Indiana University Infectious Diseases Fellowship
24 Jan,
11 tweets, 5 min read
#idboardreview 25 M ‘mud run’ in Hawaii 2wks go, ski trip in Colorado 1wk ago now presents w/ F, hypoxia, wbc20k, Hb7, plt90, ⬆️cpk 2k⬆️Cr, mild⬆️lft, required mech ventilation, bloody respiratory secretions. Diagnosis? #medEd #idmedEd #idtwitter 
diffuse alveolar hemorrhage (DAH) due to leptospirosis pulmonary hemorrhage syndrome (LPHS) #leptospira interrogans
DIffuse alveolar hemorrhage Infectious DDx dengue, malaria, influenza A, leptospirosis, hantavirus, staph aureus, adenovirus, cmv, aspergillosis, Mycoplasma, Legionella, Strongyloides
#Leptospirosis occurs in humans following contact of mucous membranes or abraded skin with the spirochete Leptospira interrogans, excreted in the urine of infected animals. Hawaii has the highest endemicity
#leptospirosis Exposure to contaminated water, soil, and other matter places several populations at risk: rural animal or vegetable farmers, slaughterhouse workers, flood victims, soldiers, and urban sanitation workers or children exposed to rat urine in garbage or alleyways
#leptospirosis aka
Weil’s syndrome,
hemorrhagic jaundice,
swineherd’s disease,
Fort Bragg fever,
swamp fever,
mud fever,
autumn fever,
field fever,
rice-field fever,
cane-cutter’s fever, and
canicola fever
Weil’s syndrome,
hemorrhagic jaundice,
swineherd’s disease,
Fort Bragg fever,
swamp fever,
mud fever,
autumn fever,
field fever,
rice-field fever,
cane-cutter’s fever, and
canicola fever
protean nature of most cases of leptospirosis, coupled with notoriously poor sensitivity & specificity of IgM for any infection make dx difficult. Convalescent sera & PCR can confirm dx but a ⬆️clinical suspicion w/ biphasic illness in high risk pt is crucial for early abx
Treatment for severe #leptospirosis should include penicillin, or a third generation cephalosporin
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