Question

A young boy presented with fever, sore throat, malaise and abdominal pain, conjunctival suffusion and calf tenderness. No history of cough, vomiting, haemorrhage and travel. What is the diagnosis?

• A. Chikungunya
• B. Leptospirosis
• C. Dengue hemorrhagic fever
• D. Hepatic encephalopathy with hepatitis A

Hint:

Leptospirosis should be suspected in patients with a history of exposure to contaminated water or soil, especially with symptoms such as conjunctival suffusion and calf tenderness.

Answer 1

The Correct Option is B

To diagnose the boy based on the given symptoms, let's analyze the conditions presented by evaluating the mentioned symptoms and their correlation with the possible diseases listed in the options.

• Fever, sore throat, malaise, and abdominal pain: These are common symptoms associated with many infections and can occur in viral or bacterial infections.
• Conjunctival suffusion: This term refers to redness of the conjunctiva without discharge. It is a key symptom of leptospirosis, resulting from vascular congestion.
• Calf tenderness: This symptom, along with conjunctival suffusion, is a classical presentation of leptospirosis.
• Absence of cough, vomiting, haemorrhage, and travel history: These factors help rule out other infections like dengue hemorrhagic fever, which often involves bleeding and travel to endemic areas.

Now let's examine each option:

1. Chikungunya: This is primarily characterized by fever and severe joint pain. Though chikungunya can cause fever and malaise, it typically involves joint pains more prominently rather than calf tenderness and does not involve conjunctival suffusion.
2. Leptospirosis: This is a bacterial infection caused by Leptospira species. Key symptoms including conjunctival suffusion and calf tenderness strongly suggest leptospirosis. The lack of cough and bleeding manifestations also supports this diagnosis.
3. Dengue hemorrhagic fever: This generally presents with high fever, muscle and joint pains, bleeding manifestations (e.g., rashes, bleeding gums), and sometimes travel to endemic areas, coupled with vomiting and abdominal discomfort. These are not highlighted in the presented symptoms.
4. Hepatic encephalopathy with hepatitis A: Typically presents with jaundice, confusion, altered mental status, and liver function test abnormalities. These are not consistent with the symptoms given.

From the analysis above, the symptoms, including fever, conjunctival suffusion, calf tenderness, and the absence of symptoms such as cough and bleeding, strongly indicate leptospirosis, making it the most likely diagnosis.

Therefore, the correct answer is Leptospirosis.