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Leptospirosis — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsLeptospirosisSCE Infectious Diseases

A 38-year-old man presents with a 5-day history of fever, headache, myalgia, and conjunctival suffusion after kayaking in a canal. His LFTs show bilirubin 85 µmol/L, ALT 120 U/L, creatinine 250 µmol/L, and platelets 80 × 10⁹/L. Leptospira IgM is positive. What is the most appropriate treatment?

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Correct answer: A — IV Benzylpenicillin 1.8 g 6-hourly (or IV Ceftriaxone 2 g daily)

This is severe leptospirosis (Weil disease) with hepatorenal syndrome and thrombocytopenia. The triad of jaundice, renal failure, and haemorrhage following freshwater exposure is classic. Severe disease requires IV Benzylpenicillin (1.8 g QDS or 6-hourly) or IV Ceftriaxone (2 g daily) for 7 days. Oral Doxycycline is appropriate for mild/early disease only. Jarisch-Herxheimer reaction can occur at treatment initiation. Dialysis may be needed for oliguric renal failure.

Reference: UKHSA 2023 – Leptospirosis guidelines; WHO 2022 – Leptospirosis management