Description

A 90 year old female, of Gujurati origin, was admitted from home with malaise, anorexia, weight loss, nausea, vomiting and hypoactive delirium of 4 weeks duration. Urine analysis on admission was positive for protein, nitrite, and white cells. C-reactive protein (CRP) was 58 mg/L (0-8) and white cell count 13.9 X 109/L (4.5-11). Mid-stream urine culture grew an e.coli species sensitive to co-amoxiclav, cef laxin, nitrofurantoin and gentamicin, but resistant to trimethoprim and amoxicillin. She was diagnosed with a urinary tract infection and in view of her failure to respond to first line antibiotics in the community, she was started on a 5 day course of co-amoxiclav. Her family also reported a white vaginal discharge. On examination, candidal infection was diagnosed, and this was correlated with a heavy growth of candida on vaginal swab. She was treated with topical and pessary clotrimazole.