Photo Quiz

Eye Changes After Recent Travel


Am Fam Physician. 2017 Dec 15;96(12):807-808.

A 28-year-old man presented with several days of fever, diarrhea, body aches, and vomiting. His urine output was low and turbid. The symptoms began one week after he returned home from a family trip to Puerto Rico. His wife had similar symptoms that resolved. During his trip, he received a few mosquito bites, went swimming in a local river, and ate local food.

Physical examination showed mild jaundice and conjunctival suffusion (Figure 1). There was a petechial rash on his forehead and swelling in all extremities that was especially pronounced along the thenar eminence of the right hand.

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Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Dengue.

B. Leptospirosis.

C. Malaria.

D. Shigellosis.


The answer is B: leptospirosis. Leptospirosis is an infection caused by Leptospira bacteria. Humans can become infected through contact with water, soil, or food that is contaminated with urine from infected animals, such as rodents (most common), deer, raccoons, and domestic dogs. As many as 10 million persons worldwide are infected with Leptospira annually, mostly in tropical areas. Symptoms appear seven to 10 days after exposure, although some persons experience minimal to no symptoms.1

When present, symptoms of leptospirosis arise in two phases. The first phase includes fever, chills, headache, myalgia, red eyes, vomiting, or diarrhea. Conjunctival suffusion is a classic sign that can be overlooked.2 The second phase is more severe and can result in meningitis and kidney and liver failure.1 At its most severe,

Address correspondence to Nathan Kittle, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Centers for Disease Control and Prevention. Leptospirosis infection. Updated June 9, 2015 Accessed February 12, 2017....

2. Day N. UpToDate. Epidemiology, microbiology, clinical manifestations, and diagnosis of leptospirosis [login required]. Updated September 7, 2017. Accessed September 25, 2017.

3. Centers for Disease Control and Prevention. Malaria parasites. Updated November 1, 2016. Accessed February 12, 2017.

4. Centers for Disease Control and Prevention. Shigella. General information. Updated March 31, 2017. Accessed September 25, 2017.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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