

The Ultrasound, showed that there were just inflammation. One thing though, his fever can only be controlled with medication.

There's been definitely improvements in the swelling in the scrotum.

He's been given both since last 3 days but his TLC/DLC hasn't reduced much.
Only changed from 24,000 -> 19,000 and hasn't changed since the last two days.

What do you suggest we do next ?
Answered by Dr. V. Sasanka 2 hours later
Yes, There seems to be still a fair bit of infection still persisting. Both Piperacillin-Tazobactam and Netilmicin are good antibiotics - Indeed, I would have started them myself had I been the treating surgeon, but if the response is sub-optimal where the TLC shows continued significant elevation up to 19,000 - a change of antibiotics to something like Meropenem or Cilastatin + Imipenem may be warranted. But these are only suggestions as hospital policies vary significantly from country to country, state -to-state, and thus I am sure your surgeon must be following guidelines which he feels are appropriate for the patient and the infection control committee recommendations of the hospital.
I hope sugars are well controlled - sometimes Insulin might be needed to ensure optimal control.
If the scrotum continues to remain red and inflamed, local Magnesium Sulphate dressings often help in relieving edema.
Hope I have been of help. Again, please feel free to ask if you have some issues to be discussed. I would also like to know the progress of the patient - even if he is imroving, so please let me know. Best wishes.
Above answer was peer-reviewed by
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