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.