A 25-year old farmer presented with history of high grade fever for 7 days and altered sensorium for 2 days. On examination, He was comatosed and had conjunctival hemorrhage. Urgent investigations showed a hemoglobin of 11 gm/dl, serum bilirubin 8 mg/dl and urea 78 mg/dl. Peripheral blood smear was negative for malarial parasite. What is the most likely diagnosis -

Ans. is 'b' i.e., Weil's disease It is a case of Weil's syndrome -It is the most severe form of leptospirosis Onset of illness is in 4-9 days.Characterized by renal and hepatic dysfunction.Hepatomegaly is usually seen Splenomegaly is seen in 20% cases.Renal failure can develop during 2nd week of illness Pulmonary involvement occurs frequently.Hemorrhagic manifestations such as epistaxis, Petechiae, purpura also occur.Leptospiral infection can also occurs as an anicteric leptospirosis.Clinical features in this case areMost patients become asymptomatic within 1 week.May present as an acute influenza like illness with fevers, chills and headache, nausea, vomiting and myalgias.Muscle pains are very common Intense headache, photophobiaMost common finding on physical examination is fever with conjunctival effusion.Rashes are also present.