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      "title": "A CASE REPORT ON LEPTOSPIROSIS (DAVAO DOCTORS' HOSPITAL,DAVAO CITY ,PHILIPPINES",
      "body": "AUTHOR : MD EBADULLAH , DAVAO DOCTORS' HOSPITAL , DAVAO CITY , PHILIPPINES \nDavao Doctors’ Hospital\n\n\nCase Presentation of \n\n\n\n\n\n\n\nSubmitted by :\nMD EBADULLAH\n\n\n\nGeneral data:\nPatient S.A. is a 20 years old female  having a birthdate of 10/27/1996 is a Student by occupation from Banga, South cotabato is a Filippino came in with a chief complaint of Headache and Fever .\n\nInformant : Self and aunt with a good reliability\n \n\n\nHistory of Present Illness :\n24 days Prior to admission (PTA) patient went with her family to place one hour away from their place Surallah, South Cotabato for swimming in freely flowing river.in the interim , no signs or symptoms noted .\n21 days PTA ,Patient experienced a sudden onset of Intermittent Fever ( Tmax : 39 degree celsius ).No consultation done ,self medicated with Paracetamol 500mg /tab. Associated signs and symptoms includes vomiting two episodes moderate in amount non bloody no bilious ,non projectile along with Loose bowel movement 4 x day x loose brown stools x 1 cup in amount along with crampy epigastric pain ( pain scale grade 5/10  ),no aggravating or relieving factor noted.in the Interim signs and symptoms persisted and were well tolerated by the patient.\n17 days PTA  Admitted in a Local Govt. Hospital  due to crampy Epigastric pain with a pain scale grade of 5/10 , managed  as a case of UTI , AGE and was treated with Ciprofloxacin 500/tab xBIDx7days.Patients signs and symptoms improved and was discharged from the hospital 15 days prior to admission.\n14 days PTA , Patient complained of  frontal headache persistent in thumping in nature ( pain scale grade 10 /10 ) with no other aggravating  or relieving fact. Associated signs and symptoms include Vomiting post prandial x 2 cups /day x projectile along with intermittent fever. In the interim, signs and symptoms worsened in severity and \n6 days PTA , consultation done to a private physician at a private hospital . Work up        done . Managed as a case of Typhoid Fever . 3 unrecalled meds taken for three days. 3days PTA, Patient started to have Visual auditory hallucination ( not suicidal , irritable and with intermittent fever and vomiting 4 x day ,projectile ,non bilous no bloody .Patient was taken to and admitted at a local Private Hospital. \n2 days PTA, patient noted to have one episodes of Epistaxis. Managed as a case of Typhoid Fever with neuro-psychotic SLE.no improvement of signs and symptoms noted.12 hours PTA ,Persistence of Same S/Sx mentioned above  Referred to our institution for further consultation . Hence admission.\n\n\n\n\nPast medical History :\n2016 : diagnosed with Appendicitis even though surgery was not done and was not a part of the treatment .\n\nFamily History :\nPaternal Side : (+) hypertension\n                          (+) diabetes mellitus \nPersonal and Social History :\nEducation : College level pursuing Education \nGood interpersonal relation with family and friends \nNo hx of taking alcohol, smoking or any substance abuse as claimed by the watcher .\n\nREVIEW OF SYSTEMS\nGeneral : (+) Anorexia (-) Weight Loss (+) Fever\nHEENT : (+)Photophobia , No dysphagia or odynophagia. (+) neck stiffness.\nGastro-intestinal (-) Diarrhea ,(+) Vomiting \nPulmonary : No Dyspnea, (-) Cough.\nCardiac : No Palpitations, No Chest pain, No Orthopnea.\nVascular : No Phlebitis, No Varicosities.\n\n\nGenito-Urinary : (-) No Dysuria, (-) No Flank Pain, No Discharges, No Urgency.\nNeurologic : No Memory Loss, No Seizures, No loss of consciousness\nMusculoskeletal : (+) Joint Pains, No Cramps.\nPsychiatric : (+) Behavioral change as claimed by the watcher \nPhysical Examination :\n\nPHYSICAL EXAMINATION:\n\nGeneral examination :Patient is examined awake, febrile, Irritable not in respiratory distress.\nSHEENT :\nS :Warm skin [+] jaundice ,good skin texture and turgor .no signs of dehydration \nH : Normocephalic Atraumatic skull ,[-] scars ,diffuse black hair distribution\nE : Pink palpebral conjunctivae,  [-]discharges [+] icterus\nE : ear grossly normal,  anatomically symmetric\nN : [-] discharges, septum midline , normal nasal turbinates \nT : [-]erythematous tonsils, [-] exudates\nNECK : midline trachea, [-] bilateral CLAD  , ( -) neck vein engorgement \n\n\n\n\n\n\nCHEST:\nI  :  not in respiratory distress. No retractions, scars, masses.\nP : equal chest expansion. Tactile fremitus equal on both lung fields\nP : resonant all over\nA : clear breath sounds, no adventitious sounds heard.