? UTI or Cystitis - Can there be infection despite negative culture?

Sorry for the long post, but there is a ton going on with this cat and kind of a mystery diagnosis situation I've got. I posted a few weeks ago on this (see link below). I have been treating for both infection and non-infectious cystitis and not much has changed at all.

If you don't have time to read the whole crazy history below, I'm basically asking if 1) a cat can indeed have a UTI even if a urine culture is negative, and 2) how likely is it given a negative culture that an 18-year-old diabetic cat would instead have a three-week-long flare up of non-infectious cystitis (just inflammatory) years after her last FLUTD episode? Details below...

http://www.felinediabetes.com/FDMB/...and-bladder-inflammation.152942/#post-1608266

So as I said, Rascal does have a history of FLUTD. She has never ever had a positive urine culture in her life. About three weeks ago she started having symptoms of UT problems - frequent trips to the litter box, voiding small amounts, licking her genitals a lot, etc. It was not as bad as the assumed cystitis flare ups she used to get when she was younger where there was blood in the urine and she was in even more distress. She still has to be uncomfortable now though too.

I took her in a couple weeks ago and they ran a urinalysis and culture and it came back negative. My understanding is a culture is definitive, right? The vet still put her on clavamox though just in case. She has been put on antibiotics in the past even when she probably did not have an infection - years ago when diagnosed with FLUTD and then zeniquin last summer for a few weeks when she wasn't even having symptoms but there were WBCs in her urine. We did not do a culture last summer, but the vet thought with her age and diabetes the risk of infection was high. We finished the antibiotics and that was that.

Years ago when she was diagnosed with FLUTD her episodes, while intense, would clear up in a few days to a week. Cystitis flare ups usually tend to ease up on their own in that time frame according to what I've read.

So this time after having symptoms but a negative culture again we made it through seven days of clavamox. It was bothering her stomach (she has IBD) so the vet said we could stop it. That was about a week ago.

We have now had about one week of symptoms before antibiotics, one week on antibiotics, and one week off now - and really nothing has changed throughout as far as UT symptoms are concerned. A lot of things don't add up here. I have no idea what this poor cat has!

If it is a UTI wouldn't it have shown up on the culture? The vet was concerned maybe an infection could still be present in the tissues without showing bacteria in the urine. If it's an infection, why did the seven days of antibiotics not do anything? Unless it was the wrong drug (but you can't do sensitivity when nothing grows on culture). I would also think it would be getting worse now again off of antibiotics for a while.

If it is FLUTD/non-infectious cystitis why is the flare up lasting this long? It never has before, and this is longer than the typical duration of an episode. I have read some cats have a more chronic presentation though. Also, why would it be flaring up at her age after no more problems for several years? I've read many cats stop having episodes as often with FLUTD as they get older. So this doesn't totally fit either!

Whatever it is, the vet has noted that her bladder wall has appeared thickened and inflamed on ultrasound the last several months. This has not changed much and is uniform in appearance so cancer is unlikely. Also the fact that she has discomfort in the genital area points to possible urethritis consistent with either infection or sterile cystitis.

With Rascal's IBD, diabetes and now this, it has been very difficult to figure out what is going on. But for the last three weeks all I can say in summing up is there have been the UT symptoms, decreased appetite, pain and/or nausea that is new, increased weakness and lethargy, increased back leg weakness especially with more of a plantigrade stance, and behavioral changes like walking into another room and howling like she's scared or confused. She's done the howling some in the past but never this much. She is 18 so there could be cognitive issues going on as well, or some of this could be medication side effects too.

She is on a slew of medications - budesonide, mirtazapine, and cerenia and buprenorphine as needed. I've given her a little prednisolone here and there lately. I started her on a low dose of pepcid. I am encouraging lots of drinking, playing with her as much as she has the energy for, using feliway pheromones, trying to decrease her stress even though there really hasn't been anything new going on. I am still giving d-mannose and Sovereign Silver when I think of it in case there is an infection. She drinks both readily on her own, and I have started a Bladder Support product from Dr. Mercola as well.

I'm at my wits' end trying to figure out what is the problem here. Is it an infection or inflammatory non-infectious cystitis?

I guess I will just keep doing what I'm doing and maybe see the vet again next week, but this is altering her food intake, her BGs and insulin needs and everything else. It is also causing me to wonder if there is something more serious going on.

If anyone has any ideas as to what this might be, I would be ecstatically grateful!!! And if you've made it this far, thank you for caring enough to read all this.

 

bump

 

Thanks for the bump, Jayla-n-Drevon! I know it's a lot of info. I edited it to sum it up in two simple questions at the top in case people don't care to read the entire thing. Hopefully someone will take a look.

