Weil syndrome, jaundice leptospirosis

Abstract

Leptospirosis is the most common zoonotic disease in the world, with great epidemic potential in the rainy season; caused by a spirochete called leptospiratransmitted by rodents and won to humans through contact with their urine. There are several clinical forms that range from mild forms that limit themselves (90%) to a severe icterohemorrhagic form (10%) that can be fatal. Its diagnosis is serological (MAT) and / or culture of the bacteria, its differential is complex for the staff due to its varied clinical forms that occur with nonspecific symptoms, fever and / or jaundice without pathognomonic findings, having a wide range of pathologies with similar characteristics for which the epidemiological antecedent must be affiliated; and finally its treatment is based on intravenous penicillins in severe forms and orally in mild forms, and in allergic macrolides or tetracyclines depending on the age group.

Objective: To describe an epidemiologically relevant clinical case in Ecuador such as Weil's syndrome, icteric leptospirosis.

Material and Methods: Retrospective descriptive study, clinical case presentation

Results: This is a young adult female patient with nopersonal history relevant to the case, debuts with flu symptoms associated with fever 39 ° daily without a predominance schedule, with an initial diagnosis of acute bronchitis receiving 5 days of amoxicillin plus clavulanic acid orally However, symptoms persist and are accompanied by jaundice, which is why complementary tests that reveal cholestatic pattern, hyperbilirubinemia are performed at the expense of direct and microscopic hematuria. Differentials of ichteric febrile syndrome are initially studied,assessing extrahepatic cholestasis with an abdominal echo that reports liver. of normal characteristics, distended gallbladder without stones, bile duct without alterations so that causes of intrahepatic cholestasis with viral hepatotropics and non-negative hepatotropes, antibodies to autoimmune hepatitis negative, febrile negative agglutinations, negative blood culture are investigated and finally, when reinterrogating the patient, she reveals the occupational risk factor of contact with rodents (storage warehouse auditor) and recent trip to the coastal area, so they are carried out to investigate tropical diseases with negative hematozoa, IgM for dengue negative and finally on the 4th day of admission with discarded differentials, by epidemiological background, leptospira is studied in blood with ELISA and in urine with positive result, taking the sample at day 7 according to the literature and receiving the result at day 8. The symptomatic picture resolved within 10 days and was sent with doxycycline at discharge on the 12th day. At 10 days in control by external consultation, asymptomatic patient with normal liver profile.

Conclusions: Given the atypical presentation of the condition, it is underdiagnosed, thus increasing the number of fatal outcomes in 5-10% of the icterohemorrhagic clinical form, so it must be considered in the differential diagnosis of ichteric tropical and febrile diseases with the epidemiological background. to start timely treatment.