\n\nCARDIAC :\nI : Adynamic Precordium \nP :  [-] heaves [-] thrills\nA : s1 s2 heard distinctly, no murmurs appreciated, normal cardiac rate and rhythm\n\nABDOMEN :\nI :  no scars no bulging noted\nA : normoactive bowel sounds\nP : non tender on light and deep palpation      [-]kidney punch sign bilaterally, [-] murphys sign, [-] fluid thrill. [+] palpable Hepatosplenomegaly , [-] mass\nP : tympanic to percussion in all quadrants \nMUSCULOSKELETAL\nGrossly normal limbs\n(+) tenderness on all joints\nGood range of motion in all extrimites: 5/5\n sensory fuction :  100% in all four limbs\n(+) calf muscle tenderness\n[-] edema of hands and feet\nFull pulses\nCRT = 2sec\n\nNEURO EXAM\n  Orientation : \n    Patient is oriented to time and person ,not with place\n \nCRANIAL NERVES\n    I – Smell intact\n    II – Visual Acquity intact \n    III, IV, IV – Patient shows adequate extraocular movements equally and bilaterally\n\n\nV - Equal Sensation to the face, masseter and buccinator muscle tone are adequate. \nVII - Patient does not exhibit facial asymmetry, all facial expressions intact \nVIII - Patient is able to hear equally on both sides , ataxia : not assessed\nIX, X - Patient is able to swallow, shows adequate gag reflex, uvula is midline.\n\n\nXI :  can shrug her shoulder against resistance \n XII : tongue movement intact \n\n\n(+)Brudzenski sign \n(-) Kernig’s sign\n\n\nAdmitting Impresssion : \n Leptospiral meningitis  vs Cerebral Malaria \n\n\n\n\nSalient Features :\n20 years old /female \nhx of swimming in a freely flowing river \nVA hallucination ( not suicidal ),\nirritability ,\nintermittent fiver \nvomiting 4 x day projectile \nAnorexia \nFever \nPhotophobia \nNeck stiffness\nCalf Muscle tenderness\nJoint Pain \nBehavioral Changes\nJaundice \n joint pain\n palpable hepatosplenomegaly \n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\nCourse in the Ward : \n \n\n\n\n\n\n \n\n \n\n\n\n\n \n \n\n\n\n\n \n \n \n\n \n\n\n\n\n\n \n\n\n\n\n\nDiscussion on Leptospirosis and complications : \n\n1 million cases occur per year worldwide with a mean case – fatality rate of nearly10%. (source : Harrison’s principles of internal medicine,19 th Edition )\n\nPrevalence : a total of 337 cases of the disease across the Philippines from January 1 to March 25, 2017, including 30 fatalities.\n      (source : Data from the Public Health Division of Epidemiology Surveillance Bureau of the Department of Health (DOH) ) \n\nIndia : detected 232 cases of leptospirosis in the five years of study period (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008)\n       (source : Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study Sunil Sethi,1,* Navneet Sharma,2 Nandita Kakkar,3 Juhi Taneja,1 Shiv Sekhar Chatterjee,1 Surinder Singh Banga,1 andMeera Sharma )\n\nSource : [Possibilities for laboratory diagnosis of leptospiroses].\n[Article in Czech] Perželová J, Jareková J, Kotrbancová M, Špaleková M\n\nLeptospiroses are worldwide spread zoonoses caused by hydrophilic bacteria of the genus Leptospira. \n\nHumans can be infected by contact with an infected animal or indirectly via staying in a contaminated environment (water, wet soil), in natural foci, while working outdoors, or while doing outdoor sport and leisure activities. \n\nLeptospirosis may manifest as a mild flu-like illness or in a severe febrile form (meningitis, pulmonary haemorrhage, hepato-renal syndrome, or myocarditis). \n\nSurvival Rate:\nMedian series mortality was 2.2% (Range 0.0-39.7%),\nmortality is high in jaundiced patients (19.1%) (Range 0.0-39.7%), \nthose with renal failure 12.1% (Range 0-25.0%) \nand in patients aged over 60 (60%) (Range 33.3-60%), \nbut low in anicteric patients (0%) (Range 0-1.7%).\n\n   ( Source : A Systematic Review of the Mortality from Untreated Leptospirosis. Taylor AJ1, Paris DH2, Newton PN1)\n\n\nHost & the Etiologic Agent :\n\n                                                     \n\na corkscrew-shaped bacterium called Leptospira interrogans, is often referred to as “rat fever” due to the principal role rats play in spreading the disease (scientists refer this type of animal as a reservoir host).\n             (Source : Leptospirosis cases up 68 percent in the Philippines in 2017 by ROBERT HERRIMAN )\n \n\n\n\n\n\n\n\nL. biflexa  , L. santarosai ,L. borgpeterseni , L. licerisiae  are other species of leptosires   (source : Harrison’s principles of internal medicine,19 th Edition )\n\n\n\n\nPathogenesis:\n \nSource : WHO South-East Asia Regional Office Leptospirosis Fact Sheet\n \n\n \nDiagnosis:\n Hx & P.E.\n\nElevated CRP and ESR \n\nThrombocytopenia ( </ 100 x 10^9 /L) associated with bleeding and renal failure \n\nAseptic meningitis : C.S.F. pleocytosis with polymorphonuclear cells (>1000 cells/micro liter)\n\nDefinitive diagnosis :PCR or MAT\n\n                                                                         (  source : Harrison’s principles of internal medicine,19 th Edition )\n\n \n\n\n                     THE END",
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      "title": "A CASE REPORT ON LEPTOSPIROSIS (DAVAO DOCTORS' HOSPITAL,DAVAO CITY ,PHILIPPINES",
