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Of
Leptospirosis
Group V-A
Bhele Jusay Kang Kasti Katuwal Khatri Kurra Laingo Lama
Binos, Dangal, Dongol, Diones
THE CASE
A 26 year old female came in at the emergency room due to fever and jaundice.
Five days prior to days admission, patient started to have fever, headache and
calf pains. Over the next few days, the patient noticed to have decreasing urine
output and jaundice. Past medical and family history were unremarkable.
The patient reported that 2 weeks prior to admission, she waded in the flood
along Taft avenue. She also said that she sustained a wound on her left toe after
having a pedicure a day before the flood wading .
THE CASE
Vital signs:
BP: 90/60
HR:110
RR: 24
Temp: 38.4 C
PHYSICAL EXAMINATION
Skin: (+) Jaundice, Warm to touch, dry, good turgor, no rashes
HEENT: icteric, conjunctival suffusion, , no aural discharge, no nasal discharge
Chest: Symmetrical chest expansion, no retraction, clear breath sounds,
tachypniec
Heart: Adynamic Precordium, tachycardic , regular rhythm; no murmurs
Abdomen: Flat, normoactive bowel sounds, soft, slight abdominal tenderness
Extremities: Grossly normal with full and equal pulses; with full range of motion,
Calf tenderness, no cyanosis, no edema
Normal neurologic examination
SALIENT FEATURES
26years
Female
(5 days PTC) History of fever, headache, calf pain
(2 weeks PTC) History of wading in the flood with an open wound on
her left toe
Decreasing urine output
On PE, noted: tachycardic, tachypneic, Icteric sclerae, conjunctival
suffusion, slight abdominal tenderness, and calf tenderness.
INITIAL IMPRESSION
Severe Leptospirosis ( Weils Syndrome)
Differential Diagnosis
Would likely consider due to: Would not likely consider
due to:
Dengue Hemorrhagic Fever Fever (+)Jaundice
Headache (+) icteric sclera
Abdominal tenderness (+) calf tenderness
Tachycardic (-) severe back pain or muscle
Tachypniec pain break bone fever
(+) conjunctival suffusion
(+) history of wading in the flood
Severe Leptospirosis
( Weils Syndrome)
Case Discussion
WEILS DISEASE (LEPTOSPIROSIS)
Is a form of bacterial infection which is caused by a spirochete
Leptospira interrogans and is carried by animals, most commonly in
rats (rodents) and cattle.
This bacterial infection can be caught by humans through contact
with rat or cattle urine, most commonly occurring through
contaminated fresh water.
Weils disease is a secondary phase of a form bacterial infection also
known as Leptospirosis. Secondary symptoms include jaundice
(yellowish skin and eyes), red eyes, abdominal pain and diarrhea.
Severe cases can also cause acute kidney failure and liver failure.
LEPTOSPIRES
Liver
Disruption of cellular cohesion Plugging of bile canaliculi Serum hyperbilirubin
Hepatitis creatinine kinase Calf pain
Pulmonary
Involvement is the result of hemorrhage and not of inflammation
Skeletal muscle
Invasion of leptospires results in swelling, vacuolation of the myofibrils and focal necrosis
Pathophysiology
Platelets
Platelet consumption in the activated endothelial surface
thrombocytopenia bleeding
Eye
Dilated conjunctival blood vessels conjunctival
manifestation