Leptospirosis

SUBJECT: Medical Therapeutics Topic: Leptospirosis Dr. (Report) Date CASE

Lepto MAT: there is a rise in the titer.

J.N. a 20 year old male, single, Filipino, Roman Catholic, presently residing in Paranaque, admitted at Medical Center Manila for the first time with a chief complaint of fever. 8 days PTC- patient experience undocumented fever, associated with generalized body malaise, nausea, loss of apetite, and headache. Patient self medicated with Bioflu which afforded temporary relief. No consult and labs done. 6 days PTCpersistence of above symptoms, with more pronounced left leg pain, and bilateral eye redness, still no consult done. 5 days PTA- patient condition improved was eating well, afebrile, more energetic. 3 days PTCundocumented fever recurred, associated with tea colored urine, nausea, loss of apetite and 2 episode of vomiting. Few hours PTC- above symptoms persisted prompted consult hence admission.

DIAGNOSIS: Leptospirosis Table 164-1 Treatment and Chemoprophylaxis of Leptospirosis Purpose of Administration

Drug Regimen

Treatment Mild leptospirosis

Doxycycline, 100 mg orally bid or Ampicillin, 500–750 mg orally qid or Amoxicillin, 500 mg orally qid

Moderate/severe leptospirosis

Personal and Social History A 3rd year nursing student, who wave in floodwater 3 weeks ago after a heavy downpour. Non smoker, non alcoholic beverage drinker.

Penicillin G, 1.5 million units IV qid or Ampicillin, 1 g IV qid or Amoxicillin, 1 g IV qid or Ceftriaxone, 1 g IV once daily or Cefotaxime, 1 g IV qid or Erythromycin, 500 mg IV qid

Chemoprophylaxis

Doxycycline, once a week

ROS Unremarkable

Jawetz: Treatment of mild leptospirosis should be with oral

Physical Examination BP 130/90 HR 96 RR 22 38.9 (+) subconjunctival suffusion (+) dry tongue and oral mucosa (+) tenderness of left thigh

MY ASSESSMENT: Mild Leptospirosis Harrisons: acute influenza-like illness, with fever, chills,

Past Medical History Non-asthmatic, with no known allergies, nondiabetic, non hypertensive, with no known heart disease. Hospitalized 10 years ago due to DHF.

Laboratory Workups CBC – WBC 13, 800 Hg 12.8 Hct 34 Neutrophils Seg 80 LyMphocytes 32 Monocytes 2 Eosinophils 2 Urine • • • • • • • • • •

yellow, clear, (-) sugar, Specific gravity 1.020, WBC 2-3, RBC too numerous to count, No Cast, Na 137, K 3.8, BUN 28, Creatinine 2.20

200

mg

orally

doxycycline, ampicillin, or amoxicillin. Treatment of moderate or severe disease should be with intravenous penicillin or ampicillin.

severe headache, nausea, vomiting, and myalgias. Muscle pain, which especially affects the calves, back, and abdomen, is an important feature of leptospiral infection; most common finding on physical examination is fever with conjunctival suffusion; less common findings include muscle tenderness

REPORTER’S OPINION: Moderate to Severe Leptospirosis Harrisons: Weil's syndrome, the most severe form of leptospirosis, is characterized by jaundice, renal dysfunction, and hemorrhagic diathesis; by pulmonary involvement in many cases

DRUG OF CHOICE Mild Leptospirosis: Doxycycline Moderate to Severe Leptospirosis: Penicillin G ALTERNATIVES Mild: I would recommend Amoxicillin because this is better absorbed by the GI tract Moderate to Severe: Based on the reporter’s sane criteris, I would recommend Ampicillin

MED THERA – Leptospirosis Page 2 of 6

PRESCRIPTIONS Mild Computations

Judee Marie A. Malubay, MD Department of Internal Medicine Ospital ng Maynila Medical Center Quirino Avenue, Manila Name: ___________

___________________________

Address: __________________________ ______________

Age/Sex:

Date:

Doxycycline (Doxicon) 100 mg/capsule #14 capsules

Sig:

Take one capsule with food every 12 hours for 7 days. Take with one full glass of water and remain upright for 30 minutes. Do not take with dairy products. Refill: none Warning: Do not give to children less than 8 years old and to pregnant women. GI irritation, toxicity, nausea, vomiting, diarrhea and tooth discoloration

Judee Marie A. Malubay Judee Marie A. Malubay Lic # 0870098

Stock Dose: 100 mg capsule Adult: 200 mg BID Pediatric (> 8 years and