Case study - Leptospirosis: Nursing

Nurse Zoey works in an emergency care setting and is caring for Angelo, a 36-year-old patient.

Angelo presents with a one-week history of fever, muscle aches, headache, and severe fatigue.

Angelo reports his symptoms have worsened during the past 24 hours, over-the-counter medications are no longer effective, and he is experiencing increasing shortness of breath.

Angelo also reports recent participation in outdoor cleanup efforts following local flooding, during which he spent several hours wading through standing water.

Given the combination of systemic symptoms and environmental exposure, the healthcare provider suspects leptospirosis and orders an enzyme-linked immunosorbent assay, or ELISA, to support the diagnosis.

While awaiting results, Nurse Zoey begins planning and implementing care for Angelo.

First, Nurse Zoey considers the pathology of leptospirosis by connecting Angelo’s symptoms with his exposure history. She recalls that leptospirosis is a bacterial zoonotic infection caused by the Leptospira species. These bacteria are commonly shed in the urine of infected animals, especially rodents, and can contaminate water and soil.

Infection occurs when the bacteria enter the body through cuts or abrasions in the skin or through mucous membranes, such as the conjunctiva of the eyes.

Angelo’s recent exposure to floodwater significantly increases his risk, as leptospirosis outbreaks often follow heavy rainfall and flooding.

Once Leptospira enters the bloodstream, it can disseminate throughout the body, leading to widespread inflammation and organ involvement. Potential complications include acute kidney injury, liver dysfunction, pulmonary involvement, meningitis, and, in severe cases, multiorgan failure.

Next, Nurse Zoey obtains Angelo’s vital signs, which reveal a temperature of 102.2°F, or 39°C, blood pressure of 98/62 mmHg, a heart rate of 112 beats per minute, respirations of 26 breaths per minute, and an oxygen saturation of 92% on room air.

Nurse Zoey notes that Angelo appears uncomfortable, and his eyes are noticeably reddened, but without drainage, which is known as conjunctival suffusion. She also notes that Angelo’s skin and sclera have mild yellow discoloration, or jaundice.

Nurse Zoey: “How are you feeling, Angelo?”

Angelo: “I’m so tired and my legs and back are very achy.”

Nurse Zoey: “How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you could imagine?”

Angelo: “About a 7. I could handle it if it was closer to a 4.”

Angelo also reports decreased urine output and describes his urine as dark yellow. When these findings are grouped together, Nurse Zoey recognizes a pattern consistent with a systemic infectious disease like leptospirosis.