Things not to miss - Leptospirosis

A 26 years old patient presented with a history of fever for approximately 5 days duration. He complained of nausea, headache, backache and myalgia. His brother has had a febrile illness about a week ago.

On examination he was ill looking. There was no rash or lymphadenopathy. Pulse rate was 110/min. Blood pressure was 90/60mmHg. There was mild tender hepatomegaly.

This is a very common clinical presentation you will encounter every now and then.

 1. What are the main differential diagnoses?

 2. What clinical features will you specifically look for?

 3. How will you initially manage the patient?

 As the patient was ill looking the house officer summoned the registrar.

 Registrar elicited following points from the history and examination.

  • The patient had worked in a paddy field during the last few weeks. (leptospirosis exposure)
  • He had conjunctival suffusion. (A feature of leptospirosis)
  • There was no icterus.
  • There was no pleural effusions, ascites. (To exclude dengue haemorrhagic fever with shock)
LESSONS
  • In any Sri Lankan febrile patient, consider dengue and leptospirosis as first differential diagnoses.
  • Never forget to ask for the history of leptospirosis exposure.
  • Hanta viral infection can present with similar manifestations. There's no specific treatment.
  • Only if you LOOK for specific physical signs, you will SEE them!
Image result for leptospirosis conjunctival suffusion

The clinical diagnosis of leptospirosis was made.

How are you going to manage this patient?

Following things were done as ordered by the registrar.

  • Immediate resuscitation with IV normal saline.
  • Monitoring of vital parameters and urine output.
  • Investigations - FBC, CRP, Serum Creatinine, Serum electrolytes, AST, ALT, Serum Bilirubin, INR, UFR.
  • Blood was sent for cross matching.
  • Two blood cultures were taken.
  • Intravenous ceftriaxone was given after the cultures were taken.
Find out why each and every investigation was ordered. What further investigations might be required for the management of this patient?

Read the basic management principals of septic shock.

What are the severe complications of leptospirosis?

Comments

  1. NirodhaOctober 12, 2019 at 10:36 PM

    1.
    fbc- neutrophilia with thrombocttopaenia
    CRP- elevated
    SCr- renal involvement
    SE- hyperkalaemia
    AST/ALT- liver involvement
    UFR- haematuria

    2.
    CXR and saturation

    3
    AKI
    Pulmonary haemorrhages (Weli's dx)
    meningituis
    Acute liver failure

    ReplyDelete

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