      "body": "AUTHOR : MD EBADULLAH , DAVAO DOCTORS' HOSPITAL , DAVAO CITY , PHILIPPINES \nDavao Doctors’ Hospital\n\n\nCase Presentation of \n\n\n\n\n\n\n\nSubmitted by :\nMD EBADULLAH\n\n\n\nGeneral data:\nPatient S.A. is a 20 years old female  having a birthdate of 10/27/1996 is a Student by occupation from Banga, South cotabato is a Filippino came in with a chief complaint of Headache and Fever .\n\nInformant : Self and aunt with a good reliability\n \n\n\nHistory of Present Illness :\n24 days Prior to admission (PTA) patient went with her family to place one hour away from their place Surallah, South Cotabato for swimming in freely flowing river.in the interim , no signs or symptoms noted .\n21 days PTA ,Patient experienced a sudden onset of Intermittent Fever ( Tmax : 39 degree celsius ).No consultation done ,self medicated with Paracetamol 500mg /tab. Associated signs and symptoms includes vomiting two episodes moderate in amount non bloody no bilious ,non projectile along with Loose bowel movement 4 x day x loose brown stools x 1 cup in amount along with crampy epigastric pain ( pain scale grade 5/10  ),no aggravating or relieving factor noted.in the Interim signs and symptoms persisted and were well tolerated by the patient.\n17 days PTA  Admitted in a Local Govt. Hospital  due to crampy Epigastric pain with a pain scale grade of 5/10 , managed  as a case of UTI , AGE and was treated with Ciprofloxacin 500/tab xBIDx7days.Patients signs and symptoms improved and was discharged from the hospital 15 days prior to admission.\n14 days PTA , Patient complained of  frontal headache persistent in thumping in nature ( pain scale grade 10 /10 ) with no other aggravating  or relieving fact. Associated signs and symptoms include Vomiting post prandial x 2 cups /day x projectile along with intermittent fever. In the interim, signs and symptoms worsened in severity and \n6 days PTA , consultation done to a private physician at a private hospital . Work up        done . Managed as a case of Typhoid Fever . 3 unrecalled meds taken for three days. 3days PTA, Patient started to have Visual auditory hallucination ( not suicidal , irritable and with intermittent fever and vomiting 4 x day ,projectile ,non bilous no bloody .Patient was taken to and admitted at a local Private Hospital. \n2 days PTA, patient noted to have one episodes of Epistaxis. Managed as a case of Typhoid Fever with neuro-psychotic SLE.no improvement of signs and symptoms noted.12 hours PTA ,Persistence of Same S/Sx mentioned above  Referred to our institution for further consultation . Hence admission.\n\n\n\n\nPast medical History :\n2016 : diagnosed with Appendicitis even though surgery was not done and was not a part of the treatment .\n\nFamily History :\nPaternal Side : (+) hypertension\n                          (+) diabetes mellitus \nPersonal and Social History :\nEducation : College level pursuing Education \nGood interpersonal relation with family and friends \nNo hx of taking alcohol, smoking or any substance abuse as claimed by the watcher .\n\nREVIEW OF SYSTEMS\nGeneral : (+) Anorexia (-) Weight Loss (+) Fever\nHEENT : (+)Photophobia , No dysphagia or odynophagia. (+) neck stiffness.\nGastro-intestinal (-) Diarrhea ,(+) Vomiting \nPulmonary : No Dyspnea, (-) Cough.\nCardiac : No Palpitations, No Chest pain, No Orthopnea.\nVascular : No Phlebitis, No Varicosities.\n\n\nGenito-Urinary : (-) No Dysuria, (-) No Flank Pain, No Discharges, No Urgency.\nNeurologic : No Memory Loss, No Seizures, No loss of consciousness\nMusculoskeletal : (+) Joint Pains, No Cramps.\nPsychiatric : (+) Behavioral change as claimed by the watcher \nPhysical Examination :\n\nPHYSICAL EXAMINATION:\n\nGeneral examination :Patient is examined awake, febrile, Irritable not in respiratory distress.\nSHEENT :\nS :Warm skin [+] jaundice ,good skin texture and turgor .no signs of dehydration \nH : Normocephalic Atraumatic skull ,[-] scars ,diffuse black hair distribution\nE : Pink palpebral conjunctivae,  [-]discharges [+] icterus\nE : ear grossly normal,  anatomically symmetric\nN : [-] discharges, septum midline , normal nasal turbinates \nT : [-]erythematous tonsils, [-] exudates\nNECK : midline trachea, [-] bilateral CLAD  , ( -) neck vein engorgement \n\n\n\n\n\n\nCHEST:\nI  :  not in respiratory distress. No retractions, scars, masses.\nP : equal chest expansion. Tactile fremitus equal on both lung fields\nP : resonant all over\nA : clear breath sounds, no adventitious sounds heard.