Pediatric recurrent bacterial infections

[Mom2Mckenna]

Our 8 year old daughter was diagnosed with VUR & began having accidents. She went a year on prophylaxis with no problems. Then Sept. of 07’ she developed a break through infection. In Dec. she was hospitalized for another.  She had a urodynamics test indicating neurogenic bladder. A MRI gave no indication of tethered cord. She continued to have kidney infections, has scarring, but good function per a DMSA in 07’. After her hospital stay she started to have chronic stomach pain. She never had any pain before even with her infections.  She was constipated on imaging despite bm’s every day. In Jun of 08’ she had bilateral reimplant. She continued to develop UTI's. Her incontinence became worse. Her stomach pain resolved, but she was almost obsessively hungry. In Nov. of 08’ we consulted with a Neuro who thought she would benefit from sect. of her filum. We opted to do the surgery and she regained complete control of her bladder. We thought we were all done, however in Jan. of this year she had a severe case of strep throat, in Feb. she had Bronchitis and fifths disease, in March she had a UTI (her urine was thick with pus) and in April she had another milder strep throat infection. She complains of chronic stomach pain, lost several lbs so we took her to a gastro. She was tested for thyroid, Celiac, food allergies, lactose intolerance, and had rectal manometry, a upper gi and ultrasound which came back normal. She was started on Miralax & pepcid. The lower stomach pain has improved. When our daughter feels good she is active in sports and social & has good grades. We give her yogurt to help with the antibiotics, our children have well balanced diets. Our 10 year old son is almost never ill; neither is my husband or myself. She is tired, mentions chest & stomach pain, headaches, neck pain, dizziness upon standing. She is hungry but says it is painful to eat. I wonder if this has become psychological, but every time I think it is, she develops some type of infection.

[Kevin Pho, MD]

This sounds like a complex case, and given that you've been seen several specialists, it is unlikely that I can come up with something new over the internet.  

Further GI workup can include an upper endoscopy, which can evaluate the upper digestive tract for inflammation or any other pathology which can lead to the symptoms.  I agree with the tests for celiac disease, I would also obtain stool tests to exclude malabsorption.

Other options can include a referral to an allergist to exclude food allergies, as well as a lower endoscopy to evaluate for anatomical causes for the constipation.  

If repeated infectious are an issue, a referral to a pediatric infectious disease specialist can be considered.

These options can be discussed with your personal physician.  

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Mom2Mckenna]

Thank you so much for your reply. I'm glad you said she is complex, we feel like she is as her parents, but we are not Doctors and have been getting frustrated by all of this given the lack of history and the fact our daughter was a normal healthy.  Her stool tests and celiac's test and food allergies were all negative.We are just trying to avoid anymore testing if not neccessary. And thank you for recommending a infectious disease specialist. I wasn't aware there was such a specialty, We will look into that right away. Do you think there is any possibilty that her strep infections can play a role in her stomach/chest pain? Or that her tonsils could be the source of any immune issues that would cause her to be supsectible to bacterial infection even in her urinary tract? We greatly appreciate your help.