LEPTOSPIROSIS
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Questions and Answers

What is the primary reason doxycycline is contraindicated during pregnancy?

  • It increases sensitivity to sunlight
  • It may cause permanent discoloration of the teeth in the baby (correct)
  • It can interact with birth control pills
  • It can lead to acute kidney injury

    • Which of the following statements regarding the effects of doxycycline is accurate?

  • Doxycycline can cause more serious sunburn reactions without proper precautions (correct)
  • Doxycycline should be taken with iron supplements to improve absorption
  • Doxycycline does not affect the efficacy of birth control pills
  • Doxycycline makes the skin less sensitive to sunlight

    • What is oliguria defined as in clinical terms?

  • Serum K > 6 meq/L
  • Fluid overload with urine output > 1 mL/kg/hr
  • Urine output < 1 mL/kg/hr
  • Urine output < 0.5 mL/kg/hr (correct)

    • What is the main laboratory test that helps differentiate acute tubular necrosis (ATN) from pre-renal azotemia?

    <p>Urine or serum neutrophil gelatinase-associated lipocalin (NGAL)</p> Signup and view all the answers

    Which condition is characterized by Acute PaO2/FIO2 ≤ 200mmHg?

    <p>ARDS</p> Signup and view all the answers

    What should be avoided when taking doxycycline to ensure its effectiveness?

    <p>Taking calcium supplements within 2 hours</p> Signup and view all the answers

    What is a common clinical feature associated with acute kidney injury (AKI) due to leptospirosis?

    <p>Severe anuric acute renal failure</p> Signup and view all the answers

    What is the first sign of pulmonary involvement in leptospirosis?

    <p>Tachypnea (RR &gt;30/min)</p> Signup and view all the answers

    What is the significance of a four-fold rise in the titer from acute to convalescent sera?

    <p>It confirms the diagnosis of leptospirosis.</p> Signup and view all the answers

    What is the preferred treatment duration for antibiotic therapy in mild leptospirosis?

    <p>7 days</p> Signup and view all the answers

    How should post-exposure prophylaxis be administered for a person with low-risk exposure?

    <p>Doxycycline 200 mg OD single dose within 24-72 hours</p> Signup and view all the answers

    What do the sensitivity rates of specific IgM rapid diagnostic tests indicate when taken within the first week of illness?

    <p>They can yield false negative results.</p> Signup and view all the answers

    Which of the following is a common finding in the complete blood count of those suspected of having leptospirosis?

    <p>Leukocytosis</p> Signup and view all the answers

    What defines high-risk exposure in the context of leptospirosis?

    <p>Continuous exposure to contaminated water with open skin lesions.</p> Signup and view all the answers

    What is the recommended regimen for pre-exposure prophylaxis for non-pregnant, non-lactating adults visiting endemic areas?

    <p>Doxycycline 200 mg OD 1-2 days before exposure</p> Signup and view all the answers

    Which laboratory finding is commonly associated with severe myalgia in leptospirosis patients?

    <p>Elevated serum creatine phosphokinase (CPK-MM)</p> Signup and view all the answers

    Which of the following alternatives is a drug of choice for moderate to severe leptospirosis?

    <p>Penicillin G</p> Signup and view all the answers

    What kind of radiologic picture is most commonly associated with leptospirosis?

    <p>Patchy alveolar pattern</p> Signup and view all the answers

    What is true regarding serum creatinine levels during leptospirosis?

    <p>They can be normal initially but may elevate later.</p> Signup and view all the answers

    What is required if initial serologic test results for leptospirosis are negative?

    <p>A second sample should be obtained.</p> Signup and view all the answers

    What is the significance of pre-exposure prophylaxis in high-risk individuals?

    <p>It may reduce the risk of contracting leptospirosis.</p> Signup and view all the answers

    What condition is indicated by a triad of fever, jaundice, and renal failure in leptospirosis patients?

    <p>Weil's Disease</p> Signup and view all the answers

    Which method of detection for leptospirosis is considered time-consuming and labor-intensive?

    <p>Culture and Isolation</p> Signup and view all the answers

    What characterizes a patient with mild leptospirosis?

    <p>Stable vital signs and good urine output</p> Signup and view all the answers

    In which setting is moderate to severe leptospirosis best managed?

    <p>Healthcare/hospital setting</p> Signup and view all the answers

    Which of the following is NOT a severe manifestation of leptospirosis?