\n\nCARDIAC :\nI : Adynamic Precordium \nP :  [-] heaves [-] thrills\nA : s1 s2 heard distinctly, no murmurs appreciated, normal cardiac rate and rhythm\n\nABDOMEN :\nI :  no scars no bulging noted\nA : normoactive bowel sounds\nP : non tender on light and deep palpation      [-]kidney punch sign bilaterally, [-] murphys sign, [-] fluid thrill. [+] palpable Hepatosplenomegaly , [-] mass\nP : tympanic to percussion in all quadrants \nMUSCULOSKELETAL\nGrossly normal limbs\n(+) tenderness on all joints\nGood range of motion in all extrimites: 5/5\n sensory fuction :  100% in all four limbs\n(+) calf muscle tenderness\n[-] edema of hands and feet\nFull pulses\nCRT = 2sec\n\nNEURO EXAM\n  Orientation : \n    Patient is oriented to time and person ,not with place\n \nCRANIAL NERVES\n    I – Smell intact\n    II – Visual Acquity intact \n    III, IV, IV – Patient shows adequate extraocular movements equally and bilaterally\n\n\nV - Equal Sensation to the face, masseter and buccinator muscle tone are adequate. \nVII - Patient does not exhibit facial asymmetry, all facial expressions intact \nVIII - Patient is able to hear equally on both sides , ataxia : not assessed\nIX, X - Patient is able to swallow, shows adequate gag reflex, uvula is midline.\n\n\nXI :  can shrug her shoulder against resistance \n XII : tongue movement intact \n\n\n(+)Brudzenski sign \n(-) Kernig’s sign\n\n\nAdmitting Impresssion : \n Leptospiral meningitis  vs Cerebral Malaria \n\n\n\n\nSalient Features :\n20 years old /female \nhx of swimming in a freely flowing river \nVA hallucination ( not suicidal ),\nirritability ,\nintermittent fiver \nvomiting 4 x day projectile \nAnorexia \nFever \nPhotophobia \nNeck stiffness\nCalf Muscle tenderness\nJoint Pain \nBehavioral Changes\nJaundice \n joint pain\n palpable hepatosplenomegaly \n\n\n\n\n\n\n\n\n\n \n\n\nCourse in the Ward : \n \n\n\n\n\n\n \n\n \n\n\n\n\n \n \n\n\n\n\n \n \n \n\n \n\n\n\n\n\n \n\n\n\n\n\nDiscussion on Leptospirosis and complications : \n\n1 million cases occur per year worldwide with a mean case – fatality rate of nearly10%. (source : Harrison’s principles of internal medicine,19 th Edition )\n\nPrevalence : a total of 337 cases of the disease across the Philippines from January 1 to March 25, 2017, including 30 fatalities.\n      (source : Data from the Public Health Division of Epidemiology Surveillance Bureau of the Department of Health (DOH) ) \n\nIndia : detected 232 cases of leptospirosis in the five years of study period (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008)\n       (source : Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study Sunil Sethi,1,* Navneet Sharma,2 Nandita Kakkar,3 Juhi Taneja,1 Shiv Sekhar Chatterjee,1 Surinder Singh Banga,1 andMeera Sharma )\n\nSource : [Possibilities for laboratory diagnosis of leptospiroses].\n[Article in Czech] Perželová J, Jareková J, Kotrbancová M, Špaleková M\n\nLeptospiroses are worldwide spread zoonoses caused by hydrophilic bacteria of the genus Leptospira. \n\nHumans can be infected by contact with an infected animal or indirectly via staying in a contaminated environment (water, wet soil), in natural foci, while working outdoors, or while doing outdoor sport and leisure activities. \n\nLeptospirosis may manifest as a mild flu-like illness or in a severe febrile form (meningitis, pulmonary haemorrhage, hepato-renal syndrome, or myocarditis). \n\nSurvival Rate:\nMedian series mortality was 2.2% (Range 0.0-39.7%),\nmortality is high in jaundiced patients (19.1%) (Range 0.0-39.7%), \nthose with renal failure 12.1% (Range 0-25.0%) \nand in patients aged over 60 (60%) (Range 33.3-60%), \nbut low in anicteric patients (0%) (Range 0-1.7%).\n\n   ( Source : A Systematic Review of the Mortality from Untreated Leptospirosis. Taylor AJ1, Paris DH2, Newton PN1)\n\n\nHost & the Etiologic Agent :\n\n                                                     \n\na corkscrew-shaped bacterium called Leptospira interrogans, is often referred to as “rat fever” due to the principal role rats play in spreading the disease (scientists refer this type of animal as a reservoir host).\n             (Source : Leptospirosis cases up 68 percent in the Philippines in 2017 by ROBERT HERRIMAN )\n \n\n\n\n\n\n\n\nL. biflexa  , L. santarosai ,L. borgpeterseni , L. licerisiae  are other species of leptosires   (source : Harrison’s principles of internal medicine,19 th Edition )\n\n\n\n\nPathogenesis:\n \nSource : WHO South-East Asia Regional Office Leptospirosis Fact Sheet\n \n\n \nDiagnosis:\n Hx & P.E.\n\nElevated CRP and ESR \n\nThrombocytopenia ( </ 100 x 10^9 /L) associated with bleeding and renal failure \n\nAseptic meningitis : C.S.F. pleocytosis with polymorphonuclear cells (>1000 cells/micro liter)\n\nDefinitive diagnosis :PCR or MAT\n\n                                                                         (  source : Harrison’s principles of internal medicine,19 th Edition )\n\n \n\n\n                     THE END",
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      "title": "A CASE REPORT ON LEPTOSPIROSIS (DAVAO DOCTORS' HOSPITAL,DAVAO CITY ,PHILIPPINES",
