Urinary Tract Infection

A 9-month-old boy presented to the emergency room with an abrupt onset of fever documented to be 103.4 F in the axilla by the emergency room staff. With oral paracetamol, the child’s fever subsided and the child was otherwise playful and active. On history, there were no localizing respiratory, gastrointestinal, or urinary symptoms. The child was fully immunized according to the national immunization program. On examination, his vital signs were normal, the anterior fontanel was flat, and no focus of infection was identifiable. In view of high fever, the possibility of urinary tract infection was considered and a urine routine analysis was done which was positive for nitrites and leucocyte was 3+. Urine automated microscopy showed pus cells 18–20/HPF. The child was started on oral cefixime, and urine culture was sent. On review after 3 days, the child was afebrile and the culture report showed Escherichia coli sensitive to amikacin, cefoperazone-sulbactam, piperacillin-tazobactam, and nitrofurantoin. However, as the child had clinically responded to oral cefixime, the antibiotic was continued for a total duration of 10 days. The child was found to have a posterior urethral valve on ultrasonography and micturating cystourethrogram. He underwent fulguration, after which he remained asymptomatic.