Discussion on Treating Pyelonephritis and Borderline Sepsis on Medical Mission Trips




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Discussion on Treating Pyelonephritis and Borderline Sepsis on Medical Mission Trips

Bianca Garcia OMS-II, Jordan Thompson OMS-III, Lesca Hadley, MD

The Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, TX; Antigua, Guatemala Medical Mission


The case report discusses the diagnosis and management of pyelonephritis while on a DOCARE medical mission trip in Guatemala. Pyelonephritis is a common and very treatable diagnosis in the United States due to easy access to resources and physicians. This case is unique because it discusses the specific challenges providers faced not only managing but diagnosing the disease due to limited resources and lack of follow up care. The goal of this case report is to demonstrate the unique obstacles providers faced while working on a medical mission trip.

Case Summary

The patient was a 27 yo female who presented to the clinic with nonspecific complaints of pelvic pain and 3 days of dysuria, polyuria and thick/yellow discharge. Upon arrival at the clinic, the patient had a BP of 115/70, pulse 91 and a temperature of 100.7. Urinalysis demonstrated moderate leukocytes and negative pregnancy test. Physical exam demonstrated negative CVA tenderness. The differential for the patient remained UTI vs pyelonephritis. The patient’s temperature and pulse met 2/4 SIRS criteria which was concerning for a more serious infection such as pyelonephritis. However, the lack of CVA pointed more towards UTI. Making a treatment planned posed challenges because without a leukocyte count or blood cultures there was no way to confirm pyelonephritis. Providers knew that it was unlikely for the patient to receive follow-up care if the infection were to progress. Due to this, it was elected to choose a more aggressive treatment for pyelonephritis with 500mg ciprofloxacin BID for 14 days and instructions to find a hospital if symptoms worsen.


In the village of the DOCARE clinic, only 10% of the village has access to health care. The closest public clinic is 1.5 hours away and hospital is 2 hours away. Based on literature review, the standard of care for pyelonephritis would include of larger workup with blood cultures to guide antibiotic choice and close monitoring and follow-up of the patient. This standard of care was not available in Guatemala. Understanding of the resources available to the patient was a key factor in choosing a more aggressive treatment for the patient.