Routine district doctor's work in a shelled city


A previously healthy 8-month old had unexplained fevers (39°C plus) for eight days. There was a diurnal variation - daily temperature hikes began at 3 am. It was found that the baby was in a chilly and damp area - and kidney infection in infants may be asymptomatic, except for fever.

The child's  mother tried to find a pediatrician, but  she said, “There is a lock on the clinic door, and there is no one”, in a war-riddled town.  So she gave the girl  an antipyretic, and blamed teething for the fevers. 

The  mother talked about this to her friend – an older and a more experienced woman - and this friend found me through Facebook.

I am a pediatrician and a family physician, I work in another clinic,  in a different medical district. 

I should not have taken on this child's case,  according to the rules of our healthcare system, crossing the borders of regional providers. Yet,  we really did not have enough doctors in the area,  because of the war-related closing of most clinics. 

The baby's general exam was within normal - she was an active, cheerful child. Her gums were pink, not swollen - so the "teething" hypothesis was not confirmed.  The nasopharyngeal exam was normal as well. This child had no evidence of an upper respiratory infection.  I have ordered urine and blood screening tests.

The mother returned from the laboratory discouraged:  the technicians told her that they did not have the chemicals needed to do the panel I ordered, they could only do "the minimal three" - the leukocyte count, hemoglobin, and ESR.

- Whatever I can get, - I thought...

Hemoglobin was normal, WBC - 11 , ESR – 15, both elevated. 

Urinalysis revealed  proteinuria, leukocyturia, multiple squamous epithelial cells.

“A kidney infection?” – I thought.

After that I hit upon the idea to ask the mother about the living conditions at her home. She told me that for the last month they had been living in a basement - it was used as a bomb shelter. They live next to the recently bombed City Youth Center, with daily shellings nearby.  In the basement it was cold and damp.

This connected the dots for me: despite all the efforts of the mother, the baby was in a chilly and damp area, possibly on a cold floor -  and kidney infection in infants may be asymptomatic, except for fever, in this case.

Appropriate treatment  was effected, and it helped -  in 10 days there was no fever, and the urinalysis normalized. 

Nothing special. This is a routine district doctor’s work in a city which is shelled on a daily basis.

Image copyright: John Kelly/thinkstock

Article last time updated on 06.10.2014.

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