Leptospirosis

Question 1

A 32-year-patient complaining of fever, headache, and myalgia. After his initial improvement he starts to deteriorate. He has been diagnosed with signs of pneumonia and on examination, conjunctival inflammation and hepatosplenomegaly was found. A chest X-ray indicated bi-basal opacities. His blood count showed a neutrophilia with a.
2. thrombocytopenia. Liver function tests showed an elevated conjugated bilirubin with mild elevation of transaminases. He was oliguric and uremic.

Answer 1

a) What is the most likely diagnosis?
Leptospirosis (Weil’s disease – severe form)
عرفت منين
Conjunctival suffusion اهم علامة (redness without discharge) – a hallmark
+Jaundice
+Renal affection

Question 2

b) How is this diagnosis confirmed?

Answer 2

1-Serology: Microscopic agglutination test (MAT) – gold standard

2-PCR for Leptospira DNA in blood or urine – early detection

3-ELISA for IgM antibodies (more widely available)

4-Culture of Leptospira from blood (early phase) or urine (late phase) – takes weeks

Question 3

c) What is the differential diagnosis?

Answer 3

1-Dengue fever – fever, thrombocytopenia, liver involvement, but lacks conjunctival suffusion or renal failure

2. Malaria – fever with thrombocytopenia and hepatosplenomegaly; do blood smear or rapid test
3. Typhoid fever – can have hepatosplenomegaly and systemic illness, but not typically associated with conjunctivitis or renal failure
4. Hantavirus infection – fever, renal failure, thrombocytopenia, but often pulmonary edema
5. Viral hepatitis – elevated LFTs and jaundice, but usually not with neutrophilia or conjunctival suffusion
6. Rickettsial infections – fever, rash, thrombocytopenia, and possible organ involvement.
7. Sepsis with multi-organ dysfunction – always a consideration

Question 4

Treatment
دي من عندي

Answer 4

Antibiotics:
- Severe disease: IV penicillin G, ampicillin, or ceftriaxone.
- Mild disease: oral doxycycline or amoxicillin.
Supportive treatment for severe cases (fluids & ICU admission).
3- For prophylaxis in endemic areas, doxycycline (200 mg/day) has been shown
to be effective.

Question 5

Causative organism

Answer 5

Leptospira interrogans

Question 6

هو leptospira
ده تبع ايه؟

Answer 6

Spirochates

Question 7

ايوا شاطر
مين بقي spirochates دول

Answer 7

دول عيلة لبط لامؤاخذة Lb T
1-Leptospira, which causes human leptospirosis (Weil’s sisease).
2-Borrelia, which causes relapsing fever and Lyme disease.
3-Treponema, which causes venereal syphilis.

Question 8

طب ما تقولنا
Pathogenesis بتاعهم كده

Answer 8

Pathogenesis [Spirochetes share a common pathogenesis as follows]:
1- The spirochetes gain entry through mucous membranes or abrasions in intact skin.
2- They multiply locally in the skin (causing skin lesion), then the organism spreads to all organs.
3- Multiplication takes place in blood (bacteremia) and in tissues, and so the organism can be isolated from blood and cerebrospinal fluid (CSF).
4- Multiplication in reticuloendothelial system results in hepatosplenomegaly,
they can damage the wall of small blood vessels; this damage leads to vasculitis
with leakage and extravasation of cells, including hemorrhages.
5- They may disseminate to nervous system (meningo-encephalitis), heart
(myocarditis), lung (cough) and kidney (renal failure).
6- After the start of antimicrobial treatment, a Jarisch-Herxheimer reaction may develop. This reaction is thought to be a response to lipoproteins released by
dying spirochetes.

Question 9

Jarisch-Herxheimer reaction
يعني ايه ؟

Answer 9

After the start of antimicrobial treatment, a Jarisch-Herxheimer reaction may develop. This reaction is thought to be a response to lipoproteins released by
dying spirochetes.