Wednesday, November 19, 2014

Subconjunctival hemorrhages and jaundice in leptospirosis.

DEFINITION
Leptospirosis (Weil’s disease) is a zoonosis caused by the spirochete Leptospira interrogans.





PHYSICAL FINDINGS AND CLINICAL PRESENTATION ANICTERIC FORM


● Milder and more common presentation of disease

● A self-limited systemic illness with two stages:
1. Septicemic stage: presents abruptly with fevers, headache, severe myalgias, rigors, prostration, and sometimes circulatory collapse; conjunctival suffusion is common; skin rash, pharyngitis, lymphadenopathy, hepatomegaly, splenomegaly.

2. Immune stage: occurs a few days after fi rst stage with similar symptoms; hallmark is aseptic meningitis.

ICTERIC LEPTOSPIROSIS (WEIL’S SYNDROME):
1. Denotes severe cases, with symptoms of hepatic, renal, and vascular dysfunction

2. Biphasic course: persistence of fever, subconjunctival hemorrhages, jaundice (Fig. ), and azotemia
3. Complications: oliguria or anuria, hemorrhage, hypotension,
vascular collapse


CAUSE
Caused by a spirochete, L. interrogans
● Infects a variety of animals, including most mammals
● Specifi c serotypes associated with different hosts—pomona in livestock, canicola in dogs, and icterohaemorrhagiae in rodents
● Exposure to animal urine or infected water method by which organism penetrates skin or mucous membranes


DIFFERENTIAL DIAGNOSIS
● Bacterial meningitis
● Viral hepatitis
● Infl uenza
● Legionnaire’s disease


WORKUP
Cultures of blood, CSF, and urine:
● Organism can be isolated from blood or CSF during fi rst 10 days of illness.
● Urine should be cultured after fi rst week and for up to 30 days after onset of illness.


LABORATORY TESTS
● Normal or elevated WBCs, at times up to 70,000/mm3
● Elevated transaminases or bilirubin
● Anemia, azotemia, hypoprothrombinemia in those with icteric illness
● Elevated CK in fi rst phase
● Meningitis in both phases, but aseptic in second phase


IMAGING STUDIES
Chest radiographs to show bilateral nonlobar infi ltrates


TREATMENT
● IV penicillin G
● Doxycycline
● Vitamin K administration if hypoprothrombinemia present

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