CASE PRESENTATION Kevaughn Henry

SCENARIO
29 y/o Female K.E Presents to Grenada General Hospital ED due to
“severe headache and pain that runs down her neck to her calves”
HPI
12 days ago KE reports eating a chicken roti from a vender for lunch
then experienced headache rated 10/10 with neck pain that shoots
down to her calves. Nausea and vomiting with yellow vomitus and
bloody streaks developed later that evening accompanied by
abdominal pain. The following day a fever greater than 100 F was
recorded at home. Pt reported mild confusion but no changes in
behavior. 3 days following the onset of symptoms, Pt developed
blurry vison and decided to come to the hospital for medical
attention. Once admitted to the wards empirical antibiotic
treatment was started with ceftriaxone, iv fluids were administered
and CBC w/ blood cultures and serology were obtained. Within a few
days of receiving treatment most of KE’s symptoms subsided.
However diarrhea and nausea persisted.
PMHX
PMHx: Chikungunya 2011, Asthma since childhood, anxiety 6
month hx
Immunization: UTD
Hospitalizations: 5x for childbirth  
Surgical Hx: Appendectomy 2011, Cholecystectomy 2019 (march)
Allergies: Pineapples [swelling], Dasheen [skin itching]
Medications: Ativan, Betamethasone, Ventolin
RELATED HX CONT.
Family Hx: Mother: hx of DM and HTN managed on medication; Father: alive and well; 5 Children
aged 12, 10, 8 ,6 ,1 year and 5 months all with asthma.
Social Hx: Married. Lives at home with her family in St. David. Home is surrounded with greenery
and orange trees. Mosquito netting in the home and running water.
Alcohol: no
Tobacco: no
Recreational drugs: no
Occupation: ward clerk for both the male and female ward at Grenada General Hospital
Diet: Low sodium and low cholesterol diet
Sexual Hx: Currently sexually active with husband, currently taking oral contraceptive
ROS: +blurry vision, +lip blisters, +muscle weakness, +joint pains (>4 joints), +orange red urine
 
 
PHYSICAL EXAM
GA – Young black woman who is alert and oriented x3 and in no
apparent distress
 
MSK – Scar noted on anterior left ankle, no erythema or
deformities on lower limb, normal joint symmetry. Full ROM of hip,
knee and ankle. Full ROM of upper limb and neck.
 
CNS – normal tone and muscle bulk in upper and lower limb. 5/5
power in upper and lower limb
PE
HEENT – Normocephalic and atraumatic head, mucus membranes
moist, slightly pale, no scleral icterus and acyanotic, no cervical or
supraclavicular lymphadenopathy.
 
Respiratory – Vesicular breath sounds heard bilateral, no
adventitious breath sounds
 
CVS – S1, S2 present
ASSESSMENT
Dx1 – Leptospirosis – flulike symptoms, myalgia (calf), photophobia
with neck stiffness, fever
Dx2 – Dengue – Flulike symptoms myalgia, fever
Dx3 – Bacterial meningitis – Photophobia with neck stiffness, fever,
flulike symptoms
PLAN
LFTs, CMP, CBC
IgM Leptospirosis
IgM and IgG Dengue
Empirical treatment with Ceftriaxone
Penicillin
.9% NaCl fluid hydration
EVIDENCE BASED ESSAY
In patients like K.E, would strategies that decrease human exposure to rodents lead to a decline in
leptospirosis infections ?
The article “Leptospira infection in rats: A literature review of global prevalence and distribution.” by
Boey et al., was published in August of 2019. The authors conducted a thorough literature review of
articles on pub med and Google scholar to understand the role of rodents in Leptospira epidemiology
and transmission. Leptospira spp. can be detected in brown rats (Rattus Norvegicus) via serum
antibody detection. Rodents are an important reservoir for Leptospira. This study found that among a
total of 169 brown rats trapped in two parishes in Grenada, 77/169 (45.5%) were positive for Leptospira
spp. antibodies. A significant difference in seropositive population of brown rats between two collection
sites was observed. Due to the close contact of brown rats with humans in Grenada, rats should be
considered a high-risk factor in transmission of Leptospira to humans. Appropriate preventive measures
should be instituted to prevent the transmission of Leptospira infection to humans.
 
Resources:
Sharma, Ravindra Nath, et al. “Detection of Serum Antibodies against Leptospira Spp. in Brown Rats
(Rattus Norvegicus) from Grenada, West Indies.” Veterinary World May-2019, vol. 12, no. 5, 2019, pp.
696–699., doi:10.14202/vetworld.2019.696-699.
EBM ESSAY CONT.
Due to the close proximity of residents of Grenada to rainforest and
wooded areas effective rodent control becomes increasingly more
important in the prevention of Leptospirosis. Primary prevention
methods such as physical barriers around homes, enclosed gardens
or separate and enclosed livestock spaces can help combat the
prevalence of Leptospirosis infections. Without these protections
patients are at a higher risk of exposure to rodents. In patients like
K.E these physical barriers and rodent traps are typically not
present and may contribute to the increased prevalence of
Leptospirosis.