    <p>Calf tenderness</p> Signup and view all the answers

    What advantage does Polymerase Chain Reaction (PCR) offer in diagnosing leptospirosis?

    <p>It provides a quick result before antibody formation</p> Signup and view all the answers

    Which of the following is a direct detection method for leptospirosis?

    <p>Polymerase Chain Reaction (PCR)</p> Signup and view all the answers

    What is the key feature of the Microagglutination test in diagnosing leptospirosis?

    <p>It detects antibodies in the acute phase of illness</p> Signup and view all the answers

    What are the characteristics of a suspected case of leptospirosis?

    <p>Fever for at least 2 days and presenting with myalgia with high-risk exposure</p> Signup and view all the answers

    Which condition best describes a patient with mild leptospirosis?

    <p>Acute febrile illness with stable vital signs and anicteric sclerae</p> Signup and view all the answers

    In which setting is severe leptospirosis most appropriately managed?

    <p>Tertiary care healthcare facility</p> Signup and view all the answers

    What triad is characteristic of Weil's Disease?

    <p>Fever, jaundice, and renal failure</p> Signup and view all the answers

    Which method is known for providing early confirmation of leptospirosis diagnosis during the acute phase?

    <p>Polymerase Chain Reaction (PCR)</p> Signup and view all the answers

    Which of the following is NOT an indirect detection method for leptospirosis?

    <p>Serum creatinine level assessment</p> Signup and view all the answers

    What characteristic distinguishes moderate to severe leptospirosis from mild leptospirosis?

    <p>Presence of pulmonary hemorrhage</p> Signup and view all the answers

    What is a common disadvantage of culture and isolation as a diagnostic method for leptospirosis?

    <p>It is time-consuming and gives low diagnostic yield.</p> Signup and view all the answers

    What potential effect does doxycycline have on oral contraceptives?

    <p>Reduces their effectiveness</p> Signup and view all the answers

    What is a common renal complication of leptospirosis?

    <p>Acute kidney injury</p> Signup and view all the answers

    In the context of doxycycline, which supplements should be avoided to maintain its efficacy?

    <p>Calcium supplements</p> Signup and view all the answers

    What indicates a poorer prognosis in a patient with acute kidney injury?

    <p>Oliguria and hyperkalemia</p> Signup and view all the answers

    What can doxycycline do to a patient's skin sensitivity?

    <p>Increase sensitivity to sunlight</p> Signup and view all the answers

    What is one of the laboratory tests recommended for diagnosing acute kidney injury?

    <p>Urine or serum neutrophil gelatinase-associated lipocalin (NGAL)</p> Signup and view all the answers

    What leads to permanent discoloration of teeth in infants when exposed to doxycycline?

    <p>Maternal use of doxycycline during pregnancy or breastfeeding</p> Signup and view all the answers

    What is the primary definition of oliguria in a clinical setting?

    <p>Urine output &lt; 0.5 mL/kg/hr</p> Signup and view all the answers

    Which of the following serum titer levels is specifically indicative of leptospirosis in symptomatic patients?

    <p>1:1600</p> Signup and view all the answers

    What is the best timing for obtaining serum samples to improve the sensitivity of specific IgM rapid diagnostic tests?

    <p>Beyond 7 days of illness onset</p> Signup and view all the answers

    Which laboratory finding is NOT commonly associated with leptospirosis?

    <p>Eosinophilia</p> Signup and view all the answers

    In patients with leptospirosis, a rise in serum creatinine levels is indicative of which condition?

    <p>Acute kidney injury</p> Signup and view all the answers

    Which substance is primarily elevated in patients with severe myalgia associated with leptospirosis?

    <p>Serum creatine phosphokinase (CPK-MM)</p> Signup and view all the answers

    What is the primary treatment duration for antibiotic therapy in patients with mild leptospirosis?

    <p>7 days</p> Signup and view all the answers

    Which antibiotic is recommended for post-exposure prophylaxis in those with moderate risk exposure to leptospirosis?

    <p>Doxycycline</p> Signup and view all the answers

    Which condition does the presence of continuous exposure to contaminated water define?

    <p>High risk exposure</p> Signup and view all the answers

    What is the method of administration for doxycycline in cases of mild leptospirosis?

    <p>100 mg bid PO</p> Signup and view all the answers

    What is the recommended dosage for post-exposure prophylaxis for individuals with a low-risk exposure?

    <p>200 mg single dose within 24-72 hours</p> Signup and view all the answers

    What is the drug of choice for moderate to severe leptospirosis?

