Leptospirosis Presentation

8/12/2019 Leptospirosis Presentation

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Differences between AKURIT and

conventional TB drugs.AKURIT is one of the fixed dose combinations for anti TB medications.The 2 FDCs available in MOH Drug formulary for adult are:

4drugs combination : INH 75mg, RIF 150mg, PZA 400mg and EMB

275mg

3 drug combination : INH 75mg, RIF 150mg, PZA 400mg

The recommended dosage for the 2 FDC are

30 - 37 kg body weight: 2 tablets daily



More than 70 kg body weight: 5 tablets daily

FDC help reducing the emergence of drug resistance TB and reduce pillburdens for patient and increase patient adherence to medication.

The conventional TB drugs is the separation of anti TB drugs and its normally

used if patients developed drug toxicity, intolerance or contraindications to its

component.


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Treatment and prophylaxis for PCPPCP prophylaxisOne double strength of cotrimoxazole daily or dapsone 100mg daily if

cotrimoxazole is contraindicated.

The duration of prophylaxis is until the CD4 count > 200 for 3 months

PCP treatment

Trimetoprim 15-20mg/kg /day plus sulfamethoxazaole 75-100mg/kg/day in

QID or TDS

Treatment duration is 21 days.

National antibiotic guideline 2008 & the National Institutes of Health, and the HIV

Medicine Association of the Infectious Diseases Society of America.


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Treatment duration for syphilisTreatment of primary and secondary syphilis among HIV infected patients in

benzathine penicilline G, 2.4 mu intramuscular in a single dose.

Most HIV positive pateints who have early syphilis might be at risk for

neurologic complications. Based on the national antibiotic guideline 2008,

patients infected with HIV with syphilis should be treated as neurospiphylis.Benzylpenicillin 3-4 mu 4 hourly for 14 days.


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Clinical

Case PresentationHIV-TB co-infection

By Khairuzzaman


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Patient Details

Name: Mr S

RN: HTJ 476731

Age: years old Race: Malay

Gender: male

DOA: 21/11/13 Weight: 95 kg


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Chief complaint

Fever and referred from private clinic

History of Presenting Illness

Fever for 2 days

Arthralgia for 1 day

Vomiting 2 times per day

Low of apatite for 2 days Lives at dengue area

Exposed to rat at home


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Social History Chronic smoker

History of alleged MVA in 1997, claimed laser done for

blood clot

Review of System

BP 89/28

PR 110

Temp 39.8

Spo2 100


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Provisional Diagnosis

1. Septic shock secondary pneumonia

2. TRO dengue fever

Diagnosis

1. leptospirosis


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Leptospirosis

Causal agent: leptospira genus (longcorkscrew-shaped bacteria). It is too thin to be

visible under ordinary microscope.

Mode of transmission: domestic animal arethe reservoir of the agent and transmitted

through contact with the urine membranous

or broken skin with water or foodcontaminated with urine of the infected

animals.


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Laboratory results:

FBC Reference range 21/11 22/11

TWBC 4-11x10/L 9.4 5.7

HB 11.5-16.5

g/100mL

14.1 13.6

Platelet 150-400 g/100mL 198 166


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Renal

profile

Reference range 21/11 22/11 25/11

Urea 1.7-8.3 mmol/L 3.7 2.1 5.6

Na+

135-145 mmol/L 132 134 126K+ 3.5-5.0 mmol/L 3.9 2.8 4.0

SCr 64122 mmol/L 104 101 112

CrCl 105-150 ml/min

PO4- 0.8-1.45 mmol/L 0.5

Ca2+ 2.12.6 mmol/L 2.07

Liver profile Reference

range

21/11 22/11 25/11

Albumin 35-50g/L 31 32 32

T. Bilirubin


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Ward medicationDrug Date

start

Date

stop

Indication

IV CEFTRIAXONE 1G BD 21/11 21/11 Empirical therapy for CAP

IV CEFTRIAXONE 2G OD 21/11 Empirical therapy for CAP

T AZITHROMYCIN 500MG

OD

22/11 Empirical therapy for CAP

T. PARACETAMOL 1G STAT 22/11 Antipyretic

IV TRAMADOL 50MG STAT

TDS

23/11 Analgesic

IV METOCHLORPRAMIDE

10MG STAT

23/11 Antiemetic

IV OMEPRAZOLE 20MG BD 25/11 Gastritis


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Pharmaceutical

Care Issue


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Inappropriate drug management

Patient was provisionally diagnosed with sepsis secondary to

pneumonia and treated with IV ceftriaxone 2g od and T.

azithromycin 500mg od. On 22/11 patient was confirmed with

leptosirosis based on the leptospirosis antibody test.

Prescriber still continue the treatment with 2g of ceftriaxone

Recommendation

Suggest to reduce the dose of ceftriaxone to 1g od.

Outcome and monitoring parameters.

Prescriber still continued the ceftriaxone 2g od.

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Leptospirosis Presentation