      "body": "AUTHOR : MD EBADULLAH , DAVAO DOCTORS' HOSPITAL , DAVAO CITY , PHILIPPINES \nDavao Doctors’ Hospital\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCase Presentation of a 20 year old female with complaints of Headache and Fever\n\n\n\n\n\n\n\n\n\n\n\nIn partial fulfillment for the requirement in the Department of Internal Medicine\n\n\n\n\n\n\n\nSubmitted by :\nMD EBADULLAH\n\n\n\nGeneral data:\nPatient S.A. is a 20 years old female  having a birthdate of 10/27/1996 is a Student by occupation from Banga, South cotabato is a Filippino came in with a chief complaint of Headache and Fever .\n\nInformant : Self and aunt with a good reliability\n \n\n\nHistory of Present Illness :\n24 days Prior to admission (PTA) patient went with her family to place one hour away from their place Surallah, South Cotabato for swimming in freely flowing river.in the interim , no signs or symptoms noted .\n21 days PTA ,Patient experienced a sudden onset of Intermittent Fever ( Tmax : 39 degree celsius ).No consultation done ,self medicated with Paracetamol 500mg /tab. Associated signs and symptoms includes vomiting two episodes moderate in amount non bloody no bilious ,non projectile along with Loose bowel movement 4 x day x loose brown stools x 1 cup in amount along with crampy epigastric pain ( pain scale grade 5/10  ),no aggravating or relieving factor noted.in the Interim signs and symptoms persisted and were well tolerated by the patient.\n17 days PTA  Admitted in a Local Govt. Hospital  due to crampy Epigastric pain with a pain scale grade of 5/10 , managed  as a case of UTI , AGE and was treated with Ciprofloxacin 500/tab xBIDx7days.Patients signs and symptoms improved and was discharged from the hospital 15 days prior to admission.\n14 days PTA , Patient complained of  frontal headache persistent in thumping in nature ( pain scale grade 10 /10 ) with no other aggravating  or relieving fact. Associated signs and symptoms include Vomiting post prandial x 2 cups /day x projectile along with intermittent fever. In the interim, signs and symptoms worsened in severity and \n6 days PTA , consultation done to a private physician at a private hospital . Work up        done . Managed as a case of Typhoid Fever . 3 unrecalled meds taken for three days. 3days PTA, Patient started to have Visual auditory hallucination ( not suicidal , irritable and with intermittent fever and vomiting 4 x day ,projectile ,non bilous no bloody .Patient was taken to and admitted at a local Private Hospital. \n2 days PTA, patient noted to have one episodes of Epistaxis. Managed as a case of Typhoid Fever with neuro-psychotic SLE.no improvement of signs and symptoms noted.12 hours PTA ,Persistence of Same S/Sx mentioned above  Referred to our institution for further consultation . Hence admission.\n\n\n\n\nPast medical History :\n2016 : diagnosed with Appendicitis even though surgery was not done and was not a part of the treatment .\n\nFamily History :\nPaternal Side : (+) hypertension\n                          (+) diabetes mellitus \nPersonal and Social History :\nEducation : College level pursuing Education \nGood interpersonal relation with family and friends \nNo hx of taking alcohol, smoking or any substance abuse as claimed by the watcher .\n\nREVIEW OF SYSTEMS\nGeneral : (+) Anorexia (-) Weight Loss (+) Fever\nHEENT : (+)Photophobia , No dysphagia or odynophagia. (+) neck stiffness.\nGastro-intestinal (-) Diarrhea ,(+) Vomiting \nPulmonary : No Dyspnea, (-) Cough.\nCardiac : No Palpitations, No Chest pain, No Orthopnea.\nVascular : No Phlebitis, No Varicosities.\n\n\nGenito-Urinary : (-) No Dysuria, (-) No Flank Pain, No Discharges, No Urgency.\nNeurologic : No Memory Loss, No Seizures, No loss of consciousness\nMusculoskeletal : (+) Joint Pains, No Cramps.\nPsychiatric : (+) Behavioral change as claimed by the watcher \nPhysical Examination :\n\nPHYSICAL EXAMINATION:\n\nGeneral examination :Patient is examined awake, febrile, Irritable not in respiratory distress.\nSHEENT :\nS :Warm skin [+] jaundice ,good skin texture and turgor .no signs of dehydration \nH : Normocephalic Atraumatic skull ,[-] scars ,diffuse black hair distribution\nE : Pink palpebral conjunctivae,  [-]discharges [+] icterus\nE : ear grossly normal,  anatomically symmetric\nN : [-] discharges, septum midline , normal nasal turbinates \nT : [-]erythematous tonsils, [-] exudates\nNECK : midline trachea, [-] bilateral CLAD  , ( -) neck vein engorgement \n\n\n\n\n\n\nCHEST:\nI  :  not in respiratory distress. No retractions, scars, masses.\nP : equal chest expansion. Tactile fremitus equal on both lung fields\nP : resonant all over\nA : clear breath sounds, no adventitious sounds heard.