    <p>Penicillin G</p> Signup and view all the answers

    Which of the following is NOT recommended for post-exposure prophylaxis in leptospirosis?

    <p>Ceftriaxone</p> Signup and view all the answers

    What is the main disadvantage of pre-exposure prophylaxis in leptospirosis?

    <p>There is no safe option for pregnant or lactating women.</p> Signup and view all the answers

    What describes a characteristic finding in the radiologic evaluation of leptospirosis?

    <p>Patchy alveolar pattern</p> Signup and view all the answers

    Study Notes

    Clinical Manifestations of Leptospirosis

    • Suspected Case: Acute fever for at least 2 days, residing in flooded areas or high-risk exposures, with at least two symptoms such as myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria.
    • Mild Leptospirosis: Characterized by acute febrile illness, stable vital signs, anicteric sclerae, good urine output, and absence of severe symptoms such as meningismus or jaundice.
    • Moderate-Severe Leptospirosis Management: Requires hospitalization, while mild cases can be managed in an outpatient setting.
    • Severe Manifestations: Include jaundice, renal failure, pulmonary hemorrhage, myocarditis, and refractory hypotension.
    • Weil’s Disease: A severe form of leptospirosis marked by a triad of fever, jaundice, and renal failure.

    Diagnostic Methods

    • Direct Detection Methods: Culture and isolation of the organism, Polymerase Chain Reaction (PCR).
    • Indirect Detection Methods: Microagglutination test (MAT), specific IgM rapid diagnostic tests, and nonspecific rapid tests (LAATS).
    • Microagglutination Test: A four-fold rise in titer from acute to convalescent sera confirms diagnosis; in endemic areas, a single titer of at least 1:1600 indicates infection.
    • IgM Rapid Diagnostic Test: Serologic tests with sensitivity rates of 63%-72% in early illness, improving to over 90% after 7 days.

    Laboratory Findings

    • Complete Blood Count (CBC): Leukocytosis, neutrophilia, and thrombocytopenia (low platelet counts).
    • Urinalysis: Findings may include proteinuria, pyuria, hematuria, and possibly casts; elevated serum creatinine may indicate acute kidney injury.
    • Serum Creatine Phosphokinase (CPK-MM): Elevated in severe myalgia.

    Radiological Findings

    • Common Picture: Patchy alveolar pattern consistent with scattered alveolar hemorrhage.

    Treatment

    • Mild Leptospirosis:
      • Drug of choice: Doxycycline (100mg bid PO for 7 days).
      • Alternatives: Amoxicillin (500mg q6h or 1g q8h PO) and Azithromycin (1g initially, followed by 500mg OD for 2 days).
    • Moderate-Severe Leptospirosis:
      • Drug of choice: Penicillin G.
      • Alternatives include parenteral ampicillin, third-generation cephalosporins, and parenteral azithromycin.
    • Antibiotic Therapy Duration: Should last for 7 days.

    Prophylaxis

    • Preventive Measure: Avoid high-risk exposure to contaminated water; wear protective gear if exposure is unavoidable.
    • Pre-exposure Prophylaxis: Doxycycline 200mg OD for non-pregnant adults starting 1-2 days before exposure; not routinely recommended for pregnant or lactating women.
    • Post-exposure Prophylaxis:
      • Low Risk Exposure: Doxycycline 200mg single dose within 24-72 hours.
      • Moderate Risk Exposure: Doxycycline 200mg once daily for 3-5 days.
      • High Risk Exposure: Doxycycline 200mg once weekly until the end of exposure.

    Contraindications and Side Effects

    • Doxycycline Contraindications: Pregnancy, breastfeeding, and not indicated for children under 8 due to risks of tooth discoloration.
    • Interaction with Birth Control: May reduce the effectiveness of birth control pills.
    • Sun Sensitivity: Increases skin sensitivity to sunlight; use sunscreen and protective clothing when outdoors.

    Complications

    • Acute Kidney Injury (AKI): A major complication characterized by mild proteinuria to severe renal failure; monitored by elevated serum creatinine and oliguria.
    • Pulmonary Complications: Tachypnea is the first sign; pulmonary hemorrhage and ARDS are common with severe cases.

    Definitions and Criteria

    • Oliguria: Urine output less than 0.5 mL/kg/hr is indicative of severe acute renal failure.
    • Acute Lung Injury/ARDS: Defined by specific PaO2/FIO2 ratios: ≤300mmHg for acute lung injury and ≤200mmHg for ARDS.

