I've been feeling very tired recently. Not all the time but most days. I've had this crampy pain in my lower abdomen and it burns when I urinate. I've been seeing my GP for about 15 years for this recurring problem and he usually gives me co-trimoxazole for my urine and it goes away. This time it has not. He put me on another antibiotic (cephalexin) as well but it did not help.Further Hx: Typical urinary symptoms; frequeny, dysuria++ and nocturia. Nil significant medical history. Well controlled hypertension and longstanding LL oedema. Has been incontinent of urine post uterine prolapse surgery 10 years ago.
Ix: Her last set of bloods and urine tests were done 2/52 ago. They showed:
- WCC 9.0 (5.4)
- Urea/Creatininie n.
- Urine MCS: Leuks 60 (<5). Erythrocytes 150 (<5). Gram + cocci but likely contaminated.
What more would you like to know? What would you look for on examination?
Learning: In women with recurrent UTI's, a daily half dose of trimethoprim (150mg) or cephalexin (250mg) orally at night is useful for prophylaxis.
You would want to learn more about her incontinence. It's not complete incontinence, just a bit of unconscious leakage. There used to be mild urge but it has been controlled by Oxybutynin.
Document that she was alert/communicative/GCS15. Confirm that she has not been having signs of sepsis: fever/chills/rigors/anorexia.
O/E: This patient was lying comfortably. Stable afebrile. No suprapubic tenderness or renal angle tenderness.
Plan: further investigation is indicated. Something is amiss if a patient has been trialled on two antibiotics and still has urinary symptoms.
- FBE, U&E
- Urine MCS
- Ultrasound ?renal pathology and post void residuals.
Outcome: It turns out she had a gram negative bug, Proteous Vulgaris in her urine. Her urine showed Leuks >500 and heavy growth of the bug. Her bloods confirmed her presentation: WCC 10.1, Erythrocytes -ve, CRP n. She's well otherwise and was started on Norfloxacin as per sensitivity testing.
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