\n\nCARDIAC :\nI : Adynamic Precordium \nP :  [-] heaves [-] thrills\nA : s1 s2 heard distinctly, no murmurs appreciated, normal cardiac rate and rhythm\n\nABDOMEN :\nI :  no scars no bulging noted\nA : normoactive bowel sounds\nP : non tender on light and deep palpation      [-]kidney punch sign bilaterally, [-] murphys sign, [-] fluid thrill. [+] palpable Hepatosplenomegaly , [-] mass\nP : tympanic to percussion in all quadrants \nMUSCULOSKELETAL\nGrossly normal limbs\n(+) tenderness on all joints\nGood range of motion in all extrimites: 5/5\n sensory fuction :  100% in all four limbs\n(+) calf muscle tenderness\n[-] edema of hands and feet\nFull pulses\nCRT = 2sec\n\nNEURO EXAM\n  Orientation : \n    Patient is oriented to time and person ,not with place\n \nCRANIAL NERVES\n    I – Smell intact\n    II – Visual Acquity intact \n    III, IV, IV – Patient shows adequate extraocular movements equally and bilaterally\n\n\nV - Equal Sensation to the face, masseter and buccinator muscle tone are adequate. \nVII - Patient does not exhibit facial asymmetry, all facial expressions intact \nVIII - Patient is able to hear equally on both sides , ataxia : not assessed\nIX, X - Patient is able to swallow, shows adequate gag reflex, uvula is midline.\n\n\nXI :  can shrug her shoulder against resistance \n XII : tongue movement intact \n\n\n(+)Brudzenski sign \n(-) Kernig’s sign\n\n\nAdmitting Impresssion : \n Leptospiral meningitis  vs Cerebral Malaria \n\n\n\n\nSalient Features :\n20 years old /female \nhx of swimming in a freely flowing river \nVA hallucination ( not suicidal ),\nirritability ,\nintermittent fiver \nvomiting 4 x day projectile \nAnorexia \nFever \nPhotophobia \nNeck stiffness\nCalf Muscle tenderness\nJoint Pain \nBehavioral Changes\nJaundice \n joint pain\n palpable hepatosplenomegaly \n\n\n\n\n\n\n\n\n\n \n\n\nCourse in the Ward : \n \n\n\n\n\n\n \n\n \n\n\n\n\n \n \n\n\n\n\n \n \n \n\n \n\n\n\n\n\n \n\n\n\n\n\nDiscussion on Leptospirosis and complications : \n\n1 million cases occur per year worldwide with a mean case – fatality rate of nearly10%. (source : Harrison’s principles of internal medicine,19 th Edition )\n\nPrevalence : a total of 337 cases of the disease across the Philippines from January 1 to March 25, 2017, including 30 fatalities.\n      (source : Data from the Public Health Division of Epidemiology Surveillance Bureau of the Department of Health (DOH) ) \n\nIndia : detected 232 cases of leptospirosis in the five years of study period (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008)\n       (source : Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study Sunil Sethi,1,* Navneet Sharma,2 Nandita Kakkar,3 Juhi Taneja,1 Shiv Sekhar Chatterjee,1 Surinder Singh Banga,1 andMeera Sharma )\n\nSource : [Possibilities for laboratory diagnosis of leptospiroses].\n[Article in Czech] Perželová J, Jareková J, Kotrbancová M, Špaleková M\n\nLeptospiroses are worldwide spread zoonoses caused by hydrophilic bacteria of the genus Leptospira. \n\nHumans can be infected by contact with an infected animal or indirectly via staying in a contaminated environment (water, wet soil), in natural foci, while working outdoors, or while doing outdoor sport and leisure activities. \n\nLeptospirosis may manifest as a mild flu-like illness or in a severe febrile form (meningitis, pulmonary haemorrhage, hepato-renal syndrome, or myocarditis). \n\nSurvival Rate:\nMedian series mortality was 2.2% (Range 0.0-39.7%),\nmortality is high in jaundiced patients (19.1%) (Range 0.0-39.7%), \nthose with renal failure 12.1% (Range 0-25.0%) \nand in patients aged over 60 (60%) (Range 33.3-60%), \nbut low in anicteric patients (0%) (Range 0-1.7%).\n\n   ( Source : A Systematic Review of the Mortality from Untreated Leptospirosis. Taylor AJ1, Paris DH2, Newton PN1)\n\n\nHost & the Etiologic Agent :\n\n                                                     \n\na corkscrew-shaped bacterium called Leptospira interrogans, is often referred to as “rat fever” due to the principal role rats play in spreading the disease (scientists refer this type of animal as a reservoir host).\n             (Source : Leptospirosis cases up 68 percent in the Philippines in 2017 by ROBERT HERRIMAN )\n \n\n\n\n\n\n\n\nL. biflexa  , L. santarosai ,L. borgpeterseni , L. licerisiae  are other species of leptosires   (source : Harrison’s principles of internal medicine,19 th Edition )\n\n\n\n\nPathogenesis:\n \nSource : WHO South-East Asia Regional Office Leptospirosis Fact Sheet\n \n\n \nDiagnosis:\n Hx & P.E.\n\nElevated CRP and ESR \n\nThrombocytopenia ( </ 100 x 10^9 /L) associated with bleeding and renal failure \n\nAseptic meningitis : C.S.F. pleocytosis with polymorphonuclear cells (>1000 cells/micro liter)\n\nDefinitive diagnosis :PCR or MAT\n\n                                                                         (  source : Harrison’s principles of internal medicine,19 th Edition )\n\n \n\n\n                                                           THE END",
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      "permlink": "a-case-report-on-leptospirosis-davao-doctors-hospital-davao-city-philippines",
      "title": "A CASE REPORT ON LEPTOSPIROSIS (DAVAO DOCTORS' HOSPITAL,DAVAO CITY ,PHILIPPINES",
