2025 – PAGE 308 – INFECTIOUS DISEASES
LEPTOSPIROSIS
LeptoSPIROsis is caused by a SPIROchete that doesn’t stain well. Look for multisystem complaints. Some of them may include a NONexudative conjunctivitis referred to as a CONJUNCTIVAL SUFFUSION, a transient rash, abdominal pain, and headache or evidence of a non-bacterial meningitis. It may also present as the combination of liver and renal failure. It’s transmitted through the urine of animals (such as dogs, cats, and squirrels). Diagnostic testing depends on timing. During the first week, get blood cultures. After that, check the urine. Treat with penicillin.
PEARL: If you see the words CONJUNCTIVAL SUFFUSION, PICK THIS AND MOVE ON! A conjunctival suffusion basically looks like conjunctivitis (seen as red sclera), but without tearing or discharge.
IMAGE: www.pbrlinks.com/LEPTOSPIROSIS1
IMAGE: www.pbrlinks.com/LEPTOSPIROSIS2
MNEMONIC: Imagine that a DOG WITH FIERY EYES LEAPT into a POND and started doing a back stroke. When the owner LEAPT in to play with the dog, his EYE hit the dog’s GENITOURINARY APPARATUS (AKA PENIS), and his ABDOMEN got hit with the dog’s legs.
- KEY: DOG WITH FIERY EYES = animal reservoir and conjunctival suffusion, LEAPT = LEPTospirosis, POND = from urine to water and then ingested, EYE = conjunctival suffusion, GU APPARATUS = transmitted via urine, and ABDOMEN = abdominal pain from liver involvement (might also remind you of renal failure).
FUNGAL & ATYPICAL BACTERIA
PEARL: Any unstable or ICU patient with sepsis due to fungemia should be treated with AMPHOTERICIN B. If there is renal disease, give liposomal amphotericin.