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Fever, urine leaking, vaginitis. Ultrasound, blood, urine, test done. Taken Septran, Metrogyl 200, sitz bath. What could be the reason?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
Hi! My DD who is 5 years and 8 months has had 3 episodes of fever in the last 2 months. She has normally been a very healthy child who hardly ever fill sick. The first bout of fever was at the end of March and lasted for 8 days. Fever was high ranging from 101 to 103F. We did a blood and urine test - all normal except urine routine showed 20-25 puss cells. We started an antibiotic (Septran) and completed the course though the urine culture came back negative.At the same time (and even before this fever episode) she began to complain that her urine would leak post void - not every time but perhaps a couple of times a day. All the investigations were done - Ultrasound and lab tests and all came back normal. About 2 weeks later she had another bout of milder fever for about 4-5 days following a bad flu that I (her mother) had. The urine leaking reduced. Then ten days ago she started a fever again!! The fever was again between 101 to 102F. On clinical exam everything seemed normal - ENT and no visible signs of infection. However, the urine leaking did increase. Then I took her to another doctor who said her vagina is very red and she has vaginitis. He asked for an ultrasound to rule out any foreign body in the vagina. The scan show everything normal except for 5-10ml of fluid in the Pouch of XXXXXXX I am still unsure what this means and plan to follow up with the doctor soon. Would you be able to help me understand what this means and why her urine would be leaking? In the meantime she is on Metrogyl 200 - 5ml 3 times a day and a sitz bath with Potassium Permanganate once a day. The redness and the fever have reduced - today is the first day of no fever. Any insight would be appreciated.
Posted Mon, 11 Jun 2012 in Child Health
Answered by Dr. Hema Yadav 1 hour later
Thanks for posting your query.
The Pouch of XXXXXXX medically known as the recto-uterine pouch is a cavity between the anus and the uterine wall, and occurs only in women. It is the deepest part of the peritoneal cavity ( abdominal cavity)and is directly related to the intestine , uterus and other abdominal organs.Any secretion in the peritoneal cavity obviously goes down and collects in its lower most part ie the pouch of XXXXXXX .
A minimal amount of free fluid is normally seen in the pouch of XXXXXXX and does not necessarily mean a disease however it can be a marker of an underlying infection ( tuberculosis etc)or inflammation ( appendicitis,ovarian cyst etc) especially when the child has other symptoms like fever.
So considering the details you have provided a genitourinary infection could be the most probable cause for your child's symptoms. Though it seems she is being appropriately treated and has responded well to the same, it's advisable that you get a repeat urine culture, a tuberculin test and if necessary voiding studies if the symptoms recurr or persist after the present episode.
At present it seems that her recurrent UTI are
due to inappropriate urine voiding and the fluid collection is a consequence of the same .
All this should resolve if treated with a complete course of antibiotic( eg metrogyl)
Say in another week she should be asymptomatic and if her symptoms return or persist then please consult a urologist for confirmation of diagnosisand treatment .
Hope I have answered your query.
Above answer was peer-reviewed by
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