      "body": "AUTHOR : MD EBADULLAH , DAVAO DOCTORS' HOSPITAL , DAVAO CITY , PHILIPPINES \nDavao Doctors’ Hospital\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCase Presentation of a 20 year old female with complaints of Headache and Fever\n\n\n\n\n\n\n\n\n\n\n\nIn partial fulfillment for the requirement in the Department of Internal Medicine\n\n\n\n\n\n\n\nSubmitted by :\nMD EBADULLAH\n\n\n\nGeneral data:\nPatient S.A. is a 20 years old female  having a birthdate of 10/27/1996 is a Student by occupation from Banga, South cotabato is a Filippino came in with a chief complaint of Headache and Fever .\n\nInformant : Self and aunt with a good reliability\n \n\n\nHistory of Present Illness :\n24 days Prior to admission (PTA) patient went with her family to place one hour away from their place Surallah, South Cotabato for swimming in freely flowing river.in the interim , no signs or symptoms noted .\n21 days PTA ,Patient experienced a sudden onset of Intermittent Fever ( Tmax : 39 degree celsius ).No consultation done ,self medicated with Paracetamol 500mg /tab. Associated signs and symptoms includes vomiting two episodes moderate in amount non bloody no bilious ,non projectile along with Loose bowel movement 4 x day x loose brown stools x 1 cup in amount along with crampy epigastric pain ( pain scale grade 5/10  ),no aggravating or relieving factor noted.in the Interim signs and symptoms persisted and were well tolerated by the patient.\n17 days PTA  Admitted in a Local Govt. Hospital  due to crampy Epigastric pain with a pain scale grade of 5/10 , managed  as a case of UTI , AGE and was treated with Ciprofloxacin 500/tab xBIDx7days.Patients signs and symptoms improved and was discharged from the hospital 15 days prior to admission.\n14 days PTA , Patient complained of  frontal headache persistent in thumping in nature ( pain scale grade 10 /10 ) with no other aggravating  or relieving fact. Associated signs and symptoms include Vomiting post prandial x 2 cups /day x projectile along with intermittent fever. In the interim, signs and symptoms worsened in severity and \n6 days PTA , consultation done to a private physician at a private hospital . Work up        done . Managed as a case of Typhoid Fever . 3 unrecalled meds taken for three days. 3days PTA, Patient started to have Visual auditory hallucination ( not suicidal , irritable and with intermittent fever and vomiting 4 x day ,projectile ,non bilous no bloody .Patient was taken to and admitted at a local Private Hospital. \n2 days PTA, patient noted to have one episodes of Epistaxis. Managed as a case of Typhoid Fever with neuro-psychotic SLE.no improvement of signs and symptoms noted.12 hours PTA ,Persistence of Same S/Sx mentioned above  Referred to our institution for further consultation . Hence admission.\n\n\n\n\nPast medical History :\n2016 : diagnosed with Appendicitis even though surgery was not done and was not a part of the treatment .\n\nFamily History :\nPaternal Side : (+) hypertension\n                          (+) diabetes mellitus \nPersonal and Social History :\nEducation : College level pursuing Education \nGood interpersonal relation with family and friends \nNo hx of taking alcohol, smoking or any substance abuse as claimed by the watcher .\n\nREVIEW OF SYSTEMS\nGeneral : (+) Anorexia (-) Weight Loss (+) Fever\nHEENT : (+)Photophobia , No dysphagia or odynophagia. (+) neck stiffness.\nGastro-intestinal (-) Diarrhea ,(+) Vomiting \nPulmonary : No Dyspnea, (-) Cough.\nCardiac : No Palpitations, No Chest pain, No Orthopnea.\nVascular : No Phlebitis, No Varicosities.\n\n\nGenito-Urinary : (-) No Dysuria, (-) No Flank Pain, No Discharges, No Urgency.\nNeurologic : No Memory Loss, No Seizures, No loss of consciousness\nMusculoskeletal : (+) Joint Pains, No Cramps.\nPsychiatric : (+) Behavioral change as claimed by the watcher \nPhysical Examination :\n\nPHYSICAL EXAMINATION:\n\nGeneral examination :Patient is examined awake, febrile, Irritable not in respiratory distress.\nSHEENT :\nS :Warm skin [+] jaundice ,good skin texture and turgor .no signs of dehydration \nH : Normocephalic Atraumatic skull ,[-] scars ,diffuse black hair distribution\nE : Pink palpebral conjunctivae,  [-]discharges [+] icterus\nE : ear grossly normal,  anatomically symmetric\nN : [-] discharges, septum midline , normal nasal turbinates \nT : [-]erythematous tonsils, [-] exudates\nNECK : midline trachea, [-] bilateral CLAD  , ( -) neck vein engorgement \n\n\n\n\n\n\nCHEST:\nI  :  not in respiratory distress. No retractions, scars, masses.\nP : equal chest expansion. Tactile fremitus equal on both lung fields\nP : resonant all over\nA : clear breath sounds, no adventitious sounds heard.