Leptospirosis Fever: Case Report- Juniper Publishers
Juniper Publishers- Journal of complementary medicine
Abstract
Leptospirosis is a zoonotic disease caused by
infection with leptospira species which is prevalent in both tropical
and temperate regions, but more common in tropics as the pathogenic
bacteria survives longer in tropical environment. Leptospira species
lives in kidneys of mammalian species like rodents, cattle, sheep and
pig but rodents are the most common reservoir in transmission of the
disease. Humans are infected incidentally after being exposed to
infected animal tissue or excreta. A 47-year-old female patient admitted
in our hospital in general medicine ward with chief complaints of fever
for 5 days, cough for 4 days and altered sensorium for 2 days. Patient
also complained about headache and involuntary passage of urine in
clothes on the day of admission. Patient was a known case of asthma on
oral treatment of FORACORT inhaler. Patient was treated with Inj.
CEFTRIAXONE, ARTESUNATE, DOXYCYCLINE, PRIMAQUINE, PARACETEMOL and IVF.
Patient was discharged after complete recovery and advised to continue
FORACORT for asthma.
Keywords: Zoonotic disease; Leptospira species; Pathogens; Tropical environment
Introduction
Leptospirosis is a zoonotic disease caused by
infection with Leptospira species which is prevalent in both tropical
and temperate regions [1], but more common in tropics as the pathogenic
bacteria survives longer in tropical environment. Leptospira species
lives in kidneys of mammalian species like rodents, cattle, sheep and
pig but rodents are the most common reservoir in transmission of the
disease. Humans are infected incidentally after being exposed to
infected animal tissue or excreta [2]. Clinical features of
Leptospirosis can be classified into 2 phases [3]. The first phase is
known as septemic phase which is characterized by high fever, headache,
myalgia, conjunctival congestion. Fever returns after a brief afebrile
period indicating the second phase of illness known as immune phase in
which liver and kidneys are involved. According to WHO guidelines
treatment regimen for less severe cases is [4] DOXYCYCLINE,
TETRACYCLINE, AMPICILLIN, AMOXICILLIN, third generation cephalosporins
like CEFTRIAXONE, CEFOTAXIME and QUINOLONE antibiotics. Severe cases
usually treated with high doses of BENZYLPENICILLIN (30mg/kg up to 1.2g
IV 6-hourly for 5-7 days). Along with antibiotics supportive care should
be provided.
Case Report
A 47year old female patient admitted in our hospital
in general medicine ward with chief complaints of fever for 5 days,
cough for 4 days and altered sensorium for 2 days. Patient developed
fever which is high grade in nature, intermittent, associated with
chills, rigors and evening rise of temperature followed by coughfor 4
days associated with scanty sputum production, mucoid in nature,
non-foul smelling, not blood tinged followed by altered behavior for 2
days in form of increased irritability. Patient also complained about
headache and involuntary passage of urine in clothes on the day of
admission. She is a known case of Asthma for 5 years which aggravates on
exposure to cold, associated with wheeze and subsides on oral treatment
with Forecourt (FORMOTEROL FUMARATE AND BUDENOSIDE) inhaler.
Diagnosis
Physical examination and laboratory tests were
performed. Report shows well defined maculopapular erythematous lesions
over both upper limbs [5], blanching rash present over abdomen and
chest, conjunctival congestion, terminal neck stiffness. There was no
jaundice, hepatospleenomegaly, lymphadenopathy, jaundice and icterus.
Laboratory results showed elevated ALT, AST and ALP with 47 IU/L, 58
IU/L and 192 IU/L respectively, elevated total serum bilirubin with
2.8mg/dl, reduced serum albumin with 2.4mg/dl and conjugated serum
bilirubin with 0.92mg/dl. Serological investigations of the patient by
ELISA technique showed presence of IgM antibodies against Leptospira
species in serum. Peripheral smear reveals no abnormalities.
Treatment
Patient was treated empirically with Inj. CEFTRIAXONE
Ig IV BD. Along with ceftriaxone other symptomatic treatment was also
given like Inj. ARTESUNATE (120mg IV BD), Cap. DOXYCYCLINE (100mg PO BD)
and T. PARACETEMOL (500mg.PO TID) as patient complaints of fever with
chills and rigors. Inj.
NEUROIND is given. Intravenous fluids like NS and RL was also
given. He is using FORACORT inhaler for asthma [6,7].
Outcome and Follow Up
Patient was discharged after complete recovery and advised
to continue FORACORT inhaler for Asthma. Maintain hygienic
conditions in order to prevent further infections. Medication for
asthma can be used whenever necessary.
Discussion
Leptospirosis is a rare zoonotic disease caused by a
spirochete called leptospira which is characterized by high
fever, headache, myalgia, conjunctival congestion. In our patient
high grade fever, headache and rashes are observed which is
supported by [5] Diagnosis is based on physical examination,
signs and symptoms and also by laboratory reports which is
supported by [4]. Treatment given in our patient is antibiotics
and supportive care which is according to WHO guidelines.
Conclusion
Leptospirosis is a rare zoonotic disease caused by a
spirochete leptospira. It is transmitted by mammalians like
rodents, cattle, sheep and pigs but rodents are the most common
host for leptospira species. Treatment regimen for leptospira
is penicillin antibiotics, third generation cephalosporins and
quinolone antibiotics. Along with the antibiotics symptomatic
treatment and supportive care is also useful in many cases.
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