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Fever, on paracetamol, urine infection, found white cells. UTI?

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My 16 week baby has been having between 38 and 39.1degrees of fever with no other symptom for 2 days. The doctor has seen him twice and says its probably viral so he has given him no treatment. The fever comes down with paracetamol but comes back stronger each time after 7-8 hours. Also when he was 8 weeks he had unexplained fever that was treated in hospital as urine infection, although they couldn't confirm it was because the urine sample was contaminated. My question is: is it right to assume this is likely to be viral despite the fact the fiver seems to be getting worse? Also, is it right to wait for three more days until the lab results come back without giving him treatment for uti? I forgot to say, the dipped an urine sample and found some White cells but not nitrites
Posted Fri, 13 Apr 2012 in Urinary and Bladder Problems
Answered by Dr. Rakhi Tayal 33 minutes later

Thanks for writing to us.

If the fever is getting worse and UTI is suspected with white cells present in the urine, then empirical treatment with antibiotics can be started but you need to consult the pediatrician to choose the best antibiotic for your child and then to prescribe it as none of the systemic antibiotics are available without a prescription.

Another thing is that if it actually is a viral fever which his pediatrician is suspecting after examining him, then antibiotics are not going to help him.

If the fever remains constant or subsides then you can wait for the lab results as it is always best to start an antibiotic based on lab results for best response specially in recurrent cases.

I hope this information has been both informative and helpful for you. If there are additional concerns, I am available for your followups.

Above answer was peer-reviewed by
Follow-up: Fever, on paracetamol, urine infection, found white cells. UTI? 40 hours later

My baby's fever has subsided on its own now (we measured 38.3, 32 hours ago and gave him paracetamol. After that he was without fever for 11 hours, when we measured 37.7. However we didn't give anything that time. The fever dissapeared on its own in a couple of hours, so he has been fever free for over 12 hours now. Based on this pattern, do you think is it more likely to have been a viral infection, or could it still be an UTI? I am just asking because due to the method we used to collect the urine sample we have been told it is very likely it was contaminated so we will not know for certain, and if that's the case I was wondering whether it is recommended to ask the doctor to repeat the test just in case..
Answered by Dr. Rakhi Tayal 2 hours later

Thanks for writing back.
If the fever has subsided on its own then most likely it was a viral fever. An infection in urine never subsides without antibiotics. Still you can repeat the urine examination after collecting the sample under aseptic conditions. The lab personal should help you.

Sincerely hope it will help. Wishing you an early recovery.
Above answer was peer-reviewed by
Follow-up: Fever, on paracetamol, urine infection, found white cells. UTI? 26 hours later
Thanks for your reply. The fever dissappeared completely but unfortunately one day after that happened the lab culture came back showing >80 white cells, and >0000 coliforms (no red blood cells), so my baby is now on trimetrophin, 2ml every 12 hours for five days. My questions now are. If this had been an infection on his kidney would the fever have dissappeared on his own, or the fact that it dissapeared on its own showed it was an uncomplicated lower UTI? And also, is there any possibility that this sample had been contaminated and he had no UTI at all, or with those numbers it is clear it was an UTI? Also, could this UTI have happened because the first (unconfirmed) infection wasn't completely cured (it was treated with IV broad spectrum antibiotics in hospital for four days and then switched to cephaloxin for 3), or is that unlikely because if it hadn't been cured it would have showed before? And finally, what are the reasons why my baby might have been getting these infections? Thank you
Answered by Dr. Rakhi Tayal 2 hours later
The disappearance of fever without any treatment indicates that the infection in the kidneys of your child is subclinical- the one which does not produce any symptoms.
Number of organisms never tell anything about the contamination of specimen. It is the association of organisms with wbc's which indicates that actually an infection is there.
Two episodes of UTI occurring at such a short interval usually indicates a recurrence and unlikely to be a fresh infection however it is difficult to commit this for sure.
Repeated UTI's in a child need many conditions to be ruled out like posterior urethral valve, diabetes, defect in urinary tract causing stasis, nephritis, lowered immunity due to any reason, etc. Your pediatrician will guide you how to go about in ruling out all these conditions.
Hope this will help you.
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