Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Presence Of Pus And Epithelial Cells In Urine Report
Question: Dear Sir/Madam
I came across your centre while online and was wondering what advice or what you can offer. My mother has been dealing with infection within her body for the last 5 year, shes actively been seen at a NHS clinic.
A brief outline of the problem is that she has Pus Cells : 10 and Epithelial Cells 6.
The medication shes on is on is Methenamine hippurate 1 gm bid (twice daily)
Vitamin C 1 gm qid (four times daily)
Cephalexin 1 gm bid (twice daily)
Azithromycin - 500 mg daily
Amitriptyline 25 mg nocte (at night)
Last report from the clinic was:
"The patient came for a urine check. She has been feeling tired and a bit light headed lately.
Today the pus cells are 10 and the epithelial cells are 6, they were 8 and 4 respectively at the last check.
The infection signal has increased.
I discussed the story with Professor xxxx and briefed him on all of the details. He has advised me on
what we should do and has checked this response.
There has been a slight bounce in her urinary sediment analysis but we shall be checking this again about
two weeks. She is on quite a complex regime that has certainly made a significant response since her start
point is we should hold the line and wait on the check in the near future. There are not symptoms to suggest
a recrudescence of the symptoms."
She has been attending this NHS clinic for 2 years and her pain around her body hasnt eased, her highest levels were Pus Cells : 27 and Epithelial Cells 12 which was two months ago but these are fluxuting month to month.
what i would like is is there a specialist clinic i could get a second opinum from a specilist on her condition in london.
Kind Regards
XXXX
I came across your centre while online and was wondering what advice or what you can offer. My mother has been dealing with infection within her body for the last 5 year, shes actively been seen at a NHS clinic.
A brief outline of the problem is that she has Pus Cells : 10 and Epithelial Cells 6.
The medication shes on is on is Methenamine hippurate 1 gm bid (twice daily)
Vitamin C 1 gm qid (four times daily)
Cephalexin 1 gm bid (twice daily)
Azithromycin - 500 mg daily
Amitriptyline 25 mg nocte (at night)
Last report from the clinic was:
"The patient came for a urine check. She has been feeling tired and a bit light headed lately.
Today the pus cells are 10 and the epithelial cells are 6, they were 8 and 4 respectively at the last check.
The infection signal has increased.
I discussed the story with Professor xxxx and briefed him on all of the details. He has advised me on
what we should do and has checked this response.
There has been a slight bounce in her urinary sediment analysis but we shall be checking this again about
two weeks. She is on quite a complex regime that has certainly made a significant response since her start
point is we should hold the line and wait on the check in the near future. There are not symptoms to suggest
a recrudescence of the symptoms."
She has been attending this NHS clinic for 2 years and her pain around her body hasnt eased, her highest levels were Pus Cells : 27 and Epithelial Cells 12 which was two months ago but these are fluxuting month to month.
what i would like is is there a specialist clinic i could get a second opinum from a specilist on her condition in london.
Kind Regards
XXXX
Brief Answer:
She may need evaluation by a urologist
Detailed Answer:
Hi XXXX,
Thank you for using Healthcare Magic. It sounds like your mother is being treated for a chronic urinary infection. I am not sure what you mean by the pain around her body. Do you mean pain in the bladder area?
The presence of pus cells indicates inflammation and not necessarily infection. The only way to know for sure if it's infection is to culture the urine and see if bacteria grow out. This might be difficult even if bacteria are present because of the 3 antibiotics she is on. My way of handling patients with presumptive recurrent or chronic urinary infections is to treat the acute infection, then treat with ONE antibiotic daily to prevent a recurrence. I am not comfortable assuming infection is still present by just monitoring a urinalysis.
Like I said, persistent pus cells in the urine can be due to other inflammatory conditions and not infection. One such condition is called interstitial cystitis. This creates symptoms similar to a urinary infection but the urine is sterile (ie, does not grow bacteria on culture), but still shows pus cells on exam.
The diagnosis is sometimes difficult to make. And other inflammatory bladder conditions may do the same.
That is why I suggest it is time for her to see a urologist. At this point she needs a cystoscopy to take a direct look at the inside of her bladder to see what is causing the problem. She also may need imaging studies of the upper urinary tract to be sure an abscess is not present. An abscess would require other therapy in addition to antibiotics to get rid of it.
Hope this is helpful. If you have further questions, I would be happy to answer them.
She may need evaluation by a urologist
Detailed Answer:
Hi XXXX,
Thank you for using Healthcare Magic. It sounds like your mother is being treated for a chronic urinary infection. I am not sure what you mean by the pain around her body. Do you mean pain in the bladder area?
