A 10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, sev

Discussion in 'MRCPCH forum' started by samuel, Sep 10, 2014.

  1. samuel

    samuel New Member

    A 10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, severe muscle pain, pharyngitis, headache, scleral injection, photophobia, and cervical adenopathy. After 7 days of symptoms he seemed to get better, but yesterday he developed fever, nausea, emesis, headache and mild nuchal rigidity. Cerebrospinal fluid (CSF) shows 200 white blood cells (WBC) per microliter (all monocytes) and an elevated protein. Correct statements about this infection include which of the following?
    a. The condition is obtained from arthropod vectors
    b. CNS involvement is uncommon
    c. Most cases are mild or subclinical
    d. Appropriate treatment includes intravenous (IV) immune globulin (IVIG) and
    e. Hepatic and renal involvement occurs in the majority of cases
  2. samuel

    samuel New Member

    The ans is C
    Leptospirosis is the most common zoonotic infection worldwide, and is often a mild or subacute illness, frequently escaping detection. Usually a history of exposure to dogs, cats, livestock, rats, or other wild animals is obtained. Two distinct courses of infection are described: “anicteric” leptospirosis and “icteric” leptospirosis (also called Weil syndrome). Both courses start with similar symptoms, as described in the case vignette, termed the “septicemic” phase. The majority of cases are anicteric, and after a few days of symptom resolution, patients go on to the “immune” phase in which meningitic symptoms return and can last up to a month. Between 50% to 90% of cases have meningeal involvement. Less than 10% of leptospirosis cases are “icteric,” but these patients go on to have more severe symptoms involving liver and kidney dysfunction. Penicillin and tetracycline (in children 10 years and older) are appropriate treatments, and seem to shorten the duration of the illness if started in the first week of symptoms. Some recommend prophylaxis with weekly doxycycline in endemic areas of the world. IVIG and aspirin are appropriate treatments for Kawasaki disease, but not leptospirosis

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