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Anas, 14 y/o, male Current dx: Leptospirosis in immune phase - Coggle…
Anas, 14 y/o, male
Current dx: Leptospirosis in immune phase
History
Swimming in contaminated
freshwater with exposed cuts
Leptospira bacteria enter body through exposed cut
Does not smoke or alcoholic
Can rule out alcoholic liver disease (ALD)
Signs and symptoms
Bilateral calf pain
Release of endotoxin →
inflammatory changes (cause direct damage to the muscle
flu-like illness & diffuse redness both eyes
1 week after vacation
Inflammation on the eye lining due to infection
Jaundice of the eyes for 4 days
Liver infection by leptospira lead to destroy of hepatocyte thus lead to leakage of bile acid in bile canaliculi
Fever with abrupt onset and high grade associated with chills
Involuntary muscle contraction → release
heat to increase body temp. to set point
Activated immune cell release IL-1/PG
Investigation and examination
C-reactive protein: +ve
(Indicative of inflammation)
Bacteria produce endotoxin →
inflammation of blood vessels
Full blood count:
High WBC (neutrophils)
Immune response activated
Lymphocytopenia
Production of lymphocytes ↓ to focus on production of neutrophils
Thrombocytopenia
↑ usage of platelet
to cover the haemmorhage
Urine leptospiral Ag: +ve
MAT: 4-fold rise in titre
Confirmation of diagnosis
Confirmation of diagnosis
Renal function test
Hyponatremia & Hypokalaemia
direct inhibition of bacteria on Na-K-Cl co-transporter activity
↑ urea & creatinine
Inflammatory response in the
kidney → inflammation
Interstitial nephritis
↓ GFR
Liver function test
↑ total bilirubin
↑ unconjugated bilirubin
↑ conjugated bilirubin
↑ALT & AST
ALP normal
Indicate there’s no biliary obstruction→ rule out gallstones
Liver enzymes released into blood
Leakage of bile from bile canaliculi
into sinusoidal blood vessels
Conjugation of bilirubin can’t occur
Treatment
IV ceftriaxone for 7 days (bactericidal)
Oral doxycycline after discharge (bacteriostatic)
Prevention
Cover cuts & abrasions with waterproof dressing
Protective clothing
Animal & Human vaccine
Flood control projects
Rodent control