1.
Case presentation on
leptospirisis -tick borne spotted
fever with AKI and
thrombocytopenia
A.Pavitra
17ER1T0017
Pharm-D internship

2.
Demographic details :
• Name : xxxx
• Age : 49yrs
• Gender : male
• IP no : 7843
• Date of admission : 9/10/22
• Ward :MM-5
• Physician : Dr.Sarayu Reddy

3.
Chief complaints :
• Fever with chills since 5 days with rash in abdomen and back of body
• Headache since 5 days
• 1 episode of tonic clonic seizures
• Altered sensorium since 1hour
Personal history :
Alcoholic since 10yrs

4.
Prognosis:
• Day :1
• O/E pt is confused and irritable
• Temp:100°F
• Spo2:95% on RA
• Bp130/90mm hg
• PR:108/min
• RR:21/min
• Grbs:100mg/dl
• Day 2:
• O/E pt is irritable
• 1 session of dialysis done
• Temp:100°F
• BP:108/80mm hg
• PR:94/min
• Gcs:E3V2M3
• Grbs-81mg/dl
• U/O:Anuric
• 1.Inj.Levipil-1.5g-iv-TID
• 2.Inj.pcm-1gm-iv-BD
• 3.Inj.pan-40mg-iv-OD
• 4.Inj.Zofer-4mg-iv-BD
• 5.Ivf 500ml bolus
• 6.Inj.Meromac-1gm-iv-TID
• 7.Inj.Doxy-100mg-iv-BD
• CST
• 1.Inj.Thiamine-200mg-iv-TID
• 2.Inj.Lonazepam-2mg-iv-sos
• 3.T.Dolo-650mg-p/o

5.
• Day 3:
• BP:140/90mm hg
• PR:110/min
• Gcs:E2V2M5
• Grbs:91mg/dl
• Day 4:
• O/E pt sensorium improved
• 2sessions of dialysis done
• U/O:Nil
• PR:100/min
• Spo2:94%on RA
• BP:140/90mmhg
• GCS:E4V5M6
• Day 5:
• O/E pt is conscious and coherent
• PR:99/min
• BP:130/70mmhg
• Spo2:97% on RA
• Temp:99 F
• U/O:Adequate
• CST
• CST
• 1.Syp.Looz-30ml-po-H/S
• 2.Inj.Clindamycin-600mg-iv-TID
• CST
• 1.T.Nephrosave-BD
• 2.T.Sobosis Forte-1gm-po-BD

6.
• Day 6:
• Day 7:
• Day 8:
• Day 9:
• CST
• 1.Inj.Dexona-2cc-iv-stat
• 2.Inj.Pcm-1gm-iv-BD
• CST
• 1.Inj.Decadron-2cc-iv-OD
• Stop inj.dexona
• Stop meromac,clindamycin,pan,
• zofer,pcm,doxycycline
• 1.T.faropenem-300mg-p/o-BD
• 2.T.Levipil-500mg-po-BD
• 3.T.Clindamycin-600mg-po-TID
• 4.T.Nephrosave-p/o-BD
• 5.T.Dolo-650mg-p/o-SOS
• 6.T.dexa-2mg-po-OD

7.
Discharge Medications:
• 1.T.faropenem-300mg-p/o-BD
• 2.T.Levipil-500mg-po-BD
• 3.T.Clindamycin-600mg-po-TID
• 4.T.Nephrosave-p/o-BD
• 5.T.Dolo-650mg-p/o-SOS
• 6.T.dexa-2mg-po-OD
• 7.T.Pan-40mg-po-OD
• 8.T.zincovit-OD
• 9.T.Omnacortil-10mg-OD
• 10.T.Sobosis-500mg-BD
• 11.Fusibet Cream
• 12.T.udiliv-300mg-BD

8.
Objective Evidence

9.
• Day 2&3:
• Sr.K+:3.4mmol/l (3.5-5.1mmol/l)
• PLT:26000L/cumm
• Pro Calcitonine:15.30 (<=0.5)
• CRP:253mg/l (0-6mg/l)
• Blood urea:82
• Sr.Creatinine:4.5
• Serum Electrolytes:
• Na+:137mmol/l (135-150mmol/l)
• K+:3.3mmol/l (3.5-5.1mmol/l)
• Cl-:104mmol/l (94-110mmol/l)
• Usg abdomen:
• Prominent in size of both kidneys with mild increased echotexture –S/O Renal
Parenchymal disease
• Polyp in GB(6mm)
• Ecg:
• Diffuse slow wave activity suggestive of encephalopathy

