Leptospirosis — DTM&H MCQ
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Correct answer: B — Leptospirosis
The correct answer is B, Leptospirosis. The combination of fever, headache, myalgia and conjunctival suffusion after wading through flood or drain water contaminated by rodent urine is the classic exposure history and clinical picture of leptospirosis, and progression to thrombocytopenia, hyperbilirubinaemia and acute kidney injury (creatinine 250 umol/L) represents Weil's disease, the severe icterohaemorrhagic form. Leptospira enters through skin abrasions or mucous membranes in contaminated water, disseminates, and causes vasculitis producing the triad of jaundice, renal impairment and haemorrhagic tendency (thrombocytopenia). Post-typhoon drain cleaning is a recognised high-risk exposure in endemic tropical settings such as the Philippines. UKHSA guidance identifies flooding and contact with contaminated water or rodent urine as key risk factors, with conjunctival suffusion as a hallmark early sign. Why the other options are wrong: A Dengue fever: causes fever and thrombocytopenia but not conjunctival suffusion, and significant renal impairment with jaundice is not a typical feature; the exposure here is water contact, not mosquito bite. B Scrub typhus: transmitted by chigger mite bite with a characteristic eschar and lymphadenopathy, not linked to floodwater or drain exposure, and does not typically cause conjunctival suffusion. D Typhoid fever: has an insidious onset over one to two weeks with relative bradycardia, abdominal symptoms and rose spots, not acute conjunctival suffusion or this pattern of renal and hepatic involvement. E Hepatitis A: causes jaundice via faecal-oral transmission but does not cause renal failure, thrombocytopenia or conjunctival suffusion. Key point: Conjunctival suffusion plus jaundice and acute kidney injury after floodwater or drain exposure is pathognomonic for leptospirosis (Weil's disease) until proven otherwise.
Reference: UK Health Security Agency (UKHSA), Leptospirosis guidance, GOV.UK, https://www.gov.uk/guidance/leptospirosis