GULLAS COLLEGE OF MEDICINE

4TH LEVEL CASE STUDY

URINARY TRACT INFECTION

A 21 months old male child was brought to you for high grade fever for 3 days now. He was
diagnosed with Cerebral palsy since birth has 2 episodes of UTI with culture positive result of E.
coli. This patient was seen by a midwife in their hometown a week ago because of fever and
seizure and was given co-trimoxazole oral for 7 days which offered temporary relief. The initial
laboratory result on the at 7 days ago showed: CBC WBC 18,000/ml; Hct 38%; Hb 120.0g/L;
platelets 605,00/ml; polys 85%, lymp 14.5%; mono 0.5%. URINALYSIS via wee-bag: dark
yellow/cloudy, foul smelling, sp gr 1.030, ph 6.8, WBC >50/hpf, RBC 5-10/hpf, bacteria many.

The patient was feeding well until just recently he was irritable and refuse to feed. He had
vomiting one time this morning after drinking milk. The last urine output was 5 hours by a
diaper.
Past History:
He is diagnosed case of HIE (hypoxic ischemic encephalopathy) at birth because of
unrecognized cephalopelvic disproportion in a lying in clinic. Mother underwent CS procedure
(at the hospital) after 16 hours of active labor.

PE: patient is very irritable, not in respiratory distress, febrile, dry lips and tongue and no tears.
HR 135/min RR 30/min T 39C BP 80/50mmHg O2 sat 98% room air
Length 70cm Weight 8kg HC 46cm

HEENT: hair equally distributed, closed fontanels, eyes no tears slightly sunken (as compared to
picture when he was well), dry lips and tongue, moist oral mucosa and clear tonsils, no
disharges on the nose and ears
Neck: no rashes, no lymphadenopathy
Chest and Lungs: equal chest expansion, rib cage are prominent, clear breath sound, no
murmurs heard, no deviation of PMI
Abdomen: no abdominal distention, no lesions, no organomegaly
Back: no hair tuft or dimpling
Perineum: uncircumcised penis, scrotum with normal rugae with descended testicles

GUIDE QUESTIONS:
1. What are other pertinent information in the history and PE that your going to get in order to
strengthen your diagnosis?

2. What could be the risk factors in this particular patient to acquire the risk of having UTI?
3. What are other laboratory work-up that help you manage the patient?

4. What is considered a significant finding in Urine Culture?

5. What are other imaging techniques that you’re going to perform to look for the cause of the
recurrent UTI?

6. How are you going to manage the patient?