10.
• DAY 4:
• CUE:
• Pus cells:2-3
• Epithelial cells:1-2
• Blood urea-72mg/dl
• Creatinine-3.1mg/dl
• PLT-57,000l/cumm
• DAY 5:
• Sr.creatinine:2mg/dl
• Blood urea:62mg/dl
• PLT:58,000l/cumm
• CRP:39.8
• DAY 7:
• PLT:71000l/cumm
• Sr.creatinine:1.4
• Doppler of both LL:
• Subcutaneous edema around Ankle &foot region-S/O Cellulitis

11.
ABG Day 1 Day 2 Day 3 Normal Values
PH 7.23 7.37 7.40 7.35-7.45
Pco2 26 27 36 35-45mmhg
Po2 77 77 64 75-105mmhg
Glu 108 78 127 3.5-5.4mmol/L
Lac 6.9 2.0 1.3 0-2mmol/L
Hco3 10.9 15.6 22.3 22-28mmol/L

12.
Assessment :
• Based on subjective and objective evaluation the
patient was diagnosed with Leptospirosis-tick
borne spotted fever with Aki and
Thrombocytopenia

13.
Planning:
Brand
Name
Generic name Indication Dose ROA Frequency Duration
Meromac Meropenem Antibiotic 1gm IV TID 1-8days
Sobisis
Forte
Sodium
Bicarbonate
To treat
metabolic
acidosis
1gm IV TID 5-9days
Nefrosave Acetyl cystine
&pyridoxime
dihydrochloride
It acts as a
neuroprotect
ive agent
750mg Oral BD 5-9days
Omnacortil Prednisolone To treat
allergies &
inflammatio
n
10 mg Oral OD Discharge
Doxycycline
_
Antibiotic
(drug of
choice)
100mg IV BD 1-6days
Zofer Ondonsetron Anti emetic 4mg IV BD 1-6days
Pan Pantoprazole Proton
pump
inhibitor
40mg IV OD 1-6days

14.
faropenem
-
Antibiotic 300
mg
Oral BD Discharge
Clindamycin
-
Antibiotic 600
mg
Oral TID 4-8days
Decadron Dexamethaso
ne
To treat severe
allergies
2cc IV OD 6-9days
Levipil Levetiraceta
m
To treat seizures 500
mg
Oral BD 1-9days
udiliv Ursodeoxych
olic acid
To prevent liver
disorders
300
mg
Oral BD Discharge
Dolo Paracetamol To treat fever 650mg Oral TID 1-9days
Lorazepam
_
To treat anxiety
and seizures
2mg IV SOS 2-6days
Thiamine
_
To prevent brain
damage(wernick
er
encephalopathy)
in alcohol pt’s
200mg IV TID 2-6days

15.
Regarding drugs:
• Meropenem: Beta Lactum Antibiotic
MOA: Acts against gram +&-ve bacteria by inhibiting cell wall synthesis
Side effects: bluish lips, chills, itching
• Sodium bicarbonate: Alkalinizing agents
MOA:To treat acid imbalance
Side effects: dizziness, mood changes, vomitings
• Prednisolone: Corticosteroid
MOA: Decreases inflammation
Side effects: weight gain, insomnia, indigestion
• Doxycycline: tetracycline antibiotics
MOA: Acts by protein synthesis of 30s ribosemes
Side effects: headache, hives, diarrhea
• Dexamethasone: Corticosteroid
• MOA: To treat severe allergies
• Side effects: anxiety, headache, decereased urine

16.
• Clindamycin:Macrolide antibiotic
MOA:Act by inhibiting protein synthesis
Side effects:abdominal pain, starry stools, cloudy urine
• Faropenem: Beta Lactum Antibiotic
MOA: Acts by inhibiting cell wall synthesis
Side effects: nausea, diarrhea, rashes
• Lorazepam: Benzodiazepenes
• MOA:They bind to ihbitory neurotransmitter GABA
• Side effects:drowsiness, dizziness, weakness
• Levipil:Anticonvulsants
• MOA:It acts by modulation of synaptic neurotransmitter release through binding to the
synaptic vesicle protein SV2A in the brain.
• Side Effects:Dizziness, headache, irritation, nasal congestion

17.
Pharmaceutical care issues :
• No Drug interactions
• ADR’S
• Errors found

18.
Definition:
• Leptospirosis is an infectious disease caused by the
spirochete Leptospira.
• Rodents are the important reservoirs. Leptospires
may enter the host through abrasions in the skin or
intact mucosa, the conjunctive and the lining of
oro-and naso-pharynx in contact with water
contaminated with leptospira

19.
Etiology:

20.
Pathophysiology:

21.
Signs and symptoms:

22.
Diagnosis:

23.
Treatment:

24.
Lifestyle modifications :