Fungal lower UTI

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Has anyone gone through fungal UTI treatment before? Looks like it's unusual. I've read all fungal UTI related pages and articles I could find, and there aren't many.

My 6-year-old male cat recently had a bacterial UTI w/E.coli and he was on an antibiotic for 13 days. Urinalysis on the 8th day and the 13th day came back negative, and today I took him in for another urinalysis, 10 days after the treatment ended to see reinfection occurred. I collected his urine sample in the morning and already noticed it was a little cloudy. I asked the vet to withdraw urine via cystocentesis and send it off to lab for C&S if they detected even a small number of WBC in the sample I handed over. What I didn't expect to hear was that they found fungi this time. They couldn't see bacteria but just to be safe his urine was sent to separate C&S for bacteria and fungi.

I've read fungal infection is usually caused by Candida, but the vet says that medicines to treat fungi carry higher risks of side effects than antibiotics to treat bacterial infection, so now we need to wait for 10-14 days for the sensitivity test results. A blood test seemed ok. A month ago his ALT was elevated to 133 due to acute gastritis and today it was 91, although he's usually 59-66. SAA also came down from 23 to 3. Creatinine was 2.4, up from 1.6-1.7 six months ago, SDMA was 12.4, up from 11 six months ago but down from 16 a month ago, which is similar to his sister's results - their creatinine is high but SDMA is normal. BUN was 28.

He did pee blood 9 days ago but he has FIC and every other month or so he does that, so I didn't think much of it at the time. He doesn't show any symptoms but again everything I read says that it takes a while for symptoms to show up. The vet thinks the antibiotic disrupted his normal flora in the body and allowed fungi to overgrow and caused the infection.
 
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FeebysOwner

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I don't know what all you found in your research, but from what I saw, I think your vet may be focused on just one of many possible causes. Nonetheless, what I found suggests that there is a probable cyclical event between cystitis and candida. There are factors than can attribute to it besides disrupted normal flora. There is even a possibility that this developed in the kidneys and was transmitted to the lower urinary tract.

Have you considered it might be time to consult with a specialty group that has various expertise - including an internal med vet and urology, as long with many other specialties that can collaborate as needed? Maybe even a vet university?

All of these articles talk about fungal infections, and may be ones you have already come across.
Feline Idiopathic Cystitis: Causes, Symptoms, & Treatment - Cats.com
Fungal Infection of Lower Urinary Tract in Cats | PetMD
Fungal Infection of Lower Urinary Tract in Cats in Cats - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost (wagwalking.com)
 
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F+V

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I don't know what all you found in your research, but from what I saw, I think your vet may be focused on just one of many possible causes. Nonetheless, what I found suggests that there is a probable cyclical event between cystitis and candida. There are factors than can attribute to it besides disrupted normal flora. There is even a possibility that this developed in the kidneys and was transmitted to the lower urinary tract.

Have you considered it might be time to consult with a specialty group that has various expertise - including an internal med vet and urology, as long with many other specialties that can collaborate as needed? Maybe even a vet university?

All of these articles talk about fungal infections, and may be ones you have already come across.
Feline Idiopathic Cystitis: Causes, Symptoms, & Treatment - Cats.com
Fungal Infection of Lower Urinary Tract in Cats | PetMD
Fungal Infection of Lower Urinary Tract in Cats in Cats - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost (wagwalking.com)
We go to a research university hospital, not a regular vet in town. If it was developed in the kidneys, wouldn't ultrasound and blood test results show something?
 
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They said there was a risk of fungi ascending to kidneys but didn't say his kidneys were infected after reviewing ultrasound and bloodwork results.
 
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For anyone in the same boat, this is an interesting read from Journal of Veterinary Internal Medicine on the topic.
It concludes, "The recent administration of antibacterial drug therapy is a potential risk factor for development of candiduria in dogs and cats. Judicious use of antibacterial drugs might help to prevent candiduria."
Antecedent antibacterial drug administration was associated with candiduria in cats (OR 15.7; 95% CI 1.9-132.3)

I also have "Candida spp. Urinary Tract Infections in 13 Dogs and Seven Cats: Predisposing Factors,Treatment, and Outcome" and "Fungal Urinary Tract Infections in the Dog and Cat: A Retrospective Study (2001–2004)" from Journal of the American Animal Hospital Association as well as "Fungal Infections of the Feline Lower Urinary Tract" from Veterinary Clinics of North America: Small Animal Practice but can't seem to upload a PDF here. If anyone is interested, I can upload them on Google drive.
 
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