Even my doctor says I'm a House episode. But they finally figured *something* out!
My doctor called. As of a week and a half ago I had enterococcus and E. Coli in my urine. Now I didn't particularly *feel* like I had a UTI at that time, nor have I felt like I had a UTI at any time since. However given my recent history he wants to treat it with Nitrofurantoin and treat it for double the normal length of treatment. I hope it works, the last thing I need is a strain of nitrofurantoin resistant bacteria, since they apparently aren't strains that respond well to antibiotics. I didn't know that nitrofurantoin is technically considered an "antibacterial" not an "antibiotic" although some the standard "medical information" sides seem to interchange the two.
I realized the doctor didn't say anything about the infamous "traces of blood" in my urine, so I called him back and asked. He said yes it was still there and there was both blood and puss. He also said that these two bacteria weren't detected before because they never ran full cultures on them, and the full cultures took over a week. They were concentrating more on my digestive system at the beginning of my long hospital stay, and the two shorter ER stays were not of a duration where they would have run cultures.
It's possible that this has absolutely nothing to do with my bout of nausea whatsoever, or it could. These bacteria mean food posioning is a possible suspect again, but it is impossible to say for sure.
Bacteria in one's urine can come from the kidneys (pylonephritis) the bladder (cystitis) and from the urinary tract (UTI). They suspect pylonephritis in my case, since I have no symptoms from the other two.
From researching on pylonephritis, cystitis and UTIs with regards to enterococcus, emphasis mine
Merck - Pylonephritis
"Infections usually ascend from the genital area through the urethra to the bladder, up the ureters, into the kidneys... Infections can also be carried to the kidneys from another part of the body through the bloodstream.
Symptoms of pyelonephritis often begin suddenly with chills, fever, pain in the lower part of the back on either side, nausea, and vomiting.
About one third of people with pyelonephritis also have symptoms of cystitis, including frequent, painful urination. One or both kidneys may be enlarged and painful, and doctors may find tenderness in the small of the back on the affected side. Sometimes the muscles of the abdomen are tightly contracted.
Diagnosis
The typical symptoms of pyelonephritis lead doctors to perform two common laboratory tests to determine whether the kidneys are infected: examining a urine specimen under a microscope [nada] and culturing bacteria in a urine specimen to determine which bacteria are present [ding, ding, ding!]. Blood tests may be performed to check for elevated white blood cells [nada] or bacteria in the blood.[nada] "
I can't find if it says that the nausea is persistent, or just an initial symptom, if it is only an inital symptom then it fits. I know I had chills while vomiting, but it was unclear as to whether I was actually running a fever or not. I definitely didn't have a fever by the time I got into the ER. The "sometimes abdominal muscles are tightly contracted" makes a lot of sense in my particular case. They've had me on tizanidine (Zanaflex) which has helped.
I didn't have standard cystits sympoms for sure, but it says only 1/3 of the patience present wtih it. It does say that in most cases it travels from the Urinary tract upward, it is possible for it to got the other way, too. I don't think we will ever know for sure.
American Acadamy of Family Physicians - (Enterococcus and E. col/ UTISi)
"As many as 90 percent of uncomplicated cystitis episodes are caused by Escherichia coli, 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent or less are caused by other Enterobacteriaceae organisms or enterococci.3
In view of the limited spectrum of causative organisms and their predictable susceptibility, urine cultures and susceptibility testing add little to the choice of antibiotic for the treatment of acute uncomplicated cystitis in young women. Therefore, urine cultures are no longer advocated as part of the routine work-up of these patients. Instead, these patients should undergo an abbreviated laboratory work-up in which the presence of pyuria is confirmed by traditional urinalysis (wet mount examination of spun urine), the cell-counting chamber technique or a dipstick test for leukocyte esterase.3,6
A positive leukocyte esterase test has a reported sensitivity of 75 to 90 percent in detecting pyuria associated with a UTI. Gram staining of unspun urine can be used to detect bacteriuria. In this semiquantitative test, one organism per oil immersion field correlates with 100,000 CFU per mL by culture.1 Because the procedure is time-consuming and has low sensitivity, it is not routinely performed in most clinical laboratories unless it is specifically requested. In today's office practice, the dipstick test for nitrite is used as a surrogate marker for bacteriuria. It should be noted that not all uropathogens reduce nitrates to nitrite. For example, enterococci, S. saprophyticus and Acinetobacter species do not and therefore give false-negative results. "
So, 1) they have to suspect a UTI, which I wasn't presenting. 2) Even though I wasn't presenting it, they checked for it with the fast tests and they rarely reccommend full urine culture workups these days. 3) They were finding red blood cells in my urine, not white blood cells. If they'd been finding white blood cells, they would have been more suspicious of an infection. 4) enterococci give false negatives on the short tests. I don't know what the relative amounts of E.coli vs. the Enterococci were, but my money is that the Enterococci was there first, and the E. coli threshold was too low to be detected by the short tests.
It may not have made any difference because they spin it down either way, but the urine specimen I gave him for this test was more concentrated than any previous specimen. It was my first pee after waking up in the morning, and definitely darker and in a smaller relative quanity than any of the others. With most of the others, including the catherization they did, I had been drinking water fairly steadily beforehand in order to make sure I produced enough urine.
So at least we know something. Hopefully this first round of drugs will knock it out, and I might, just maybe, feel more normal again.
AJ