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Old 10-07-2011
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Question Sewer worker with fever, jaundice & renal failure.

Sewer worker presented with high fever, chills, muscle aches, vomiting & diarrhea, on examination, conjunctival suffusion, jaundice, purpura, hepatomegally . Serum creatinine 2.3 mg/dl. The most likely diagnosis?
1. Hepatitis B.
2. Leptospirosis.
3. Typhoid fever.
4. Wermer’s syndrome.
5. Acute renal failure.
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Old 10-07-2011
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Leptospirosis
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Old 10-07-2011
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Default hmmm

is it leptospirosis?
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Old 10-07-2011
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im assuming though, in the sewer there are a lot of rats. i know leptospirosis is huge during times of floods when the rats are floating everywhere so i kinda assumed tht case here. also his SSx which is of course important...

Clinical description: The usual presentation is an acute febrile illness with headache, myalgia (particularly calf muscle) and prostration associated with any of the following symptoms/signs:
  • Conjunctival suffusion
  • Anuria or oliguria
  • Jaundice
  • Cough, haemoptysis and breathlessness
  • Haemorrhages (from the intestines; lung bleeding is notorious in some areas)
  • Meningeal irritation
  • Cardiac arrhythmia or failure
  • Skin rash.
Note. Other common symptoms include nausea, vomiting, abdominal pain, diarrhoea, arthralgia. The clinical diagnosis is difficult where diseases with symptoms similar to those of leptospirosis occur frequently.
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Old 10-08-2011
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The correct answer is: Leptospirosis: The described scenario is Weil’s syndrome (severe form of Leptospirosis)
Spirochetes, thin with hooks. Transmission contact with animal urine in water, organism penetrates mucous membranes or enters small breaks in epidermis. So remember sewer worker & recreational waters (jet skiers). Diagnosis: agglutination test, culture (blood, CSF & urine), Dark-field microscopy. Treatment: Penicillin or Doxycycline.
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