 

I wish I knew enough to give you solid advice.... I don't want to steer you wrong.
I am familiar with Dr. Mercola and Dr Karen Becker.... I attend many of her lectures.
I am not sure what the ingredients are in the bladder support formula as I have not looked into that particular 1 in a while but personally I prefer to use D Mannose with no cranberry or anything else. I have had good success with it and no complications. Again this has been my experience for myself and my kittys. In my experience cranberry is fine for prevention (although I would not give with a FD kitty ) but if there is any sort of inflamed tissue it ignites it.
I have also had incidence where nothing showed up and a week of AB cleared up symptoms.
I hope someone else can offer more insight for you
Again this has just been my experience....

 

HMMMM
for some reason I thought she was getting SQ fluids--
from the symptoms your describing (nausea -decreased appy - confused- lethargic and weak ) I think she would feel a whole lot better with SQ fluids... I would call and talk to the vet about giving at home -all of these things could be from the kidneys which at 18 is pretty common-if CRF toxins build up which "can " cause all of these symptoms... a blood panel will let you know her kidney values.
My guy is 17 and gets fluids 3x a week. It is amazing how such a simple thing like water can change a cat in just a day.

 

Some infections require a longer antibiotic treatment. Seven days is short and a lot of vets use 10 days or even two weeks. Sometime a month/28 days is required.
Some vets use cosequin for cystitis.

 

Have a look at the symptom list at Tanya's Site for howling:

http://www.felinecrf.org/symptoms_treatments_index.htm#H


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Thank you! Critter Mom, yes, I love Tanya's site. Rascal has howled in the past off and on, then not again for months. It's never been like this though. They list cognitive dysfunction, mirtazapine side effects and waste product imbalances, all of which could be involved here.

I'm taking her in on Wednesday to get her checked out. When she was in a few weeks ago she only saw the tech and they only did a urinalysis and culture. Her creatinine has been inching a little higher so it could be her kidneys. I will have blood work done to check on that. Jayla-n-Drevon, you may be spot on with that. I'm going to try SQ fluids too. Great suggestion! We've used them once before for a few days when she was not feeling well and not eating as much, so thankfully the vets are willing to give us another bag today without having to bring her in before Wednesday. I really hope it helps. How much do you give at a time? Rascal weighs about 7 pounds.

Larry and Kitties, I've had her on ABs for 4-6 weeks one time when they suspected a UTI. She had no symptoms then though so it didn't do anything one way or the other. Well maybe her creatitine went down a tiny bit, but that could be from anything. I do know one week is often not enough, but this time we had a negative culture and the AB seemed to be further upsetting her stomach so the vet just said to stop. I know if she does have an infection, especially a stubborn one, she might need a much longer course, but we don't know that she has one. I would think if she did even just one week on ABs should have at least given her some improvement. There was no response. And now that she's been off again for a while you'd think if it was an infection and a short course of ABs didn't cut it, it would be flaring back up again. The symptoms have really stayed the same before, during and after ABs which is part of what makes me question whether it was an infection at all. That and the NEGATIVE culture. That's why I asked my main question: Can there be an infection even if the culture is negative?

I've heard Cosequin helps some cats with cystitis. We used it in the past. I might try it again. I have a product with the same ingredient in it, I think, but I will probably stop that one since it has cranberry in it, and this is not the first time I've heard now that cranberry might not be a good idea. Great. Another wasted attempt.

Off to pick up our bag of fluids! Thank you, everyone!

 

With kidney status unknown this is a smart move. The cranberry is acidifying (IIRC).

Be sure to update us on Wednesday. Sending positive vibes for Rascal and s for you.


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Thank you!!!! I just gave her some SQ fluids and honestly it seems like she's already a little more energetic and with it. It's not a cure all, I'm sure, and I don't want to get too excited, but it really seems like it already made some kind of difference. I will update you after her appointment, but in the meantime I am very grateful for the suggestion to try that and the warning to stay away from the cranberries!

She's still just acting so weird with her urinary tract symptoms. Something is definitely bothering her down there. I just wish I knew what it was. Infection or inflammatory cystitis??????? Oh well. Mommy's got a little UTI going too now so we can both be miserable together. Lol! Thankfully d-mannose really helps me.

 

I don't envy you a houseful of UTI's and/or cystitis. I can't imagine taking care of my own UTI and if Shaak had one at the same time. I am an absolute cry baby when I have one!

 

One more question: Rascal has this raspy, wheezing, snoring sound going on. It's not coming from her lungs. Definitely from the throat or nose. She had it about a year ago and it went away. Now it's been back for a few months. I've been worried about cancer, but it's hard to believe it would be a mass since the sound isn't there all the time. Could this be related to kidney issues or dehydration? I think hoarseness and the like can also be from acid reflux. She has IBD and has had other symptoms that might point to acid reflux like grinding her teeth when she eats, obsessed with eating grass on her supervised trips outside, wanting fluids and gravy and not solid food, interest in food and taking a couple bites and then refusing it, etc. Any ideas? Thanks

 

I've had really bad ones and then these little mini flare ups. Thankfully right now it's the latter. Seriously, d-mannose has helped a lot. They are miserable though, aren't they? If you've had one yourself you really feel for your kitty when they do all the more because you KNOW!