\n\nCARDIAC :\nI : Adynamic Precordium \nP :  [-] heaves [-] thrills\nA : s1 s2 heard distinctly, no murmurs appreciated, normal cardiac rate and rhythm\n\nABDOMEN :\nI :  no scars no bulging noted\nA : normoactive bowel sounds\nP : non tender on light and deep palpation      [-]kidney punch sign bilaterally, [-] murphys sign, [-] fluid thrill. [+] palpable Hepatosplenomegaly , [-] mass\nP : tympanic to percussion in all quadrants \nMUSCULOSKELETAL\nGrossly normal limbs\n(+) tenderness on all joints\nGood range of motion in all extrimites: 5/5\n sensory fuction :  100% in all four limbs\n(+) calf muscle tenderness\n[-] edema of hands and feet\nFull pulses\nCRT = 2sec\n\nNEURO EXAM\n  Orientation : \n    Patient is oriented to time and person ,not with place\n \nCRANIAL NERVES\n    I – Smell intact\n    II – Visual Acquity intact \n    III, IV, IV – Patient shows adequate extraocular movements equally and bilaterally\n\n\nV - Equal Sensation to the face, masseter and buccinator muscle tone are adequate. \nVII - Patient does not exhibit facial asymmetry, all facial expressions intact \nVIII - Patient is able to hear equally on both sides , ataxia : not assessed\nIX, X - Patient is able to swallow, shows adequate gag reflex, uvula is midline.\n\n\nXI :  can shrug her shoulder against resistance \n XII : tongue movement intact \n\n\n(+)Brudzenski sign \n(-) Kernig’s sign\n\n\nAdmitting Impresssion : \n Leptospiral meningitis  vs Cerebral Malaria \n\n\n\n\nSalient Features :\n20 years old /female \nhx of swimming in a freely flowing river \nVA hallucination ( not suicidal ),\nirritability ,\nintermittent fiver \nvomiting 4 x day projectile \nAnorexia \nFever \nPhotophobia \nNeck stiffness\nCalf Muscle tenderness\nJoint Pain \nBehavioral Changes\nJaundice \n joint pain\n palpable hepatosplenomegaly \n\n\n\n\n\n\n\n\n\n \n\n\nCourse in the Ward : \n \n\n\n\n\n\n \n\n \n\n\n\n\n \n \n\n\n\n\n \n \n \n\n \n\n\n\n\n\n \n\n\n\n\n\nDiscussion on Leptospirosis and complications : \n\n1 million cases occur per year worldwide with a mean case – fatality rate of nearly10%. (source : Harrison’s principles of internal medicine,19 th Edition )\n\nPrevalence : a total of 337 cases of the disease across the Philippines from January 1 to March 25, 2017, including 30 fatalities.\n      (source : Data from the Public Health Division of Epidemiology Surveillance Bureau of the Department of Health (DOH) ) \n\nIndia : detected 232 cases of leptospirosis in the five years of study period (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008)\n       (source : Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study Sunil Sethi,1,* Navneet Sharma,2 Nandita Kakkar,3 Juhi Taneja,1 Shiv Sekhar Chatterjee,1 Surinder Singh Banga,1 andMeera Sharma )\n\nSource : [Possibilities for laboratory diagnosis of leptospiroses].\n[Article in Czech] Perželová J, Jareková J, Kotrbancová M, Špaleková M\n\nLeptospiroses are worldwide spread zoonoses caused by hydrophilic bacteria of the genus Leptospira. \n\nHumans can be infected by contact with an infected animal or indirectly via staying in a contaminated environment (water, wet soil), in natural foci, while working outdoors, or while doing outdoor sport and leisure activities. \n\nLeptospirosis may manifest as a mild flu-like illness or in a severe febrile form (meningitis, pulmonary haemorrhage, hepato-renal syndrome, or myocarditis). \n\nSurvival Rate:\nMedian series mortality was 2.2% (Range 0.0-39.7%),\nmortality is high in jaundiced patients (19.1%) (Range 0.0-39.7%), \nthose with renal failure 12.1% (Range 0-25.0%) \nand in patients aged over 60 (60%) (Range 33.3-60%), \nbut low in anicteric patients (0%) (Range 0-1.7%).\n\n   ( Source : A Systematic Review of the Mortality from Untreated Leptospirosis. Taylor AJ1, Paris DH2, Newton PN1)\n\n\nHost & the Etiologic Agent :\n\n                                                     \n\na corkscrew-shaped bacterium called Leptospira interrogans, is often referred to as “rat fever” due to the principal role rats play in spreading the disease (scientists refer this type of animal as a reservoir host).\n             (Source : Leptospirosis cases up 68 percent in the Philippines in 2017 by ROBERT HERRIMAN )\n \n\n\n\n\n\n\n\nL. biflexa  , L. santarosai ,L. borgpeterseni , L. licerisiae  are other species of leptosires   (source : Harrison’s principles of internal medicine,19 th Edition )\n\n\n\n\nPathogenesis:\n \nSource : WHO South-East Asia Regional Office Leptospirosis Fact Sheet\n \n\n \nDiagnosis:\n Hx & P.E.\n\nElevated CRP and ESR \n\nThrombocytopenia ( </ 100 x 10^9 /L) associated with bleeding and renal failure \n\nAseptic meningitis : C.S.F. pleocytosis with polymorphonuclear cells (>1000 cells/micro liter)\n\nDefinitive diagnosis :PCR or MAT\n\n                                                                         (  source : Harrison’s principles of internal medicine,19 th Edition )\n\n \n\n\n                                                           THE END",
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