A 22-year-old farmer from Tamil Nadu presents after heavy rain with fever, severe muscle pain, jaundice, conjunctival suffusion, and haematuria. Blood culture on Fletcher's EMJH medium is ordered. Microscopic agglutination test (MAT) with live Leptospira serovars shows titre of 1:800 against serovar Icterohaemorrhagiae. Which complication is this patient at highest risk for, and what antibiotic is used for severe leptospirosis?
- A Weil's disease (icteric leptospirosis) with AKI, hepatic failure, pulmonary haemorrhage; treated with intravenous penicillin G or ceftriaxone 1 g IV OD ✓
- B Anicteric leptospirosis (mild form); treated with doxycycline 100 mg BD orally for 7 days only
- C Weil's disease; treated with azithromycin as first-line due to nephrotoxicity of beta-lactams in AKI
- D Haemorrhagic fever; no antibiotic is effective; supportive care with dialysis is the only management
Explanation
The clinical triad of jaundice + AKI + hepatic dysfunction with conjunctival suffusion and muscle tenderness in a farmer after flooding defines Weil's disease (icteric/severe leptospirosis), caused predominantly by serovar Icterohaemorrhagiae (from rats). This is confirmed by MAT titre ≥1:800 (or fourfold rise in paired sera). Complications include acute kidney injury, hepatorenal failure, myocarditis, uveitis, and severe pulmonary haemorrhage syndrome (SPHS). For severe leptospirosis: IV penicillin G 1.5 MU QID or ceftriaxone 1 g IV OD for 7 days. Doxycycline 100 mg BD for 7 days is used for mild (anicteric) disease. Dialysis may be needed adjunctively for AKI.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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