Pediatrics/child suffering from fever,High ESR,pus cell in urine and wbc
QUESTION: Dear Sir,
My child is suffering from fever and complaining about the stomach pain repeatedly for one week past. We already consulted a doctor and he advised to consult a gastro+pediatrician. As per we consulted and took scan of abdomen and pelvis-result is liver,gall bladder,spleen,pancreas,kidney all are normal, but few enlarged lymph-nodes in abdomen and pelvis. The impression stated is "Mesenteric Lymphadenitis". Doctor done TB test for a 48 hr observation, at that time given OV200 Tab and tested blood,urine. Mantox test was negative. In blood test high ESR-60 mm/hr,and WBC-15450/Cmm others normal and in Urine test pus cells 6-8 hpf,1-2 epithelial cells. Now she is admitted in hospital and doctor want to observe for four days. Stopped OV200 as says it has no effect in this observation period and now giving multiple electrolyte-dextrose injection type-iveolyte-P and Offomac IP.
Dear Doctor, We are in big tension because her screaming of pain and she is the apple of my eye. Is we are going in the right direction?. What is the cause of this? is this any serious UTI?, what are the precautions?. How much time needed to cure from it?.
I am very much waiting for an advice from you. I have never raised any questions yet but read many reply's from you for many queries and found all are precious stones, by the way became a fan of you. Please help me in this issue,
With all the respect and regards,
ANSWER: Hi, Visakh,
I don't know what an OV200 Tab is. This is unfamiliar to me as a USA pediatrician. Ofloxacin is an antibiotic we don't use in children in the USA.
If the urine culture is positive, then this is a UTI. This is a pretty easy diagnosis. Mesentaric adenitis can be painful and is usually a result of a viral or a bacterial infection. It is a secondary diagnosis and the node enlargement is caused by some other infection. As long as they did a culture of the urine, a blood culture and are watching things carefully, this sounds like a reasonable course.
The high ESR is usually a sign of infection or some sort of inflammation and is very non-specific.
Good luck, and tell me if they find anything to treat, Dr. Olson
---------- FOLLOW-UP ----------
QUESTION: Hi Sir,
The urine culture result is negative today, means no UTI. But still she had pain in stomach. The doctor advised to be in hospital for two more days,but I am not so confident about his analysis. Because initially he thought it was migraine and given some tabs for stomach pain(cyclopalm),later done TB-Mantox test and it was negative, now UTI and it was also negative. More than a week gone as of tommarow and i am in a doubt that my child is getting the exact treatment. In these two days more dose of ofloxacin injected
Again, this is not the way we in the USA would handle this problem, but I hesitate to say what another doctor, in another country, with a different set of circumstances, should be doing. The high ESR bothers me, as this is a pretty objective test, although non-specific, of inflammation/infection. If things don't improve, then a visit to a pediatrician at a pediatric hospital to evaluate and coordinate care might be done.
Good luck, Dr. Olson