A patient presented with fever, jaundice & some neuro- logical symptoms in the rainy season, most probable diagnosis is

Ans a. (Leptospirosis). (Ref. Harrison, Medicine, 18th/Ch. 171)LeptospirosisCausative organism isLeptospira interrogans.Exposure to water contaminated with animal urine.# Maculopapular eruption; conjunctivitis; scleral hemorrhage in some cases.# Fever, haemorrhages, jaundice, renal failure, conjunctival congestion, purpura, large bruising, hematemesis, malena, bleeding into cavities, thrombocytopenia, hepatomegaly, myocarditis, encephalitis and aseptic meningitis can occur - fulminant form: icterohemorrhagic fever (Weil's disease).LEPTOSPIROSIS# Leptospira enters human skin, mucous membrane, facilitated by cuts and water immersion.# It is associated with 3 'R' (epidemiological trends) (r)- Rats- Rainfall (Floods)- Rice-fields# Four clinical syndromes are known:- Bacteremia- Aseptic meningitis- Pulmonary syndrome- Icteric leptospirosis (Weil's disease)# Treatment of leptospirosis:Rx of leptospirosisMild leptospirosisDoxycycline, 100 mg orally bid orAmpicillin, 500-750 mg orally qid orAmoxicillin, 500 mg orally qid.Moderate/severe leptospirosisPenicillin G, 1.5 million units IV qid orAmpicillin, 1 g IV qid orAmoxicillin, 1 g IV qid orErythromycin, 500 mg IV qid.ChemoprophylaxisDoxycycline, 200 mg orally once a week.