A 28-year-old pregnant woman at 36 weeks develops painless jaundice, haematuria, thrombocytopenia and altered sensorium after exposure to flood water. Weil-Felix test is negative. Microscopic agglutination test (MAT) shows titre ≥1:200 against Leptospira icterohaemorrhagiae. Which organ failure pattern is most characteristic of Weil's disease and what is the first-line antibiotic?

• A Renal failure alone; treated with doxycycline
• B Predominantly pulmonary failure (ARDS); treated with azithromycin
• C Neurological failure (meningitis) without hepato-renal involvement; treated with rifampicin
• D Combined hepatic and renal failure (hepato-renal syndrome) with haemorrhagic manifestations; treated with IV penicillin G or IV ceftriaxone ✓

Explanation

Weil's disease (severe leptospirosis) is caused by Leptospira interrogans serovar icterohaemorrhagiae. The hallmark is biphasic illness with a hepato-renal syndrome: jaundice + acute tubular necrosis (oliguric renal failure) + haemorrhagic manifestations (thrombocytopenia, bleeding tendency). In pregnancy, leptospirosis is particularly dangerous as it can cause fetal demise. First-line treatment for severe Weil's disease is IV penicillin G or IV ceftriaxone (equivalent). Doxycycline (100 mg BD) is used for mild/moderate non-icteric leptospirosis and prophylaxis. MAT (Microscopic Agglutination Test) is the WHO gold standard serological reference method.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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