    Clinical Manifestations of Leptospirosis

    • Suspected leptospirosis cases present with fever for at least 2 days, exposure to flooded areas, and at least two symptoms: myalgia, calf tenderness, conjunctival suffusion, chills, abdominal pain, headache, jaundice, or oliguria.
    • Mild leptospirosis includes acute febrile illness with stable vital signs, no jaundice, good urine output, and absence of meningismus, sepsis, or respiratory distress.
    • Moderate-severe leptospirosis is best managed in a healthcare/hospital setting.

    Severe Manifestations

    • Severe symptoms may include jaundice, renal failure, pulmonary hemorrhage, myocarditis, and hypotension that is resistant to fluid resuscitation.

    Weil's Disease

    • Characterized by the triad of fever, jaundice, and renal failure.

    Diagnostic Methods

    • Culture and isolation remains the gold standard but is time-consuming and has a low yield.
    • Polymerase Chain Reaction (PCR) allows early diagnosis during the acute illness phase.
    • Direct detection methods: Culture and PCR.
    • Indirect detection methods: Microagglutination test (MAT), specific IgM rapid diagnostic tests, and nonspecific tests like LAATS.

    Microagglutination Test

    • A four-fold rise in titer from acute to convalescent sera confirms diagnosis.
    • In endemic areas, a single titer of at least 1:1600 in symptomatic individuals indicates leptospirosis.

    Specific IgM Rapid Diagnostic Tests

    • Detect Leptospira-specific IgM antibodies quickly, with a sensitivity of 63-72% in early stages, improving past 7 days.

    Laboratory Findings

    • Complete blood count may show leukocytosis, neutrophilia, and thrombocytopenia.
    • Urinalysis typically reveals proteinuria, pyuria, and sometimes hematuria, with possible casts seen early in the illness.
    • Serum creatinine levels can remain normal initially but may rise, indicating acute kidney injury.

    Radiologic Findings

    • Common findings include a patchy alveolar pattern due to scattered alveolar hemorrhage.

    Treatment Protocols

    • Mild leptospirosis is treated with doxycycline as the drug of choice; alternatives include amoxicillin and azithromycin.
    • Moderate-severe cases require Penicillin G, with alternatives including parenteral ampicillin and third-generation cephalosporins.
    • Antibiotic therapy should be completed within 7 days.

    Antibiotic Administration

    • Doxycycline: 100 mg twice daily for 7 days.
    • Amoxicillin: 500 mg every 6 hours or 1 g every 8 hours for 7 days.
    • Azithromycin: 1 g initially, followed by 500 mg daily for 2 days.

    Prophylaxis

    • The most effective prevention involves avoiding high-risk exposures. If unavoidable, personal protective measures are recommended.
    • Pre-exposure prophylaxis with doxycycline 200 mg once daily is recommended for individuals at high risk.
    • No recommended pre-exposure prophylaxis is safe for pregnant or lactating women.

    Post-Exposure Prophylaxis

    • Low risk exposure: Doxycycline 200 mg single dose within 24-72 hours.
    • Moderate risk exposure: Doxycycline 200 mg daily for 3-5 days.
    • High risk exposure: Doxycycline 200 mg weekly until end of exposure.

    Contraindications and Side Effects

    • Doxycycline is contraindicated during pregnancy and breastfeeding due to risk of permanent discoloration of teeth in infants.
    • Not advised for children under 8 years due to similar concerns.
    • May reduce effectiveness of birth control pills and increase sensitivity to sunlight.

    Complications of Leptospirosis

    • Acute kidney injury (AKI) is a major complication, characterized by proteinuria to severe anuria.
    • AKI manifests with oliguria and hyperkalemia, portending a poor prognosis.
    • Key indicators include serum creatinine, sodium, potassium, urinalysis, and potentially urine/serum neutrophil gelatinase-associated lipocalin (NGAL).

    Pulmonary Complications

    • Tachypnea is the first sign of pulmonary involvement.
    • Common complications include pulmonary hemorrhage and ARDS, associated with high mortality rates.
    • Acute lung injury is defined by acute PaO2/FIO2 ≤ 300 mmHg, while ARDS is defined by acute PaO2/FIO2 ≤ 200 mmHg.

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    Description

    This quiz explores the clinical manifestations and risk factors associated with leptospirosis, particularly in patients presenting with acute fever. Learn how to identify suspected cases based on specific symptoms and exposure history, and understand the criteria for mild leptospirosis.

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