Introduction: Leptospirosis is a zoonotic bacterial infection caused by Leptospira interrogans, typically transmitted through contact with contaminated water or soil. It presents a wide range of symptoms, from mild febrile illness to severe forms with multiorgan involvement. This case study highlights the comprehensive management of a 25-year-old male patient presenting with acute febrile sepsis, thrombocytopenia, shock, hepatitis, altered sensorium, acute renal failure (ARF), hyponatremia, vomiting, and body aches. The initial challenge was to identify the causative agent, which was successfully accomplished by the tele-ICU intensivists through specific diagnostic investigations.
Case Presentation: Mr. ABC, a previously healthy 25-year-old male, was admitted to the ICU with a high-grade fever persisting for several days. He appeared lethargic, disoriented, and displayed signs of systemic inflammation, including tachycardia, hypotension, and bradycardia. Laboratory investigations revealed thrombocytopenia, elevated liver enzymes, altered renal function, and hyponatremia. Widal test results were negative, suggesting an alternative etiology. The patient required ionotropic support and close monitoring in the tele-ICU, as his condition deteriorated rapidly.
Diagnostic Investigation: Recognizing the need for further investigation, the tele-ICU intensivists recommended testing for Leptospira IgM antibodies. The laboratory test results came back positive for leptospirosis, confirming the suspected diagnosis. The positive identification of the causative agent enabled targeted treatment and a shift in the patient’s management plan.
Management Strategy: Upon the confirmation of leptospirosis, the multidisciplinary team in the tele-ICU devised a comprehensive management strategy aimed at controlling the infection, stabilizing the patient’s hemodynamics, and preserving organ function.
Antibiotic Therapy: The patient was promptly initiated on doxycycline, a broad-spectrum antibiotic effective against Leptospira interrogans. The therapy was continued according to the recommended duration to ensure complete eradication of the bacteria.
Fluid Resuscitation: Aggressive fluid resuscitation was initiated to address the hypotension and shock associated with leptospirosis. Crystalloid solutions were administered judiciously to maintain optimal hemodynamic parameters while avoiding fluid overload.
Supportive Care: The patient received ionotropic support to stabilize his blood pressure and maintain adequate organ perfusion. Close monitoring of vital signs, including heart rate, blood pressure, and oxygen saturation, was performed continuously to guide titration of medications and interventions.
Renal Replacement Therapy: Due to the development of acute renal failure (ARF), the patient required renal replacement therapy (RRT). Continuous renal replacement therapy (CRRT) was initiated to manage electrolyte imbalances, maintain fluid balance, and assist in toxin removal.
Symptomatic Management: Symptomatic relief was provided to alleviate the patient’s discomfort. Antiemetic medications were administered to manage vomiting, and analgesics were used to alleviate body aches.
Clinical Outcome: Within 24 hours of initiating doxycycline therapy, the patient’s fever began to subside. His overall clinical condition improved, allowing him to be transferred from the ICU to the general ward for further care and monitoring. Subsequent laboratory investigations revealed a gradual resolution of thrombocytopenia, normalization of liver enzymes, improvement in renal function, and correction of hyponatremia.
Conclusion:
This case study demonstrates the importance of a multidisciplinary approach in managing complex and challenging cases of leptospirosis. The collaboration between the tele-ICU intensivists at the command center and the on-site spoke team resulted in timely intervention, coordinated care, and successful patient survival. The accurate identification of leptospirosis as the underlying cause of the patient’s high fever, along with the initiation of appropriate antibiotic therapy and comprehensive supportive care, played a vital role in the patient’s recovery. This case highlights the significant impact that effective teamwork and expertise from both the command center and the bedside clinicians can have in optimizing patient outcomes in the intensive care setting.
