Severe leptospirosis — DTM&H MCQ

Correct answer: A — Intravenous ceftriaxone or benzylpenicillin with supportive care

The correct answer is A, intravenous ceftriaxone or benzylpenicillin with supportive care. This patient has severe leptospirosis (Weil's disease) with the classic triad of jaundice, acute kidney injury (oliguria, rising creatinine) and pulmonary involvement (crackles, hypoxia), which mandates hospital admission, parenteral antibiotics and organ support rather than oral therapy. Intravenous penicillin G is the drug of choice for severely ill patients requiring hospitalisation, with third-generation cephalosporins such as ceftriaxone or cefotaxime as widely used, equally effective alternatives. Supportive care, including fluid and electrolyte management, renal replacement therapy if needed, oxygen and monitoring for pulmonary haemorrhage, is essential because severe leptospirosis carries significant mortality from multi-organ failure. Clinicians should also anticipate a possible Jarisch-Herxheimer reaction on starting antibiotics. Why the other options are wrong: D. Rifampicin and clofazimine: these are antileprosy agents active against Mycobacterium leprae, with no activity against Leptospira interrogans, so they have no role here. B. Oral azithromycin with discharge: oral macrolides may be used for very mild leptospirosis in the community, but discharging a hypoxic patient with rising creatinine and jaundice ignores the criteria for severe disease requiring admission and IV therapy. E. Albendazole and iron replacement: albendazole is an anthelmintic for helminth infections, not a spirochaetal disease, and iron replacement does nothing for the acute renal and pulmonary pathology driving this presentation. C. Praziquantel after urine microscopy: praziquantel treats schistosomiasis and other trematode infections; while urine microscopy might feature in a schistosomiasis work-up, it delays appropriate empirical antibiotic treatment for a clinically diagnosed severe leptospirosis case. Key point: Severe leptospirosis with jaundice, renal impairment and pulmonary involvement requires immediate hospital admission for IV benzylpenicillin or ceftriaxone plus aggressive supportive and organ support care.

Reference: Patient.info (Professional Reference), Leptospirosis (Weil's Disease), reviewed 2023, https://patient.info/doctor/infectious-disease/leptospirosis-weils-disease