Urinary Tract Infection in a 2-Year-Old Without Fever
Case at a Glance
A 2-year-old male presents with persistent vomiting and decreased urine output without fever, raising concern for possible urinary tract infection.
Patient's Story
The patient's parents brought their 2-year-old son to medical attention after he began vomiting all milk intake the previous day. The vomiting had persisted for 9 hours at the time of presentation. Parents noted that the child's diaper appeared drier than usual, suggesting decreased urine production. Notably, the child had no documented fever throughout this episode.
Initial Assessment
The primary concern was dehydration secondary to persistent vomiting. However, the combination of vomiting and decreased urine output in the absence of fever prompted consideration of urinary tract infection as a potential underlying cause. Oral rehydration therapy was initiated as recommended by the treating physician.
The Diagnostic Journey
The medical team explained that simple cystitis (bladder infection) can present without fever, particularly in the early stages of infection. Fever becomes more likely if the infection ascends to involve the kidneys (pyelonephritis). A urine sample collection was planned for definitive diagnosis. The parents inquired about blood work utility, and were informed that while blood tests might show elevated white blood cell counts or inflammatory markers, urine testing remains the gold standard for UTI diagnosis as blood markers are neither specific nor consistently elevated in urinary tract infections.
Final Diagnosis
Suspected urinary tract infection with secondary dehydration
Treatment Plan
Continuation of oral rehydration therapy while awaiting urine culture results. Urine sample collection prioritized over blood work for diagnostic accuracy. Appropriate antibiotic therapy to be initiated based on culture results and sensitivity patterns.
Outcome and Follow-up
Patient management continued with close monitoring for fever development, which would suggest progression to upper urinary tract involvement. Parents were educated on the importance of maintaining hydration and monitoring for clinical improvement following appropriate treatment initiation.