Wednesday: MR with Alice and Dr. Harry Hollander: Leptospirosis

A middle aged man with fever, bone pain who presents after travel with thrombocytopenia, transaminitis, and AKI ultimately diagnosed with Leptospirosis.

*How do I factor in prophylaxis in a returning traveler?– know that malaria has A LOT of resistance – you need to know if the patient received appropriate prophylaxis for Falciparum in the region – Malarone (atovaquone and proguanil) is generally good for malaria prophylaxis.  The Yellow Fever is a good vaccine

*Know the DDx for fever in a returning traveler: Malaria, Dengue, Chikungunya, Rickettsia, Scrub Typhus, Leptospirosis, Influenza, and Acute HIV

*This case was a very classic presentation for leptospirosis known as Weil’s disease-> liver damage (causing jaundice), AKI (tends to be an interstitial nephritis); and bleeding

*Most ricketssial disease have a dramatic response to doxycycline – also the drug of choice for leptospirosis if the patient does not have meningeal disease

*Geosentinel is a global surveillance network of travel medicine clinics that collect data from ill international travels.

http://www.istm.org/geosentinel

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