The presence of pus cells indicates inflammation and not necessarily infection. The only way to know for sure if it's infection is to culture the urine and see if bacteria grow out. This might be difficult even if bacteria are present because of the 3 antibiotics she is on. My way of handling patients with presumptive recurrent or chronic urinary infections is to treat the acute infection, then treat with ONE antibiotic daily to prevent a recurrence. I am not comfortable assuming infection is still present by just monitoring a urinalysis.
Like I said, persistent pus cells in the urine can be due to other inflammatory conditions and not infection. One such condition is called interstitial cystitis. This creates symptoms similar to a urinary infection but the urine is sterile (ie, does not grow bacteria on culture), but still shows pus cells on exam.
The diagnosis is sometimes difficult to make. And other inflammatory bladder conditions may do the same.
That is why I suggest it is time for her to see a urologist. At this point she needs a cystoscopy to take a direct look at the inside of her bladder to see what is causing the problem. She also may need imaging studies of the upper urinary tract to be sure an abscess is not present. An abscess would require other therapy in addition to antibiotics to get rid of it.
Hope this is helpful. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear Doctor Steinberg,
Thank you for your reply, i have passed this on to my mum to take to her GP to see if we can get this booked in.
With regards to the pain i was referring to was that she has very high temperature and sometimes she gets a spot around her body where infection starts sipping out from, this lastly happened on her leg where a couple of blister looking spots appeared which caused her alot severe pain, once they burst she was fine.
Look forward to hearing from you.
XXXX
Thank you for your reply, i have passed this on to my mum to take to her GP to see if we can get this booked in.
With regards to the pain i was referring to was that she has very high temperature and sometimes she gets a spot around her body where infection starts sipping out from, this lastly happened on her leg where a couple of blister looking spots appeared which caused her alot severe pain, once they burst she was fine.
Look forward to hearing from you.
XXXX
Brief Answer:
She might need an infectious disease specialist
Detailed Answer:
Dear XXXX,
Your mother's situation is unclear to me. High temperatures and then getting outbreaks of infection on different parts of her body sounds more like some kind of systemic infection or immune problem. Has she gotten other tests besides urinalysis? Such as blood counts, checks on kidney and liver function, blood sugar, etc? Has a doctor looked at these painful blisters she gets and done a culture to see if bacteria grow out? Persistent fevers without identifying a cause is called fever of unknown origin, and requires an extensive work up to figure out the cause.
If there truly is an infection, it is somewhere hidden in her body, and it needs to be found so it can be treated appropriately. Just throwing antibiotics at it isn't going to help. If bacteria are in an internal abscess in some organ, or in the heart valves or bone, or somewhere else, they are going to remain there unless physically removed by some kind of procedure. What needs to be done is to locate the source of infection and eliminate the source.
At this point I would be considering a complete and thorough history and physical exam, extensive bloodwork, and imaging studies depending on what shows up in the initial evaluation. You could start with an internal medicine specialist, or if everyone is convinced this is infectious, go straight to the infectious disease specialist. If she has had some kind of infection for 2 years without response to combinations of antibiotics, then a thorough evaluation needs to be done to find out why she is not getting over it.
Hope this helps. Feel free to ask more questions if needed.
--Dr Steinberg
She might need an infectious disease specialist
Detailed Answer:
Dear XXXX,
Your mother's situation is unclear to me. High temperatures and then getting outbreaks of infection on different parts of her body sounds more like some kind of systemic infection or immune problem. Has she gotten other tests besides urinalysis? Such as blood counts, checks on kidney and liver function, blood sugar, etc? Has a doctor looked at these painful blisters she gets and done a culture to see if bacteria grow out? Persistent fevers without identifying a cause is called fever of unknown origin, and requires an extensive work up to figure out the cause.
If there truly is an infection, it is somewhere hidden in her body, and it needs to be found so it can be treated appropriately. Just throwing antibiotics at it isn't going to help. If bacteria are in an internal abscess in some organ, or in the heart valves or bone, or somewhere else, they are going to remain there unless physically removed by some kind of procedure. What needs to be done is to locate the source of infection and eliminate the source.
At this point I would be considering a complete and thorough history and physical exam, extensive bloodwork, and imaging studies depending on what shows up in the initial evaluation. You could start with an internal medicine specialist, or if everyone is convinced this is infectious, go straight to the infectious disease specialist. If she has had some kind of infection for 2 years without response to combinations of antibiotics, then a thorough evaluation needs to be done to find out why she is not getting over it.
Hope this helps. Feel free to ask more questions if needed.
--Dr Steinberg
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
